Ferrigno D, Buccheri G
A. Carle Hospital of Chest Diseases, Cuneo, Italy.
Chest. 1994 Oct;106(4):1025-9. doi: 10.1378/chest.106.4.1025.
With the possible exception of chemotherapy for the small-cell type, a complete surgical excision is still the only effective treatment of lung cancer. Routine brain computed tomography (CT) for staging purposes has been both advocated and opposed. In this retrospective study, we aimed to assess the clinical yield of the technique. We saw 184 consecutive patients with a new histologically proven non-small-cell lung cancer. Using as reference criteria clinical judgment supported by a strict follow-up evaluation, we counted 1 false- and 23 true-positive brain CT results, plus 2 false- and 158 true-negative findings. These figures allow for sensitivity, specificity, and accuracy of 92 percent, 99 percent, and 98 percent. The frequency of brain metastases did not correlate with the various histologic types, even though adenocarcinoma was the most common cause of cerebral metastases. The absence of neurologic symptoms did not exclude cerebral involvement: in our experience, 16 of 25 patients with positive brain CT scans were asymptomatic (64 percent). Three of 31 subjects (10 percent) with an otherwise operable carcinoma were found to have metastases after brain CT. We conclude that routine cranial CT is useful in the staging evaluation of the patient with non-small-cell lung cancer (NSCLC) and that it should be performed in any candidate prior to surgical resection.
除了对小细胞类型可能适用的化疗外，完整的手术切除仍然是肺癌唯一有效的治疗方法。对于分期目的的常规脑部计算机断层扫描（CT），有人主张也有人反对。在这项回顾性研究中，我们旨在评估该技术的临床价值。我们连续观察了184例新确诊的组织学证实的非小细胞肺癌患者。以严格随访评估支持的临床判断作为参考标准，我们统计出1例假阳性和23例真阳性的脑部CT结果，以及2例假阴性和158例真阴性结果。这些数据得出的敏感度、特异度和准确度分别为92%、99%和98%。脑转移的发生率与各种组织学类型无关，尽管腺癌是脑转移最常见的原因。没有神经系统症状并不排除脑部受累：根据我们的经验，脑部CT扫描阳性的25例患者中有16例无症状（64%）。在31例原本可手术切除的癌症患者中，有3例（10%）在脑部CT检查后发现有转移。我们得出结论，常规头颅CT对非小细胞肺癌（NSCLC）患者的分期评估有用，并且在任何手术切除候选患者术前都应进行。
