Brea Tara Pereiro, Raviña Alberto Ruano, Villamor José Martín Carreira, Gómez Antonio Golpe, de Alegría Anxo Martínez, Valdés Luís
University Hospital Complex, Pneumology Service, Santiago de Compostela, Spain.
Medicine School. University of Santiago. Area of Preventive Medicine and Public Health, Santiago de Compostela, Spain; CIBER of Epidemiology and Public Health. CIBERESP, Madrid, Spain.
Arch Bronconeumol (Engl Ed). 2019 Jan;55(1):9-16. doi: 10.1016/j.arbres.2018.03.007. Epub 2018 May 24.
The aim of this study is to assess the diagnostic value of the magnetic resonance imaging (MRI) in differentiating metastasic from non-metastatic lymph nodes in NSCLC patients compared with computed tomography (CT) and fluorodeoxyglucose (FDG) - positron emission tomography (PET) or both combined.
Twenty-three studies (19 studies and 4 meta-analysis) with sample size ranging between 22 and 250 patients were included in this analysis. MRI, regardless of the sequence obtained, where used for the evaluation of N-staging of NSCLC. Histopathology results and clinical or imaging follow-up were used as the reference standard. Studies were excluded if the sample size was less than 20 cases, if less than 10 lymph nodes assessment were presented or studies where standard reference was not used. Papers not reporting sufficient data were also excluded.
As compared to CT and PET, MRI demonstrated a higher sensitivity, specificity and diagnostic accuracy in the diagnosis of metastatic or non-metastatic lymph nodes in N-staging in NSCLC patients. No study considered MRI inferior than conventional techniques (CT, PET or PET/CT). Other outstanding results of this review are fewer false positives with MRI in comparison with PET, their superiority over PET/CT to detect non-resectable lung cancer, to diagnosing infiltration of adjacent structures or brain metastasis and detecting small nodules.
MRI has shown at least similar or better results in diagnostic accuracy to differentiate metastatic from non-metastatic mediastinal lymph nodes. This suggests that MRI could play a significant role in mediastinal NSCLC staging.
本研究旨在评估磁共振成像（MRI）在非小细胞肺癌（NSCLC）患者中鉴别转移性与非转移性淋巴结方面的诊断价值，并与计算机断层扫描（CT）、氟脱氧葡萄糖（FDG）-正电子发射断层扫描（PET）或两者联合使用的情况进行比较。
本分析纳入了23项研究（19项研究和4项荟萃分析），样本量在22至250例患者之间。无论获得何种序列，MRI均用于评估NSCLC的N分期。组织病理学结果以及临床或影像学随访被用作参考标准。如果样本量少于20例、淋巴结评估少于10个或未使用标准参考的研究，则将其排除。未报告足够数据的论文也被排除。
与CT和PET相比，MRI在NSCLC患者N分期中诊断转移性或非转移性淋巴结时表现出更高的敏感性、特异性和诊断准确性。没有研究认为MRI比传统技术（CT、PET或PET/CT）差。本综述的其他突出结果是，与PET相比，MRI的假阳性较少，在检测不可切除的肺癌、诊断相邻结构浸润或脑转移以及检测小结节方面优于PET/CT。
在鉴别转移性与非转移性纵隔淋巴结的诊断准确性方面，MRI已显示出至少相似或更好的结果。这表明MRI在纵隔NSCLC分期中可能发挥重要作用。
