Section of General Thoracic Surgery, Emory University School of Medicine, Atlanta, Ga; Atlanta Veterans Affairs Medical Center, Decatur, Ga.
Division of Cardiothoracic Surgery, University of Virginia School of Medicine, Charlottesville, Va.
J Thorac Cardiovasc Surg. 2015 Jan;149(1):35-41, 42.e1. doi: 10.1016/j.jtcvs.2014.08.075. Epub 2014 Sep 17.
The prevalence of mediastinal lymph node metastases is unknown for patients with clinical N0 lung cancer who are thought to be at high risk for occult nodal metastases. Further, the utility of mediastinoscopy in these patients is unknown. We performed a prospective trial to evaluate the utility of routine cervical mediastinoscopy for patients who may be at high risk of occult nodal metastases.
From January 1, 2008, July 31, 2013, 90 patients with lung cancer with clinical stage T2N0 or T1N0 with standardized uptake value greater than 10 by positron emission tomography/computed tomography underwent routine cervical mediastinoscopy before lung resection. Biopsy of a minimum of 3 nodal stations at mediastinoscopy and a minimum of 4 nodal stations with lung resection was advised. The prevalence of nodal metastases at mediastinoscopy and lung resection was recorded.
Some 64% of patients with lung cancer were male with a mean age of 67.3 years. A total of 81 patients had clinical T2N0 and 9 patients had T1N0 with standardized uptake value greater than 10. Mean tumor size was 4.3 ± 1.7 cm, and mean standardized uptake value was 13.5 ± 6.8. One patient (1.1%) had occult metastases detected at mediastinoscopy. A total of 86 patients underwent surgical resection; 4 patients (4.6%) were upstaged to pN2, and 18 patients (21%) were upstaged to pN1. Of 90 patients with clinically staged N0 lung cancer by positron emission tomography/computed tomography, 5.6% (5) were upstaged to pN2 and 20% (18) were upstaged to pN1 (total nodal upstaging = 25.6%).
Mediastinoscopy seems to have limited utility in these patients with T1 and T2 clinically staged N0 by positron emission tomography/computed tomography. Selective use of mediastinoscopy is recommended, along with thorough mediastinal lymph node evaluation in all patients at the time of lung cancer resection.
对于临床 N0 肺癌患者，若其被认为存在隐匿性淋巴结转移的高风险，那么纵隔淋巴结转移的发生率尚不清楚。此外，纵隔镜检查在这些患者中的作用也不清楚。我们进行了一项前瞻性试验，以评估常规颈纵隔镜检查对于可能存在隐匿性淋巴结转移高风险的患者的效用。
从 2008 年 1 月 1 日至 2013 年 7 月 31 日，90 例临床 T2N0 或 T1N0 且正电子发射断层扫描/计算机断层扫描标准化摄取值大于 10 的肺癌患者在肺切除术前接受了常规颈纵隔镜检查。建议纵隔镜检查至少活检 3 个淋巴结站，肺切除时至少活检 4 个淋巴结站。记录纵隔镜和肺切除时的淋巴结转移发生率。
约 64%的肺癌患者为男性，平均年龄为 67.3 岁。81 例患者为临床 T2N0，9 例患者为 T1N0，且标准化摄取值大于 10。肿瘤平均大小为 4.3 ± 1.7 cm，平均标准化摄取值为 13.5 ± 6.8。1 例患者（1.1%）在纵隔镜检查中发现隐匿性转移。86 例患者接受了手术切除；4 例（4.6%）患者分期升级为 pN2，18 例（21%）患者分期升级为 pN1。90 例临床 N0 肺癌患者经正电子发射断层扫描/计算机断层扫描分期为 N0，5.6%（5 例）分期升级为 pN2，20%（18 例）分期升级为 pN1（总淋巴结分期升级率为 25.6%）。
纵隔镜检查在经正电子发射断层扫描/计算机断层扫描临床分期为 T1 和 T2 的这些患者中似乎作用有限。建议选择性使用纵隔镜检查，并在所有肺癌切除患者中对纵隔淋巴结进行彻底评估。
