Akamatsu H, Terashima M, Koike T, Takizawa T, Kurita Y
Department of Respiratory and Cardiovascular Surgery, Niigata Cancer Center Hospital, Japan.
Ann Thorac Surg. 1996 Aug;62(2):352-5.
The necessity of an easy and noninvasive technique to evaluate mediastinal node status cytopathologically is considered.
Eighteen cases of clinical N2 primary lung cancer were examined. Under local anesthesia, the lymph node was punctured with a 19-gauge needle using intermittent computed tomographic monitoring, and samples were studied cytologically. Subcarinal (no. 7) nodes and lower paratracheal (no. 4) nodes were sampled using the paraspinal posterior approach. Anterior mediastinal (no. 6) nodes were sampled using the parasternal anterior approach. Node status was diagnosed pathologically at operation.
Number 7 nodes were examined in 11 cases, no. 4 nodes in 5 cases, and no. 6 nodes in 2 cases. Malignant cells were detected in 14 cases. Fourteen cases were diagnosed as true positive, 2 cases as true negative, and 2 cases as false negative. The sensitivity, specificity, and accuracy of this method were 88%, 100%, and 89%, respectively. Pneumothorax developed in 4 cases (22%).
Computed tomography-guided percutaneous needle cytology of mediastinal lymph nodes is useful for staging primary lung cancer. Because this is a small series, additional studies are necessary.
考虑采用一种简便、无创的技术通过细胞病理学评估纵隔淋巴结状态的必要性。
对18例临床诊断为N2期的原发性肺癌患者进行检查。在局部麻醉下，使用19号穿刺针在计算机断层扫描间歇性监测下对淋巴结进行穿刺，并对样本进行细胞学研究。采用脊柱旁后路对隆突下（7区）淋巴结和气管旁下（4区）淋巴结进行采样。采用胸骨旁前路对前纵隔（6区）淋巴结进行采样。术中对淋巴结状态进行病理诊断。
对11例患者的7区淋巴结、5例患者的4区淋巴结和2例患者的6区淋巴结进行了检查。14例检测到恶性细胞。14例诊断为真阳性，2例为真阴性，2例为假阴性。该方法的敏感性、特异性和准确性分别为88%、100%和89%。4例（22%）发生气胸。
计算机断层扫描引导下经皮纵隔淋巴结针吸细胞学检查对原发性肺癌分期有用。由于本研究样本量较小，需要进一步研究。
