White P G, Adams H, Crane M D, Butchart E G
Department of Radiology, Llandough Hospital, NHS Trust, Penarth, South Glamorgan, UK.
Thorax. 1994 Oct;49(10):951-7. doi: 10.1136/thx.49.10.951.
The aim of preoperative computed tomographic (CT) assessment of patients with carcinoma of the bronchus is to stage the tumour accurately, and forewarn the surgeon of any possible local extrapulmonary extension of tumour in patients considered to have potentially resectable disease. The ability of CT scanning to differentiate between conventionally resectable lung cancer (TNM stages I and II), locally advanced but resectable lung cancer (TNM stage IIIa), and locally advanced but unresectable lung cancer (TNM stage IIIb) was determined in a group of patients accepted for surgery.
Computed tomographic scans of 110 patients who underwent thoracotomy for intended resection of carcinoma of the bronchus, including 52 cases with stage III and 58 cases with stage I or II disease, were reviewed and the CT features and radiological interpretations correlated with the surgical and pathological findings.
Thirteen CT scans were judged not to have been of diagnostic quality: of the remaining 97 cases 45 had stage III lung cancer, of whom 30 had successful resections, and 52 had stage I or stage II tumours. There was no difference in the frequencies of CT observations--including contiguity of tumour and mediastinum or chest wall, apparent mediastinal or chest wall invasion, proximity of tumour to the carina, mediastinal nodal enlargement, pulmonary collapse or consolidation and pleural effusion--in patients with stage I/II disease and patients with stage III disease. Similar results were found when the same observations were compared in all patients with resected disease and those with unresectable tumour. Sensitivity and specificity of CT was 27% and 96% respectively for tumour unresectability, 50% and 89% for mediastinal invasion, 14% and 99% for chest wall invasion, and 61% and 76% for mediastinal nodal metastases. Only 19 of 45 stage III tumours were correctly identified as being stage III and resectable or unresectable.
In patients being considered for thoracotomy for resection of lung cancer, CT scanning used as the sole method of staging is of limited value for differentiating between stage I/II and stage III tumours. Patients should not be denied the opportunity for curative surgery on the basis of equivocal CT signs.
对支气管癌患者进行术前计算机断层扫描（CT）评估的目的是准确对肿瘤进行分期，并在认为可能可切除的患者中，预先警告外科医生肿瘤任何可能的肺外局部扩展情况。在一组接受手术的患者中，确定了CT扫描区分传统可切除肺癌（TNM分期I期和II期）、局部晚期但可切除肺癌（TNM分期IIIA期）以及局部晚期但不可切除肺癌（TNM分期IIIB期）的能力。
回顾了110例因计划切除支气管癌而接受开胸手术患者的CT扫描结果，其中包括52例III期患者和58例I期或II期患者，并将CT特征及影像学解释与手术和病理结果进行关联。
13份CT扫描被判定诊断质量不佳：在其余97例病例中，45例为III期肺癌，其中30例成功切除，52例为I期或II期肿瘤。I/II期疾病患者和III期疾病患者在CT观察结果（包括肿瘤与纵隔或胸壁的连续性、明显的纵隔或胸壁侵犯、肿瘤与隆突的距离、纵隔淋巴结肿大、肺不张或实变以及胸腔积液）的频率上没有差异。在所有可切除疾病患者和不可切除肿瘤患者中比较相同观察结果时，也发现了类似结果。对于肿瘤不可切除，CT的敏感性和特异性分别为27%和96%；对于纵隔侵犯，分别为50%和89%；对于胸壁侵犯，分别为14%和99%；对于纵隔淋巴结转移，则分别为61%和76%。45例III期肿瘤中只有19例被正确判定为III期且可切除或不可切除。
在考虑行开胸手术切除的患者中，仅将CT扫描用作分期方法在区分I/II期和III期肿瘤方面价值有限。不应基于不明确的CT征象而剥夺患者进行根治性手术的机会。
