Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY.
Department of Surgery, Thoracic Service, Memorial Sloan Kettering Cancer Center, New York, NY.
J Thorac Oncol. 2014 Jul;9(7):1023-1030. doi: 10.1097/JTO.0000000000000204.
The aim of the study was to identify preoperative computed tomography (CT) imaging characteristics that correlated with surgical resectability.
We retrospectively reviewed the CT scans of 133 patients who underwent surgical resection for thymoma at our institution between July 21, 1997, and September 22, 2010. Imaging characteristics recorded included tumor size, attenuation, contact of mediastinal vessels, tumor morphology, infiltration of surrounding fat, changes in the adjacent lung parenchyma, lymphadenopathy, and pleural involvement.
The study group included 66 men and 67 women, aged 23-88 years (mean 58.8 years). Eighty patients (60.2%) were Masaoka stage I or II and 53 (39.8%) were Masaoka stage III or IV. Twenty-three patients (17.3%) had an incomplete surgical resection. Of these, 15 patients had microscopic residual disease (11.2%) and eight had gross residual disease (6.0%). The preoperative CT characteristics that correlated with an incomplete surgical resection included a lobulated tumor contour (p = 0.016), greater than or equal 50% abutment of the circumference of an adjacent vessel (p < 0.001), thoracic lymphadenopathy (p = 0.029), adjacent lung changes (p = 0.005) and pleural nodularity (p = 0.001). Tumor size was larger in the incompletely versus completely resected groups, with mean values of 9.7 and 6.9 cm (p value 0.013). On multivariate analysis, only degree of abutment of adjacent vessels and pleural nodularity were independent predictors of incomplete resection.
Preoperative CT findings can predict the likelihood of successful surgical resection and could help to identify patients who might benefit from neoadjuvant chemotherapy.
本研究旨在确定与外科可切除性相关的术前计算机断层扫描（CT）影像学特征。
我们回顾性分析了 1997 年 7 月 21 日至 2010 年 9 月 22 日期间在我院接受胸腺瘤手术切除的 133 例患者的 CT 扫描。记录的影像学特征包括肿瘤大小、衰减、纵隔血管接触、肿瘤形态、周围脂肪浸润、相邻肺实质变化、淋巴结病和胸膜累及。
研究组包括 66 名男性和 67 名女性，年龄 23-88 岁（平均 58.8 岁）。80 例（60.2%）为 Masaoka Ⅰ或Ⅱ期，53 例（39.8%）为 Masaoka Ⅲ或Ⅳ期。23 例（17.3%）手术不完全切除。其中，15 例患者有镜下残留病变（11.2%），8 例患者有肉眼残留病变（6.0%）。与不完全手术切除相关的术前 CT 特征包括分叶状肿瘤轮廓（p = 0.016）、相邻血管周长大于或等于 50%的毗邻（p < 0.001）、胸内淋巴结病（p = 0.029）、相邻肺改变（p = 0.005）和胸膜结节状（p = 0.001）。不完全切除组肿瘤直径大于完全切除组，分别为 9.7cm 和 6.9cm（p 值 0.013）。多因素分析显示，只有毗邻血管的毗邻程度和胸膜结节状是不完全切除的独立预测因子。
术前 CT 表现可预测外科手术切除的可能性，并有助于识别可能受益于新辅助化疗的患者。
