Sider L, Horejs D
Department of Radiology, Northwestern University Medical School, Chicago, IL 60611.
AJR Am J Roentgenol. 1988 Nov;151(5):893-5. doi: 10.2214/ajr.151.5.893.
The only cure for bronchogenic carcinoma is complete surgical resection; the most common reason for not attempting surgical resection is mediastinal adenopathy. However, we have found that even when the lymph nodes are normal in size, the presence of extrathoracic metastases may preclude successful resection. In a series of 263 patients with pathologically proved non-small cell bronchogenic carcinoma who were seen over a 2-year period, we identified 95 patients in whom a preoperative CT scan showed only a solitary lung mass without evidence of hilar or mediastinal metastases, pleural effusion, or definite chest-wall involvement. The medical records and preoperative imaging studies were evaluated in this group. Twenty-four (25%) of these patients who had potentially resectable masses proved to have extrathoracic metastases; thus they were not candidates for surgery. Occurring in 16 (67%) of these 24 patients, adenocarcinoma was the most common cell type; squamous cell carcinoma was present in five patients (21%), and large cell carcinoma was present in three patients (13%). These findings suggest that extrathoracic metastases from bronchogenic carcinoma may occur without CT evidence of enlarged hilar or mediastinal lymph nodes. Such metastases may preclude successful surgical resection.
支气管源性癌的唯一治愈方法是完整的手术切除；不尝试手术切除的最常见原因是纵隔淋巴结肿大。然而，我们发现，即使淋巴结大小正常，胸外转移的存在也可能妨碍成功切除。在一系列263例经病理证实为非小细胞支气管源性癌的患者中，这些患者在两年内就诊，我们确定了95例患者，其术前CT扫描仅显示孤立性肺肿块，无肺门或纵隔转移、胸腔积液或明确胸壁受累的证据。对该组患者的病历和术前影像学研究进行了评估。这些有潜在可切除肿块的患者中有24例（25%）被证实有胸外转移；因此他们不适合手术。腺癌是这24例患者中16例（67%）最常见的细胞类型；鳞状细胞癌见于5例患者（21%），大细胞癌见于3例患者（13%）。这些发现表明，支气管源性癌的胸外转移可能在无肺门或纵隔淋巴结肿大的CT证据的情况下发生。这种转移可能妨碍成功的手术切除。
