Nagamoto N, Saito Y, Ohta S, Sato M, Kanma K, Sagawa M, Takahashi S, Usuda K, Nakada T, Hashimoto K
Department of Surgery, Research Institute for Chest Diseases and Cancer, Tohoku University, Sendai, Japan.
Am J Surg Pathol. 1989 Dec;13(12):1009-13. doi: 10.1097/00000478-198912000-00002.
We investigated the relationship of lymph node metastasis to primary tumor size and microscopic appearance in 92 resected specimens obtained from patients with roentgenographically occult lung cancer (ROLC) located at a site along the airway between the main bronchus and the sub-subsegmental bronchi. Most of the patients were discovered by mass screening. All were treated surgically after bronchoscopic localization of cancer. The bronchial tree of the resected specimens was serial-sectioned into 2-mm thick blocks from the margin of resection to the sub-subsegmental bronchi. Bronchial wall invasion was noted in some blocks of all the specimens. The length of longitudinal extension (LLE) was defined as the product of the thickness and the number of consecutive blocks involved, counting from the most proximal to the most distal block. LLE was used as primary tumor size. Hilar and mediastinal lymph nodes were examined in 84 patients who underwent lymph node dissection. No nodal involvement was found in 59 cancers with LLE of less than 20 mm. Of 25 cancers with LLE of 20 mm or more, six showed nodal involvement. Eleven in situ carcinomas and four cancers of the "suspicious for invasion" type showed no lymph node metastasis. We contend that no lymph node dissection is required when pulmonary resection is performed for patients with ROLC if it is in situ carcinoma, if it is of the "suspicious for invasion" type, or if the LLE is smaller than 20 mm.
我们研究了92例经手术切除的标本中，淋巴结转移与原发肿瘤大小及微观表现之间的关系。这些标本取自影像学隐匿性肺癌（ROLC）患者，肿瘤位于主支气管与亚亚段支气管之间的气道部位。大多数患者是通过大规模筛查发现的。所有患者在经支气管镜确定癌症位置后均接受了手术治疗。将切除标本的支气管树从切除边缘至亚亚段支气管连续切成2毫米厚的组织块。所有标本的一些组织块中均发现有支气管壁侵犯。纵向延伸长度（LLE）定义为厚度与连续受累组织块数量的乘积，从最近端组织块计数至最远端组织块。LLE用作原发肿瘤大小。对84例行淋巴结清扫术的患者检查了肺门和纵隔淋巴结。LLE小于20毫米的59例癌症未发现淋巴结受累。在LLE为20毫米或更大的25例癌症中，6例出现淋巴结受累。11例原位癌和4例“可疑侵犯”型癌症未显示淋巴结转移。我们认为，对于ROLC患者，如果是原位癌、“可疑侵犯”型或LLE小于20毫米，在进行肺切除时无需进行淋巴结清扫。
