Bonomo L, Ciccotosto C, Guidotti A, Storto M L
Department of Radiology, University of Chieti, Ospedale, SS. Annunziata, Italy.
Eur J Radiol. 1996 Aug;23(1):35-45. doi: 10.1016/0720-048x(96)01032-7.
Because complete resection remains the only reliable method of cure of lung cancer, one important aim of preoperative staging is to select patients with localised disease who may benefit from surgery, while avoiding unnecessary thoracotomies in patients with unresectable neoplasm. Computed tomography (CT) of the chest is a valuable method for staging local and regional spread of lung neoplasms, although limitations in its accuracy are well-known. While gross invasion of the mediastinum and major structures as well as the presence of metastatic disease can be easily demonstrated with CT, differentiation between tumour contiguity and subtle invasion of mediastinum or chest wall often remains a problem. Although magnetic resonance imaging (MRI) may have the same limitations as CT, in specific situations it may be superior in diagnosing minimal chest wall or mediastinal invasion. Moreover, MRI is useful in the assessment of patients with superior sulcus tumours as well as in patients with contraindication to intravenous administration of ionic contrast material. Since nodal size is the only useful criterion for evaluating lymph node metastases, CT and MRI show similar, poor accuracies in lymph node staging resulting from both low sensitivity (normal-sized nodes may contain microscopic metastases) and low specificity (enlarged lymph nodes may be reactive). For this reason, if enlarged lymph nodes are detected, further evaluation is recommended before excluding the patient from a potentially curative resection. Advantages and limitations of CT and MRI in the preoperative staging of non-small-cell carcinoma are reviewed in this article. The imaging of small-cell carcinoma is not included because most patients with this cell type do not benefit from surgical resection. Similarly we do not discuss imaging of distant metastases.
由于完整切除仍然是治愈肺癌的唯一可靠方法，术前分期的一个重要目标是选择可能从手术中获益的局限性疾病患者，同时避免对不可切除肿瘤患者进行不必要的开胸手术。胸部计算机断层扫描（CT）是对肺肿瘤进行局部和区域扩散分期的一种有价值的方法，尽管其准确性存在局限性是众所周知的。虽然CT可以很容易地显示纵隔和主要结构的明显侵犯以及转移疾病的存在，但肿瘤与纵隔或胸壁的连续性与细微侵犯之间的区分往往仍然是个问题。尽管磁共振成像（MRI）可能与CT有相同的局限性，但在特定情况下，它在诊断最小程度的胸壁或纵隔侵犯方面可能更具优势。此外，MRI在评估肺上沟瘤患者以及对静脉注射离子型造影剂有禁忌证的患者中很有用。由于淋巴结大小是评估淋巴结转移的唯一有用标准，CT和MRI在淋巴结分期方面的准确性都较差，这是因为敏感性低（正常大小的淋巴结可能含有微小转移灶）和特异性低（肿大的淋巴结可能是反应性的）。因此，如果检测到肿大的淋巴结，在将患者排除在可能治愈性切除之外之前，建议进行进一步评估。本文综述了CT和MRI在非小细胞癌术前分期中的优缺点。小细胞癌的影像学未包括在内，因为大多数这种细胞类型的患者不能从手术切除中获益。同样，我们也不讨论远处转移的影像学。
