Jegge P, Ayer G, Voegeli E
Schweiz Med Wochenschr. 1985 Mar 2;115(9):297-301.
The planning of treatment in patients with non-oat cell carcinoma of the lung requires an extensive diagnostic work-up. As far as TN-staging is concerned, the role of CT is controversial. On the basis of 25 operated and histologically proven cases of non-oat cell cancer of the lung, the results of both CT and conventional radiography are critically evaluated. In the present study CT is found to be more sensitive but not more specific than conventional radiography in detecting pleural invasion and regional, especially mediastinal, lymphnode metastases. These results are in accordance with those of others. Since both modalities follow the same diagnostic criteria (lymphnode size, contact to pleura), an increase in sensitivity is intimately related to a corresponding loss of specificity. The relatively high sensitivity of CT on the one hand, and the relatively high specificity of conventional radiography on the other hand, suggest the following procedure: if conventional radiography is definitely positive, additional CT can be omitted. If CT proves negative as well, the presence of mediastinal metastases or pleural invasion is very unlikely. Positive findings on CT, however, need histologic verification.
非小细胞肺癌患者的治疗规划需要广泛的诊断性检查。就TN分期而言，CT的作用存在争议。基于25例经手术及组织学证实的非小细胞肺癌病例，对CT和传统放射摄影的结果进行了严格评估。在本研究中，发现在检测胸膜侵犯及区域，尤其是纵隔淋巴结转移方面，CT比传统放射摄影更敏感，但特异性并不更高。这些结果与其他研究结果一致。由于两种检查方式遵循相同的诊断标准（淋巴结大小、与胸膜的接触情况），敏感性的提高与相应的特异性丧失密切相关。一方面CT具有较高的敏感性，另一方面传统放射摄影具有较高的特异性，这提示了以下操作流程：如果传统放射摄影明确为阳性，则可省略额外的CT检查。如果CT检查也为阴性，则纵隔转移或胸膜侵犯的可能性非常小。然而，CT上的阳性发现需要组织学验证。
