非小细胞肺癌术前肺门纵隔淋巴结CT检查和术后病理结果比较的研究

目的 :比较非小细胞肺癌 (NSCLC)患者术前肺门纵隔淋巴结CT检查结果和术中淋巴结情况以及术后病理检查淋巴结转移情况 ,分析探讨CT检查对于诊断肺癌患者肺门纵隔淋巴结转移的价值。方法 :2 0 0 1年 6月 - 2 0 0 3年 5月在我院行手术切除的 86例资料完整的NSCLC患者 ,全部患者均有术前胸部CT、术中肺门纵隔淋巴结描述以及术后病理检查淋巴结转移与否的结果。CT和手术诊断淋巴结异常的标准是 :淋巴结最小径≥ 10mm ,CT检查和术中检查淋巴结异常相一致者定义为敏感性 ,CT发现淋巴结异常而病理报道为淋巴结转移者定义为特异性。结果 :CT检查肺门纵隔淋巴结转移的敏感性和特异性与淋巴结的大小关系密切 ,当淋巴结短径 <10mm时淋巴结的转移率为 16 % (12 77) ;10～19mm时转移率为 4 0 % (5 4 136 ) ;2 0～ 2 9mm时转移率为 75 % (2 7 36 ) ;≥ 30mm时转移率为 6 6。总的敏感性为 6 6 % (16 9 2 5 5 ) ,特异性为 5 1% (131 2 5 5 )。结论 :CT对NSCLC患者肺门纵隔淋巴结转移具有较高的诊断价值 ,尤其淋巴结短径≥ 2 0mm时 ,CT检查的敏感性较高。影响CT准确性的因素有淋巴结大小以及患者是否伴有肿瘤引起的阻塞性肺炎或肺不张

Comparison of Preoperative Thoracic CT Scan of Hilar and Mediastinal Lymph Nodes and Pathologic Diagnosis in Non-small-cell Lung Cancer

Objective To compare the results among preoperative thoracic CT of hilar and mediastinal lymph nodes,surgical finding and postoperative lymph node metastasis confirmed by pathology in the patients with non-small-cell lung cancer (NSCLC) in order to evaluate the accuracy of CT in the assessment of hilar and mediastinal node metastasis.Methods From June 2001 to May 2003,86 patients with NSCLC were retrospectively studied.All the patients had preoperative thoracic CT,surgical finding and postoperative pathologic results in lymph node metastasis.Hilar and mediastinal lymph nodes were considered abnormal if they exceeded 10 mm in the short axis diameter.Result The sensibility and specificity of CT for hilar and mediastinal lymph nodes metastasis had cosely relation with the diameter(s) of lymph nodes.The metastasis rate was 16%(12/27) when the short diameter of lymph nodes were under 10 mm,while 40%(54/136) in 10-19 mm,75%(27/36)in 20-29 mm and 6/6 beyond 30 mm.The overall sensitivity rate of CT for hilar and mediastinal nodes was 66% and specificity 51%.Conclusions CT has rather high evaluation on the diagnosis of hilar and mediastinal nodes in NSCLC,and metastasis rate is high especially when the lymph nodes beyond 20 mm.The factors influencing the accuracy of CT include the lymph node size and the presence of tumor-induced obstructive pneumonitis and atelectasis.The other factors including the locations of primary tumor and lymph nodes,long history of smoking and chronic bronchitis do not influence the accuracy of CT in the evaluation of thoracic lymph nodes.