盆腔侧方淋巴结转移对低位直肠癌预后的影响

Objective To evaluate the prognostic value of lateral pelvic lymph node metastasis on low rectal cancer. Methods One hundred and seventy-six patients with low rectal cancer who underwent radical resection combined with lateral pelvic lymph node dissection between 1994 and 2005 were reviewed. The data of the cases was investigated to define the prognostic value of lateral pelvic lymph node metastasis on the patients. Results Lateral node metastasis occurred in 33 patients (18.8%), and 51.5% of the metastasis occurred in internal iliac nodes or nodes at middle rectal roots and 39.4% in obturator nodes. Age ≤40 years, infiltrative cancer, T3-4 tumor, upward lymph node metastasis were risk factors for lateral node metastasis in low rectal cancer (P ＜ 0.05). The overall 5-year survival rate was 64.1%, and it was 94.1%, 79.1%, 42.1% for patients with TNM stage Ⅰ , Ⅱ , Ⅲ cancer, respectively. Tumor size, depth of infiltration, upward lymph node metastasis, lateral node metastasis was correlated significantly with prognosis (P ＜ 0.05). The 5-year survival rate of the patients without lateral metastasis was 73.6%, which was significant higher than that of patients with lateral metastasis (21.4%, P ＜0.05). Conclusion Lateralpelvic lymph node metastasis is an important prognostic factor for low rectal cancer.     

盆腔侧方淋巴结转移对低位直肠癌预后的影响

Objective To evaluate the prognostic value of lateral pelvic lymph node metastasis on low rectal cancer. Methods One hundred and seventy-six patients with low rectal cancer who underwent radical resection combined with lateral pelvic lymph node dissection between 1994 and 2005 were reviewed. The data of the cases was investigated to define the prognostic value of lateral pelvic lymph node metastasis on the patients. Results Lateral node metastasis occurred in 33 patients (18.8%), and 51.5% of the metastasis occurred in internal iliac nodes or nodes at middle rectal roots and 39.4% in obturator nodes. Age ≤40 years, infiltrative cancer, T3-4 tumor, upward lymph node metastasis were risk factors for lateral node metastasis in low rectal cancer (P ＜ 0.05). The overall 5-year survival rate was 64.1%, and it was 94.1%, 79.1%, 42.1% for patients with TNM stage Ⅰ , Ⅱ , Ⅲ cancer, respectively. Tumor size, depth of infiltration, upward lymph node metastasis, lateral node metastasis was correlated significantly with prognosis (P ＜ 0.05). The 5-year survival rate of the patients without lateral metastasis was 73.6%, which was significant higher than that of patients with lateral metastasis (21.4%, P ＜0.05). Conclusion Lateralpelvic lymph node metastasis is an important prognostic factor for low rectal cancer.     

盆腔侧方淋巴结转移对低位直肠癌预后的影响

Objective To evaluate the prognostic value of lateral pelvic lymph node metastasis on low rectal cancer. Methods One hundred and seventy-six patients with low rectal cancer who underwent radical resection combined with lateral pelvic lymph node dissection between 1994 and 2005 were reviewed. The data of the cases was investigated to define the prognostic value of lateral pelvic lymph node metastasis on the patients. Results Lateral node metastasis occurred in 33 patients (18.8%), and 51.5% of the metastasis occurred in internal iliac nodes or nodes at middle rectal roots and 39.4% in obturator nodes. Age ≤40 years, infiltrative cancer, T3-4 tumor, upward lymph node metastasis were risk factors for lateral node metastasis in low rectal cancer (P ＜ 0.05). The overall 5-year survival rate was 64.1%, and it was 94.1%, 79.1%, 42.1% for patients with TNM stage Ⅰ , Ⅱ , Ⅲ cancer, respectively. Tumor size, depth of infiltration, upward lymph node metastasis, lateral node metastasis was correlated significantly with prognosis (P ＜ 0.05). The 5-year survival rate of the patients without lateral metastasis was 73.6%, which was significant higher than that of patients with lateral metastasis (21.4%, P ＜0.05). Conclusion Lateralpelvic lymph node metastasis is an important prognostic factor for low rectal cancer.     

盆腔侧方淋巴结转移对低位直肠癌预后的影响

Objective To evaluate the prognostic value of lateral pelvic lymph node metastasis on low rectal cancer. Methods One hundred and seventy-six patients with low rectal cancer who underwent radical resection combined with lateral pelvic lymph node dissection between 1994 and 2005 were reviewed. The data of the cases was investigated to define the prognostic value of lateral pelvic lymph node metastasis on the patients. Results Lateral node metastasis occurred in 33 patients (18.8%), and 51.5% of the metastasis occurred in internal iliac nodes or nodes at middle rectal roots and 39.4% in obturator nodes. Age ≤40 years, infiltrative cancer, T3-4 tumor, upward lymph node metastasis were risk factors for lateral node metastasis in low rectal cancer (P ＜ 0.05). The overall 5-year survival rate was 64.1%, and it was 94.1%, 79.1%, 42.1% for patients with TNM stage Ⅰ , Ⅱ , Ⅲ cancer, respectively. Tumor size, depth of infiltration, upward lymph node metastasis, lateral node metastasis was correlated significantly with prognosis (P ＜ 0.05). The 5-year survival rate of the patients without lateral metastasis was 73.6%, which was significant higher than that of patients with lateral metastasis (21.4%, P ＜0.05). Conclusion Lateralpelvic lymph node metastasis is an important prognostic factor for low rectal cancer.     

盆腔侧方淋巴结转移对低位直肠癌预后的影响

Objective To evaluate the prognostic value of lateral pelvic lymph node metastasis on low rectal cancer. Methods One hundred and seventy-six patients with low rectal cancer who underwent radical resection combined with lateral pelvic lymph node dissection between 1994 and 2005 were reviewed. The data of the cases was investigated to define the prognostic value of lateral pelvic lymph node metastasis on the patients. Results Lateral node metastasis occurred in 33 patients (18.8%), and 51.5% of the metastasis occurred in internal iliac nodes or nodes at middle rectal roots and 39.4% in obturator nodes. Age ≤40 years, infiltrative cancer, T3-4 tumor, upward lymph node metastasis were risk factors for lateral node metastasis in low rectal cancer (P ＜ 0.05). The overall 5-year survival rate was 64.1%, and it was 94.1%, 79.1%, 42.1% for patients with TNM stage Ⅰ , Ⅱ , Ⅲ cancer, respectively. Tumor size, depth of infiltration, upward lymph node metastasis, lateral node metastasis was correlated significantly with prognosis (P ＜ 0.05). The 5-year survival rate of the patients without lateral metastasis was 73.6%, which was significant higher than that of patients with lateral metastasis (21.4%, P ＜0.05). Conclusion Lateralpelvic lymph node metastasis is an important prognostic factor for low rectal cancer.     

盆腔侧方淋巴结转移对低位直肠癌预后的影响

Objective To evaluate the prognostic value of lateral pelvic lymph node metastasis on low rectal cancer. Methods One hundred and seventy-six patients with low rectal cancer who underwent radical resection combined with lateral pelvic lymph node dissection between 1994 and 2005 were reviewed. The data of the cases was investigated to define the prognostic value of lateral pelvic lymph node metastasis on the patients. Results Lateral node metastasis occurred in 33 patients (18.8%), and 51.5% of the metastasis occurred in internal iliac nodes or nodes at middle rectal roots and 39.4% in obturator nodes. Age ≤40 years, infiltrative cancer, T3-4 tumor, upward lymph node metastasis were risk factors for lateral node metastasis in low rectal cancer (P ＜ 0.05). The overall 5-year survival rate was 64.1%, and it was 94.1%, 79.1%, 42.1% for patients with TNM stage Ⅰ , Ⅱ , Ⅲ cancer, respectively. Tumor size, depth of infiltration, upward lymph node metastasis, lateral node metastasis was correlated significantly with prognosis (P ＜ 0.05). The 5-year survival rate of the patients without lateral metastasis was 73.6%, which was significant higher than that of patients with lateral metastasis (21.4%, P ＜0.05). Conclusion Lateralpelvic lymph node metastasis is an important prognostic factor for low rectal cancer.     

盆腔侧方淋巴结转移对低位直肠癌预后的影响

Objective To evaluate the prognostic value of lateral pelvic lymph node metastasis on low rectal cancer. Methods One hundred and seventy-six patients with low rectal cancer who underwent radical resection combined with lateral pelvic lymph node dissection between 1994 and 2005 were reviewed. The data of the cases was investigated to define the prognostic value of lateral pelvic lymph node metastasis on the patients. Results Lateral node metastasis occurred in 33 patients (18.8%), and 51.5% of the metastasis occurred in internal iliac nodes or nodes at middle rectal roots and 39.4% in obturator nodes. Age ≤40 years, infiltrative cancer, T3-4 tumor, upward lymph node metastasis were risk factors for lateral node metastasis in low rectal cancer (P ＜ 0.05). The overall 5-year survival rate was 64.1%, and it was 94.1%, 79.1%, 42.1% for patients with TNM stage Ⅰ , Ⅱ , Ⅲ cancer, respectively. Tumor size, depth of infiltration, upward lymph node metastasis, lateral node metastasis was correlated significantly with prognosis (P ＜ 0.05). The 5-year survival rate of the patients without lateral metastasis was 73.6%, which was significant higher than that of patients with lateral metastasis (21.4%, P ＜0.05). Conclusion Lateralpelvic lymph node metastasis is an important prognostic factor for low rectal cancer.     

盆腔侧方淋巴结转移对低位直肠癌预后的影响

Objective To evaluate the prognostic value of lateral pelvic lymph node metastasis on low rectal cancer. Methods One hundred and seventy-six patients with low rectal cancer who underwent radical resection combined with lateral pelvic lymph node dissection between 1994 and 2005 were reviewed. The data of the cases was investigated to define the prognostic value of lateral pelvic lymph node metastasis on the patients. Results Lateral node metastasis occurred in 33 patients (18.8%), and 51.5% of the metastasis occurred in internal iliac nodes or nodes at middle rectal roots and 39.4% in obturator nodes. Age ≤40 years, infiltrative cancer, T3-4 tumor, upward lymph node metastasis were risk factors for lateral node metastasis in low rectal cancer (P ＜ 0.05). The overall 5-year survival rate was 64.1%, and it was 94.1%, 79.1%, 42.1% for patients with TNM stage Ⅰ , Ⅱ , Ⅲ cancer, respectively. Tumor size, depth of infiltration, upward lymph node metastasis, lateral node metastasis was correlated significantly with prognosis (P ＜ 0.05). The 5-year survival rate of the patients without lateral metastasis was 73.6%, which was significant higher than that of patients with lateral metastasis (21.4%, P ＜0.05). Conclusion Lateralpelvic lymph node metastasis is an important prognostic factor for low rectal cancer.     

盆腔侧方淋巴结转移对低位直肠癌预后的影响

Objective To evaluate the prognostic value of lateral pelvic lymph node metastasis on low rectal cancer. Methods One hundred and seventy-six patients with low rectal cancer who underwent radical resection combined with lateral pelvic lymph node dissection between 1994 and 2005 were reviewed. The data of the cases was investigated to define the prognostic value of lateral pelvic lymph node metastasis on the patients. Results Lateral node metastasis occurred in 33 patients (18.8%), and 51.5% of the metastasis occurred in internal iliac nodes or nodes at middle rectal roots and 39.4% in obturator nodes. Age ≤40 years, infiltrative cancer, T3-4 tumor, upward lymph node metastasis were risk factors for lateral node metastasis in low rectal cancer (P ＜ 0.05). The overall 5-year survival rate was 64.1%, and it was 94.1%, 79.1%, 42.1% for patients with TNM stage Ⅰ , Ⅱ , Ⅲ cancer, respectively. Tumor size, depth of infiltration, upward lymph node metastasis, lateral node metastasis was correlated significantly with prognosis (P ＜ 0.05). The 5-year survival rate of the patients without lateral metastasis was 73.6%, which was significant higher than that of patients with lateral metastasis (21.4%, P ＜0.05). Conclusion Lateralpelvic lymph node metastasis is an important prognostic factor for low rectal cancer.     

盆腔侧方淋巴结转移对低位直肠癌预后的影响

Objective To evaluate the prognostic value of lateral pelvic lymph node metastasis on low rectal cancer. Methods One hundred and seventy-six patients with low rectal cancer who underwent radical resection combined with lateral pelvic lymph node dissection between 1994 and 2005 were reviewed. The data of the cases was investigated to define the prognostic value of lateral pelvic lymph node metastasis on the patients. Results Lateral node metastasis occurred in 33 patients (18.8%), and 51.5% of the metastasis occurred in internal iliac nodes or nodes at middle rectal roots and 39.4% in obturator nodes. Age ≤40 years, infiltrative cancer, T3-4 tumor, upward lymph node metastasis were risk factors for lateral node metastasis in low rectal cancer (P ＜ 0.05). The overall 5-year survival rate was 64.1%, and it was 94.1%, 79.1%, 42.1% for patients with TNM stage Ⅰ , Ⅱ , Ⅲ cancer, respectively. Tumor size, depth of infiltration, upward lymph node metastasis, lateral node metastasis was correlated significantly with prognosis (P ＜ 0.05). The 5-year survival rate of the patients without lateral metastasis was 73.6%, which was significant higher than that of patients with lateral metastasis (21.4%, P ＜0.05). Conclusion Lateralpelvic lymph node metastasis is an important prognostic factor for low rectal cancer.     

支气管内超声引导针吸活检术在纵隔淋巴结CT阳性肺癌分期中的价值

目的 评价支气管内超声引导下针吸活检术(EBUS-TBNA)在纵隔淋巴结CT阳性肺癌病例分期中的应用价值.方法 2009年9月至12月共对28例胸部CT纵隔淋巴结阳性(短径≥1 cm)的肺癌病人行EBUS-TBNA检查.总结穿刺结果,评价该方法的诊断价值和安全性.结果 28例共穿刺淋巴结40组,淋巴结穿刺取材满意率96.3%(27/28例),无任何相关并发症.EBUS-TBNA阳性(取得恶性细胞病理学证据)20例,阴性(未取得恶性细胞病理学证据)8例;阴性者接受进一步外科手术,术后证实纵隔淋巴结转移2例(EBUS-TBNA假阴性).EBUS-TBNA检查准确率92.9%(26/28例),灵敏度90.9%(20/22例),特异度100%(6/6例),阳性预测值100%(20/20例),阴性预测值75%(6/8例).结论 EBUS-TBNA是评价纵隔淋巴结CT阳性肺癌分期的安全有效方法.     

支气管内超声引导针吸活检术在非小细胞肺癌术前分期中的临床应用

目的探讨支气管内超声引导针吸活检术(EBUS-TBNA)在非小细胞肺癌纵隔淋巴结分期中的应用价值。 方法2010年9月至2012年9月,北京大学人民医院利用EBUS-TBNA对术前确诊或CT扫描高度怀疑非小细胞肺癌且伴有纵隔淋巴结肿大(N₂站淋巴结短径≥1.0cm,或N₁站淋巴结短径≥1.0cm且N₂多站短径≥0.5cm者),有手术切除可能,术前无放、化疗史的126例患者进行纵隔淋巴结分期。最终入组82例非小细胞肺癌患者。 结果该组82例患者,经EBUS-TBNA检查证实纵隔淋巴结转移(阳性)者54例,未见纵隔淋巴结转移(阴性)者28例。EBUS-TBNA在该组肺癌术前纵隔淋巴结分期中的敏感度、特异度和准确性分别为94.7%(54/57)、100.0%(25/25)和96.3%(79/82),阳性预测值及阴性预测值分别为100.0%(54/54)和89.3%(25/28)。而CT对于本组患者纵隔淋巴结分期中的敏感度、特异度和准确性分别为98.2%(55/56)、38.5%(10/26)和79.3%(65/82),阳性预测值及阴性预测值分别为77.5%(55/71)和90.9%(10/11)。CT在术前纵隔淋巴结分期中的假阳性率为22.5%(16/71)。全组中,16例(19.5%)肺癌患者因EBUS-TBNA病理结果改变了治疗策略。 结论EBUS-TBNA用于非小细胞肺癌纵隔淋巴结分期的敏感性、特异性和准确性较高。EBUS-TBNA可以作为非小细胞肺癌术前分期、指导治疗策略的检查手段。     

The value of mediastinal staging with endobronchial ultrasound-guided transbronchial needle aspiration in patients with lung cancer

Objective: To evaluate the diagnostic yield, the learning curve and the safety of endobronchial ultrasound-guided transbronchial needle biopsy (EBUS-TBNA) in mediastinal staging of patients with lung cancer. Methods: Mediastinal staging was performed with EBUS-TBNA according to the Danish national guidelines in patients fulfilling one or more of the following criteria: (1) central tumour; (2) enlarged (>10 mm) mediastinal lymph nodes on computed tomography; or (3) positron emission tomography (PET)-positive mediastinal lymph nodes. The study period began in January 2006 when EBUS-TBNA was introduced in the department and ended in December 2007. All records were reviewed retrospectively. None of the four examiners had any previous experience with EBUS-TBNA or ultrasound when the study began. All examinations were performed under general anaesthesia. Patients without useful cytological material from the EBUS-TBNA were subjected to a supplementary standard cervical mediastinoscopy if the mediastinal lymph nodes were found to be enlarged (>10 mm), PET positive or if the examiner was insecure of the result of the EBUS-TBNA. Patients with mediastinal lymph node involvement, detected by EBUS-TBNA or standard cervical mediastinoscopy, were referred to oncological treatment, while those without mediastinal lymph node involvement underwent – if they were otherwise eligible for surgery – resection and systematic lymph node sampling either by thoracotomy or by video-assisted thoracoscopy. Final mediastinal staging was defined as positive if mediastinal lymph node involvement was detected by EBUS-TBNA, standard cervical mediastinoscopy or surgery, or defined as negative otherwise. Results: A total of 157 patients were included in the study. N2/N3 disease was found in 67 patients (42.6%). EBUS-TBNA missed the mediastinal spread in 10 patients. Five of the ten patients had lymph node metastases in station 5, 6 or 8 – out of reach of EBUS-TBNA or standard cervical mediastinoscopy. EBUS-TBNA had a sensitivity of 0.85 (0.74–0.93) and a negative predictive value of 0.90 (0.82–0.95). No complications occurred from EBUS-TBNA. The number of supplementary standard cervical mediastinoscopies decreased significantly in the study period. Conclusion: The results of this study suggest that staging of the mediastinum with EBUS-TBNA is safe and easy to learn – even without previous experience with ultrasound. The diagnostic yield of EBUS-TBNA is in accordance with the yield of standard cervical mediastinoscopy reported in the literature. We do not find any indications in the present study of the recommended necessity for mediastinoscopy in all EBUS-TBNA-negative patients.     

支气管内超声引导针吸活检术诊断胸部疾病

目的 探讨EBUS-TBNA在诊断胸部疾病中的应用价值.方法 回顾性分析2009年9月至2011年8月343例经EBUS-TBNA术检查患者资料,男219例,女124例;年龄(59.4±13.6)岁.其中影像学可疑或已明确肺癌,并伴有纵隔或肺门淋巴结肿大208例;不伴有肺内占位的纵隔和(或)肺门淋巴结肿大或纵隔占位94例;邻近大气道的肺实质内占位41例.结果 患者胸部病变短径(1.94±1.01) cm,穿刺胸部病变(1.77±0.86)个/例,穿刺(4.71±2.69)次,每处病变平均穿刺2.66次.本组EBUS-TBNA诊断纵隔和(或)肺门良、恶性病变总的敏感性95.6％(238/249例)、特异性100％( 94/94例)、阳性预测值100％(238/238例)、阴性预测值89.5％(94/105例)、准确性96.8％(332/343例).208例明确或可疑肺癌患者中151例经EBUS-TBNA诊断纵隔淋巴结转移,4例为结核,2例为Ⅱ期结节病;51例EBUS-TBNA阴性患者中37例接受进一步手术,32例证实为真阴性.EBUS-TBNA对本组188例肺癌患者纵隔淋巴结分期的敏感性96.8％(151/156例)、特异性100.0％(32/32例)、准确性97.3％(183/188例),阳性预测值100.0％(151/151例)、阴性预测值86.5％(32/37例).94例纵隔和(或)肺门淋巴结肿大或纵隔占位患者中22例恶性病变,73例良性病变中有23例诊断为淋巴结反应性增生,其中有13例接受进一步手术,6例为假阴性.EBUS-TBNA诊断本组纵隔病变良、恶性的敏感性88.0％(22/25例)、特异性100％(73/73例)、阴性预测值95.9％(70/73例)准确性97.9％(92/94例).EBUSTBNA对本组纵隔恶性和良性病变诊断的准确率分别为88.0％(22/25例)和95.9％(70/73例).41例邻近大气道的肺实质内占位中恶性33例;8例EBUS-TBNA阴性,其中4例经进一步手术证实为假阴性.EBUS-TBNA诊断大气道旁肺实质内占位中的敏感性89.2％(33/37例)、准确性90.2％(37/41例).全组病例无穿刺相关并发症发生.结论 EBUS-TBNA术对于肺癌的病理分期可靠,诊断邻近大气道的肺门或纵隔占位等胸部疾病安全、有效.     

Is sampling really effective in staging non-small cell lung cancer? A prospective study

Is sampling really effective in staging non-small cell lung cancer? The aim of the study was to assess if systematic nodal dissection is necessary in order to stage non-small cell lung cancer correctly or whether mediastinal lymph node sampling can be used and whether in selected cases it could replace systematic nodal dissection for the treatment of lung cancer. A prospective study was conducted in 94 patients affected by clinically resectable non-small cell lung cancer (stages I-IIIB) who were surgically treated by the same team of surgeons. During surgery mediastinal lymph node sampling was done first and then another surgeon completed the systematic nodal dissection and performed the lung resection. One hundred and ninety-three mediastinal nodal stations were investigated using the American Thoracic Society lymph node map to identify them. On analysing the 193 mediastinal nodal stations investigated, it emerged that in 181 cases (94%) mediastinal lymph node sampling and systematic nodal dissection yielded the same histopathological findings, whereas in 12 cases (6%) there was no agreement between the two techniques. The negative predictive value of mediastinal lymph node sampling was 92.8% (103/111). The results of the study show no statistical difference between mediastinal lymph node sampling and systematic nodal dissection in staging non-small cell lung cancer. However, it is possible that in a limited percentage of cases a nodal station could be understaged and thus the surgical resection could prove incomplete if mediastinal lymph node sampling alone is performed. Moreover, in those cases where mediastinal lymph node sampling detects N2 disease and systematic nodal dissection has not been completed, the intervention cannot be considered radical.     

Role of endobronchial ultrasound-guided transbronchial needle aspiration in the management of lung cancer

Endobronchial ultrasound (EBUS) is a promising new modality first introduced during the early 1990s. The radial probe EBUS was initially developed seeking for high-resolution imaging of processes in the airway wall and outside the airways. The structure of special importance was lymph nodes, walls of the central airways, and the mediastinum. After the development of miniaturized radial probes with flexible catheters having a balloon at the tip, it has been applied to aid bronchoscopists during biopsy of patients with respiratory diseases. In particular, the role of EBUS in transbronchial needle aspiration (TBNA) has been established. Radial probe EBUS-guided TBNA has increased the yield of TBNA of mediastinal lymph nodes, although it was still not a real-time procedure with target visualization. New convex probe EBUS (CP-EBUS) with the ability to perform real-time EBUS-guided TBNA (EBUS-TBNA) has emerged to overcome these problems. Indications for EBUS-TBNA are (1) lymph node staging in lung cancer patients; (2) diagnosis of intrapulmonary tumors; (3) diagnosis of unknown hilar and/or mediastinal lymphadenopathy; and (4) diagnosis of mediastinal tumors. Case series using EBUS-TBNA for mediastinal lymph node staging in lung cancer have reported a high yield, ranging from 89% to 98% (average 94.5%). To date, there are no reports of major complications related to EBUS-TBNA. EBUS-TBNA is a novel approach with a high diagnostic yield that is safe. The aim of this article was to review the current role of EBUS-TBNA for the management of lung cancer patients.     

支气管内超声引导针吸活检术在肺癌分期的应用

目的 接受EBUS-TBNA检查,其评价支气管内超声引导针吸活检术(endobronchial ultrasound-guided transbronchial needle aspiration,EBUS-TBNA)在肺癌分期的应用价值.方法 2008年7月至2010年3月,128例肺癌患者中男102例,女26例,年龄37 -85岁,平均60.1岁.胸部CT或PET/CT影像学检查均提示肺癌并肺门或纵隔淋巴结肿大,未除外转移.回顾分析其临床影像学与内镜超声的表现及穿刺活检的结果.结果 128例内镜超声均可见肺门或纵隔多组肿大的淋巴结,短径6～16 mm,平均12.3 mm.成功穿刺189组淋巴结,过程顺利,无并发症发生.EBUS-TBNA准确率98.53％,灵敏度98.50％,特异度100％.结论EBUS-TBNA作为肺门及纵隔淋巴结活检的一种新手段,创伤小,并发症少,准确性高,在肺癌分期的应用安全、可行.     

Comparison of Integrated Positron Emission Tomography/Computed Tomography and Mediastinoscopy in Mediastinal Staging of Non-Small Cell Lung Cancer: Analysis of 212 Patients

Background : Mediastinal staging is crucial to determine the prognosis and treatment options for patients with non-small cell lung cancer (NSCLC). In this study, we compared the results of integrated positron emission tomography-computerised tomography (PET/CT) with those of mediastinoscopy in mediastinal staging of NSCLC patients. Methods : PET/CT and mediastinoscopy was performed on 250 consecutive patients diagnosed with NSCLC between September 2005 and March 2008. Thirty-eight patients were excluded from the study. Standard cervical mediastinoscopy was performed in all patients, and simultaneous extended cervical mediastinoscopy was performed in 52 patients with left sided lesions. Patients with negative mediastinoscopy underwent resection. The pathological results were correlated with PET/CT findings.

Results : A total of 212 patients (199 male, 13 female; mean age: 58.3 years) were evaluated. In PET/CT analysis 60 true-positive, 45 false-positive, 103 true-negative and 4 false-negative patients were found. The rate of PET/CT positivity of mediastinal lymph nodes was 49.5%. The sensitivity, specificity, positive and negative predictive values and accuracy for PET/CT were 93.8%, 69.6%, 57.1%, 96.3% and 76.9% respectively. The incidence of N2 disease in NSCLC patients with negative mediastinal lymph node uptake on PET/CT was 3.7% (4 of 107). In univariate analysis, right upper lobe tumours were significantly (p < 0.05) more associated with occult N2 disease.

Conclusions : In patients with positive mediastinal lymph node uptake on PET/CT invasive mediastinal staging appears necessary for exact staging. Mediastinoscopy can be omitted in NSCLC patients with negative mediastinal uptake on PET/CT in regions where the rate of PET/CT positivity of mediastinal lymph nodes is high.     

Invasive staging of superior mediastinum in non-small cell lung cancer patients with specific indications

This prospective study was done between February 2001 and December 2002 on 84 non-small cell lung cancer patients who were apparently operable. We selectively performed mediastinoscopy to 46 patients (54.76%, group 1) with the following indications: clinical T4 tumor, high operative risk, radiologically enlarged mediastinal lymph nodes, clinical T3 tumors with central location, radiologically identified mediastinal lymph nodes of any size with adeno or large cell carcinoma histology. Other 38 patients (45.23%, group 2) underwent thoracotomy without mediastinoscopy. Sensitivity, specificity, negative predictive value and positive predictive value of the indications were calculated. Cost analysis was done in the 84 patients and the results were compared with alternative mediastinal staging strategies (vs. routine, and vs. selectively to patients with radiologically positive mediastinal lymph nodes) if they had been applied to our population. Group 1 had higher selectivity to differentiate N2 patients (p=0.02). Sensitivity, specificity, negative predictive value and positive predictive value of indications were calculated as: 0.85, 0.54, 0.92 and 0.36, respectively. Our approach was most economical in terms of total cost per patient and money spent unnecessarily per patient. Mediastinal evaluation in operable lung cancer patients should decrease the number of surgical procedures, N2 disease found at thoracotomy and cost.     

直径≤3cm的周围型非小细胞肺癌纵隔淋巴结转移规律的初步研究

目的探讨直径≤3cm的周围型非小细胞肺癌(non-small cell lung cancer,NSCLC)纵隔淋巴结转移的情况,分析早期周围型NSCLC纵隔淋巴结转移的规律。方法 2000年1月1日～2008年12月31日治疗直径≤3cm的周围型NSCLC161例,男89例,女72例,年龄(63.4±10.7)岁,行肺叶切除或肺局限性切除加系统性纵隔淋巴结清扫术,分析其临床特征、病理特点及纵隔淋巴结转移规律。结果全组手术顺利,无死亡及严重并发症发生。肺叶切除153例,肺楔形切除7例,肺段切除1例。全组共清扫淋巴结2456枚,平均每例4.5±1.6组、13.1±7.3枚。术后病理:腺癌99例,鳞癌30例,肺泡细胞癌19例,其他类型肺癌13例。术后TNM分期:ⅠA期50例,ⅠB期62例,ⅡA期6例,ⅡB期10例,ⅢA期33例。N1组淋巴结转移率为23.6%(38/161),N2组转移率为20.5%(33/161),其中隆突下淋巴结转移率为8.1%(13/161),跳跃式纵隔转移率为6.8%(11/161),全组未发现下纵隔淋巴结转移。肺泡细胞癌及直径≤2cm的鳞癌、直径≤1cm的腺癌均无pN2转移。上肺癌发生pN2转移时上纵隔100%(19/19)受累,其中21.1%(4/19)同时伴有隆突下淋巴结转移;下肺癌则除主要转移至隆突下外(64.3%,9/14),还常直接单独转移至上纵隔(35.7%,5/14)。转移的纵隔淋巴结左肺癌主要分布在第5、6、7组,右肺癌主要分布在第3、4、7组。结论对于直径≤3cm的周围型NSCLC,肿瘤直径越大,其纵隔淋巴结转移率越高,肺泡细胞癌、直径≤2cm的鳞癌和≤1cm的腺癌其纵隔淋巴结转移率相对较低;上肺癌主要转移在上纵隔,下肺癌则隆突下及上纵隔均可转移;第5、6、7组淋巴结是左肺癌主要转移的位置,第3、4、7组是右肺癌主要转移的位置,术中应重点清扫。