电视纵隔镜和多排螺旋CT诊断非小细胞肺癌纵隔淋巴结转移的对比研究

目的 比较电视纵隔镜和多排螺旋CT在诊断非小细胞肺癌纵隔淋巴结转移上的临床价值,比较两者之间的差异,探讨两者在诊断非小细胞肺癌纵隔淋巴结转移上的优势.方法 2009年10月至2011年8月,我院手术收治的肺癌患者48例,均行术前电视纵隔镜检查和多排螺旋CT检查；以手术清扫淋巴结的病理诊断为金标准,分析电视纵隔镜和多排螺旋CT诊断纵隔淋巴结转移的敏感性、特异性等.结果 48例患者中,术后病理显示,11例出现纵隔淋巴结转移.多排螺旋CT可以准确判断纵隔淋巴结转移8例,准确率为89.58%;电视纵隔镜可以准确判断纵隔淋巴结转移10例,准确率为97.92％；电视纵隔镜诊断准确率优于多排螺旋CT( P＜0.05).多排螺旋CT诊断性灵敏度为72.73％,特异度为94.59％,假阴性率为27.27％,假阳性率为5.41％,总的阳性和阴性预测值分别是80.00％和92.1 1％,约登指数为67.31％;电视纵隔镜诊断性灵敏度为90.91％.特异度为100.00％,假阴性率为9.09％,假阳性率为0.00％,总的阳性和阴性预测值分别是100.00％和97.37％,约登指数为90.90％.结论 电视纵隔镜检查和多排螺旋CT均可以诊断肺癌纵隔淋巴结转移,但电视纵隔镜检查有更高的敏感性和准确性.

Video-mediastinoscopy and multi-slice spiral CT for the diagnosis of medisstinal lymphatic metastasis of non-small cell lung cancer

Objeetive To cpmpare the clinical value of video-mediastinoscopy and multi-slice spiral CT （ MSCT ） in determining mediastinal lymphatic metastasis of non-small cell lung cancer （ NSCLC ）. Methods From October 2009 to August 20 l 1,48 patients with NSCLC undergoing surgical treatment were preoperatively investigated by video-mediastinoscopy and MSCT in our hospital. Pathological diagnosis of mediastinal lymph nodes dissection accepted as the gold standard to examine the sensitivity and specificity of video-mediastinoscopy and MSCT. Results A total of 11 of the 48 patients with NSCLC were pathologically confirmed as mediastinal lymphatic metastasis. 8 patients with mediastinal lymphatic metastasis were accurately detected by CT, with an accuracy of 89.58%, while 10 patients were accurately confirmed by video-mediastinoscopy, with an accuracy of 97.92%. The a~curacy of video-mediastinoscopy was superior to that of MSCT （ P〈 0.05 ）. The sensitivity, specificity, false negative rate, false positive rate, positive predictive value, negative predictive value, and Youden＇s index for detecting mediastinal lymphatic metastasis were 72.73%, 94.59%, 27.27%, 5.41%, 80.00%, 92.11%, and 67.31 by CT, respectively, versus 90.91%, 100.00%, 9.09%, 0.00%, 100.00%, 97.37%, and 90.90% by videomediastinoscopy, respectively. ,Gonclusions Both video-mediastinoscopy and MSCT can detect mediastinal lymphatic metastasis of lung cancer, and video-mediastinoscopy has a better sensitivity and and better accuracy.