Fosburg R G, Hopkins G B, Kan M K
J Thorac Cardiovasc Surg. 1979 Jan;77(1):76-82.
Delineation of the metastatic spread of lung cancer has been attempted by a variety of means. Controversy as to the indications for organ surveys, mediastinoscopy, scintillation scanning, and biopsy techniques still exists. Since definition of the micrometastatic state is yet unachieved, the staging of disease for therapy continues to be predicted on documented spread beyond the site of the origin. The records of 75 patients in whom the presence or absence of mediastinal metastases was known were retrospectively reviewed to establish the sensitivity, specificity, predictive values, and accuracy of 67Ga scintigrams. Comparisons were made with chest roentgenograms, mediastinal tomograms, and endoscopic findings. Five patients had 67Ga-negative studies. In the 70 patients having 67Ga-positive lung lesions, mediastinal 67Ga uptake had a sensitivity of 88%, a specificity of 86%, predictive values of 93% for a positive test and 76% for a negative test, and a test accuracy of 87%. These studies, plus those of others, permit selectivity of choosing candidates for mediastinoscopy. If the primary is 67Ga positive, a negative mediastinal scan obviates mediastinoscopy. If the mediastinum is 67Ga positive, mediastinal exploration is indicated. The level of involvement dictates whether resection is undertaken in suitable surgical candidates. This approach, employed since 1976, has lowered the costs of staging, and 67Ga has become our scintigram of choice.
人们已尝试通过多种方法来描绘肺癌的转移扩散情况。关于器官检查、纵隔镜检查、闪烁扫描及活检技术的适应证仍存在争议。由于尚未实现微转移状态的定义，疾病治疗分期仍依据已记录的超出原发部位的扩散情况来预测。对75例已知有无纵隔转移患者的记录进行回顾性分析，以确定镓-67闪烁扫描的敏感性、特异性、预测值及准确性。并与胸部X线片、纵隔断层扫描及内镜检查结果进行比较。5例患者镓-67检查结果为阴性。在70例镓-67肺部病变阳性的患者中，纵隔镓摄取的敏感性为88%，特异性为86%，阳性试验的预测值为93%，阴性试验的预测值为76%，检查准确性为87%。这些研究以及其他研究结果有助于选择纵隔镜检查的候选者。如果原发灶镓-67阳性，纵隔扫描阴性则无需进行纵隔镜检查。如果纵隔镓-67阳性，则需进行纵隔探查。受累程度决定了合适的手术候选者是否进行切除。自1976年以来采用的这种方法降低了分期成本，镓-67已成为我们首选的闪烁扫描剂。
