非小细胞肺癌纵隔淋巴结分期:螺旋CT和病理检查对照

背景与目的:非小细胞肺癌纵隔淋巴结分期对肿瘤的规范化治疗方案的选择和预后判断具有极其重要的意义。本研究旨在通过比较螺旋CT和病理检查对非小细胞肺癌纵隔淋巴结分期的结果,评价螺旋CT检查对纵隔淋巴结分期的临床参考价值。方法:对89例病理确诊的非小细胞肺癌患者同时进行螺旋CT检查和纵隔镜检查,将CT对纵隔淋巴结分期结果与淋巴结最后病理分期做一一对照,对比分析螺旋CT检查诊断纵隔淋巴结转移的敏感性、特异性和准确率。结果:与纵隔淋巴结最后病理分期一一对照,螺旋CT检查诊断纵隔淋巴结转移的敏感性为58.9%,特异性为70.0%,阳性预测值60.5%,阴性预测值68.6%,总的准确率为65.2%。螺旋CT检查诊断4R、5、6、7组淋巴结转移的准确率和特异性偏低,诊断4R组和7组淋巴结转移的假阳性和假阴性较高。结论:螺旋CT检查对非小细胞肺癌纵隔淋巴结临床分期有一定的临床参考价值,但存在一定的假阳性和假阴性,应结合其他检查手段,比如纵隔镜,以进行更精确的分期。

Mediastinal lymph node staging in non-small cell lung cancer: comparison between spiral computed tomographic findings and pathology

BACKGROUND & OBJECTIVE: Mediastinal lymph node staging in non-small cell lung cancer (NSCLC) is important to choose standard treatment plan and estimating prognosis. This study was to evaluate the clinical value of spiral CT in staging mediastinal lymph node in NSCLC through comparing spiral CT findings with corresponding pathology. METHODS: A total of 89 patients with pathologically proven NSCLC received spiral CT and mediastinoscopic biopsy. The spiral CT findings and corresponding pathologic findings in staging mediastinal lymph node were compared. The sensitivity, specificity, and accuracy of diagnosing mediastinal lymph node metastasis were calculated. RESULTS: Compared with corresponding pathologic results, the overall sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of mediastinal lymph node staging with spiral CT were 58.9%, 70.0%, 60.5%, 68.6%, and 65.2%, respectively. The accuracy and specificity of spiral CT was relatively low in staging 4R, 5, 6, 7 lymph node groups; the false negative and false positive rates were relatively high in staging 4R, 7 lymph node groups. CONCLUSIONS: Spiral CT is a non-invasive clinical examination which may be used in staging mediastinal lymph node in NSCLC; however, there exists false negative and false positive rates. It should be combined with other investigations, such as mediastinoscopy, to assess a more accurate mediastinal lymph node staging.