Gdeedo A, Van Schil P, Corthouts B, Van Mieghem F, Van Meerbeeck J, Van Marck E
Dept of Thoracic Surgery, University Hospital of Antwerp, Edegem, Belgium.
Eur Respir J. 1997 Jul;10(7):1547-51. doi: 10.1183/09031936.97.10071547.
Precise mediastinal lymph node (LN) staging is imperative in otherwise operable non-small cell lung cancer (NSCLC), as it determines subsequent treatment and possible inclusion in a neoadjuvant trial. The roles of mediastinoscopy and computed tomography (CT) remain controversial. To determine the accuracy of current CT scanners, a prospective study was performed. From April 1993 until September 1995, 100 consecutive patients with NSCLC without distant metastases underwent staging by CT and cervical mediastinoscopy. Naruke's map was used for classification, and LNs larger than 1 cm were considered CT positive. There were 91 males and 9 females, with a mean age of 64 (range 45-82) yrs. Fifty nine tumours were central and 41 peripheral, 64 right-sided and 36 left-sided. Thoracotomy with mediastinal LN sampling was performed in 74 patients, nonoperated patients having multilevel stage IIIA or stage IIIB disease. Twenty five (25%) mediastinoscopies were positive and three were false-negative (3%). There were 29 false-positive CT scans and 12 false-negative. Overall sensitivity and specificity of CT were 63 and 57%, respectively, and of mediastinoscopy 89 and 100%, respectively. Positive and negative predictive values of CT were 41 and 77%, respectively, and of mediastinoscopy 100 and 96%, respectively. Accuracy of CT was 59% and of mediastinoscopy 97%. Accuracy of CT was lowest for left-sided and centrally located tumours, and for LN station 7. Even with current computed tomography scanners, sensitivity and specificity remain low. Although overall cost may increase, routine cervical mediastinoscopy is necessary for precise staging of non-small cell lung cancer, and subcarinal lymph nodes should be routinely sampled.
对于原本可手术切除的非小细胞肺癌（NSCLC），精确的纵隔淋巴结（LN）分期至关重要，因为它决定后续治疗方案以及是否可能纳入新辅助治疗试验。纵隔镜检查和计算机断层扫描（CT）的作用仍存在争议。为确定当前CT扫描仪的准确性，进行了一项前瞻性研究。从1993年4月至1995年9月，100例无远处转移的NSCLC患者连续接受了CT和颈部纵隔镜分期检查。采用Naruke图谱进行分类，直径大于1 cm的淋巴结被视为CT阳性。患者中男性91例，女性9例，平均年龄64岁（范围45 - 82岁）。59个肿瘤位于中央，41个位于周边；64个位于右侧，36个位于左侧。74例患者接受了开胸纵隔淋巴结采样，未手术的患者患有多水平IIIA期或IIIB期疾病。25例（25%）纵隔镜检查结果为阳性，3例为假阴性（3%）。CT扫描有29例假阳性和12例假阴性。CT的总体敏感性和特异性分别为63%和57%，纵隔镜检查的敏感性和特异性分别为89%和100%。CT的阳性预测值和阴性预测值分别为41%和77%，纵隔镜检查的阳性预测值和阴性预测值分别为100%和96%。CT的准确性为59%，纵隔镜检查的准确性为97%。CT对左侧和中央型肿瘤以及第7组淋巴结的准确性最低。即使使用当前的计算机断层扫描仪，敏感性和特异性仍然较低。尽管总体成本可能会增加，但对于非小细胞肺癌的精确分期，常规颈部纵隔镜检查是必要的，并且应该常规对隆突下淋巴结进行采样。
