术前CT检查在可手术非小细胞肺癌TNM分期中的应用评价

 目的 比较术前CT检查和术后病理诊断的非小细胞肺癌TNM分期结果，评价术前CT检查对非小细胞肺癌TNM分期的临床参考价值。 方法 112例临床确诊为NSCLC的患者行术前螺旋CT检查，临床分期为Ⅰ～ⅢA患者行手术切除加系统性淋巴结清扫，术前CT检查对TNM的分期结果定义为临床TNM（cTNM），术后的病理分期定义为病理TNM（pTNM）。对比患者的cTNM与pTNM，评价术前CT检查确定非小细胞肺癌TNM分期的敏感度、特异性和准确率。 结果 （1）术前CT检查诊断T分期的敏感度和特异性分别为76.6％和85.7％，阳性预测值为92.2％，阴性预测值为62.5％，准确率为79.5％。一致性检验有统计学意义（Kappa=0.658，P<0.05）；（2）术前CT检查诊断纵隔淋巴结转移的敏感度和特异性分别为72.9％和84.9％，阳性预测值为84.3％，阴性预测值为73.8％，准确率为78.6％，一致性检验有统计学意义（Kappa=0.667，P<0.05）。螺旋CT检查诊断 4R、5、6 组纵隔淋巴结转移的准确率和特异性偏低，其中4R组淋巴结转移的假阳性和假阴性较高。 结论 术前CT检查对非小细胞肺癌TNM分期有重要的临床参考价值，但存在假阳性和假阴性，应结合其他检查手段如PET-CT或纵隔镜等提高术前TNM分期准确率。

Clinical Value of Presurgical Computed Tomography in Diagnosis of TNM Staging of Non small Cell Lung Cancer

Objective To evaluate the clinical value of presurgical CT in diagnosis of TNM staging in NSCLC through comparing with corresponding postoperative pathology. Methods A total of 112 patients with NSCLC as clinical phase Ⅰ～ⅢA  proved by pathological features received spiral CT. After the mediastinal lymph node dissection and tumor resection,the spiral CT findings and corresponding pathologic results in TNM staging were compared. The sensitivity,specificity and accuracy of presurgical CT scan for diagnosis of TNM staging were evaluated. Results Compared with corresponding pathologic results in T category,the overall sensitivity and specificity were 76.6% and 85.7% respectively;the positive predictive value was 92.2%,and the negative predictive value was 62.5%.The accuracy was 79.5%（Kappa=0.658，P<0.05）；(2) as for mediastinal lymph node category,the overall sensitivity and specificity were 72.9%,84.9% respectively.The positive predictive value was 84.3% and negative predictive value was 73.8%.The accuracy was 78.6%（Kappa=0.667，P<0.05）.The accuracy and specificity of spiral CT were relatively low in staging 4R,5,6 lymph node groups;and the false negative and false positive rates were high in staging 4R lymph node groups. Conclusion The clinical TNM staging based on preoperative CT scan is valuable but not very accurate.The high false negative and positive predictive value of CT in T and N category may hamper its clinical application.Other methods such as PET CT and mediastinoscopy should be combined for elevating the accuracy of TNM staging.