De Leyn P, Vansteenkiste J, Cuypers P, Deneffe G, Van Raemdonck D, Coosemans W, Verschakelen J, Lerut T
Department of Thoracic Surgery, University Hospitals Leuven, Belgium.
Eur J Cardiothorac Surg. 1997 Nov;12(5):706-12. doi: 10.1016/s1010-7940(97)00253-4.
The results of primary surgery for non-small cell lung cancer (NSCLC) with involved ipsilateral mediastinal or subcarinal lymph nodes (N2 disease) remains poor. However, several studies suggest that induction chemotherapy could increase long-term survival in patients with N2 disease. Therefore, accurate preoperative staging of the mediastinum remains of paramount importance for the treatment policy in patients with NSCLC. Enlarged mediastinal lymph nodes (MLN) on CT scan are positive in only half of the patients. Small lymph nodes can contain metastatic deposits of clinical importance. However, many surgeons believe that a normal mediastinum at computed tomography allows them to cancel their preoperative mediastinal exploration. It was the aim of this study to evaluate the results of cervical mediastinoscopy in patients without enlarged MLN on CT scan.
Between January 1990 and June 1994, 235 patients with potentially operable NSCLC underwent a cervical mediastinoscopy despite the absence of enlarged MLN on CT scan. MLN were considered enlarged if they were equal to or larger than 15 mm at their maximal cross-sectional diameter.
Cervical mediastinoscopy was positive in 47 patients (20%). In 21 patients, N2 disease was extranodal and in 16 patients more than one level was involved. Mediastinoscopy was positive in 9.5% of the cT1N0 cases, in 17.7% of the cT2N0 lesions, in 31.2 and 33.3% of cT3N0 or cT4N0 tumors, respectively. After a negative cervical mediastinoscopy, resectability for unforeseen N2 disease was as high as 95%.
We recommend a cervical mediastinoscopy in every patient with potentially operable NSCLC.
对于同侧纵隔或隆突下淋巴结受累（N2期病变）的非小细胞肺癌（NSCLC），一期手术的效果仍然较差。然而，多项研究表明诱导化疗可提高N2期病变患者的长期生存率。因此，纵隔的准确术前分期对于NSCLC患者的治疗策略仍然至关重要。CT扫描显示纵隔淋巴结肿大（MLN）的患者中只有一半为阳性。小淋巴结可能含有具有临床意义的转移灶。然而，许多外科医生认为CT显示纵隔正常可使他们取消术前纵隔探查。本研究的目的是评估CT扫描显示MLN未肿大的患者行颈部纵隔镜检查的结果。
1990年1月至1994年6月期间，235例可能可手术切除的NSCLC患者接受了颈部纵隔镜检查，尽管CT扫描显示MLN未肿大。MLN最大横径等于或大于15mm时被视为肿大。
颈部纵隔镜检查阳性的患者有47例（20%）。21例患者的N2期病变为结外病变，16例患者累及一个以上区域。cT1N0病例中纵隔镜检查阳性率为9.5%，cT2N0病变中为17.7%，cT3N0或cT4N0肿瘤中分别为31.2%和33.3%。颈部纵隔镜检查阴性后，意外N2期病变的可切除率高达95%。
我们建议对每例可能可手术切除的NSCLC患者进行颈部纵隔镜检查。
