Suzuka I, Shiota K, Yamane M, Nishihara M, Nakagawa J, Shimizu N
Department of Surgery, Kagawa Prefectural Central Hospital, Japan.
Hepatogastroenterology. 1998 Nov-Dec;45(24):2127-31.
BACKGROUND/AIMS: We studied the accuracy rate of intra-operative lymph node assessment compared with pathological examination to determine whether surgeons could modify the extent of lymphadenectomy during the operation.
Intra-operative and pathological lymph node assessments were compared in 360 patients with carcinoma of the colon.
A total of 6,431 lymph nodes were examined, mean number per patient was 17.9. The overall accuracy rate of intra-operative diagnosis was 56.1%, sensitivity was 93.2%, and specificity was 41.7%. The accuracy rate of the diagnosis of N1 and N2 was 43.7% and that of N3 and N4 was 78.3% (p=0.001). There was no significant difference in the diagnosis rates in the colonic region. These results indicated that diagnosis in < or = N3 was more accurate than that in > or = N2. There were 5 false-negative cases. All of the false-negative lymph nodes were located adjacent to the colonic wall.
Intra-operative diagnosis of the positivity of < or = N2 lymph nodes was too poor to decide the extent of lymph node dissection of < D2. It is adequate to dissect according to at least the D2 criteria in all cases. If the surgeon observes N3 involvement, he should add the D3 dissection.
背景/目的：我们研究了术中淋巴结评估与病理检查相比的准确率，以确定外科医生在手术过程中是否可以修改淋巴结清扫范围。
对360例结肠癌患者的术中及病理淋巴结评估进行了比较。
共检查了6431个淋巴结，每位患者的平均数量为17.9个。术中诊断的总体准确率为56.1%，敏感性为93.2%，特异性为41.7%。N1和N2诊断的准确率为43.7%，N3和N4诊断的准确率为78.3%（p = 0.001）。结肠区域的诊断率无显著差异。这些结果表明，≤N3的诊断比≥N2的诊断更准确。有5例假阴性病例。所有假阴性淋巴结均位于结肠壁附近。
术中对≤N2淋巴结阳性的诊断太差，无法决定<D2的淋巴结清扫范围。在所有病例中，至少按照D2标准进行清扫是足够的。如果外科医生观察到N3受累，应增加D3清扫。
