锁骨上超声检查提高原发性肺癌N分期的应用价值

Clinical Value of Ultrasound in the Diagnosis of Supraclavicular Lymph Node Metastasis of Primary Lung Cancer

背景与目的原发性肺癌是常见的恶性肿瘤之一,术前准确的局部淋巴结(N)分期可避免不必要的手术创伤,N3期已非手术治疗指征。本研究旨在探讨超声在诊断原发性肺癌锁骨上淋巴结转移及确定其分期中的应用价值。方法回顾性分析2012年10月-2013年11月经病理确诊为肺癌患者131例,所有患者均在术前行锁骨上区域的超声和增强计算机断层扫描(computed tomography,CT),对检查结果为阳性的患者行超声引导下穿刺活检,将组织病理学诊断作为淋巴结转移的诊断标准,对比两种检查方法与病理结果的一致性。结果 131例肺癌患者中经病理证实共有50例为锁骨上淋巴结转移,经超声检查阳性者54例,转移者50例;增强CT检查阳性者41例,其中36例为恶性。超声的灵敏度、特异度、正确指数、阳性预测值及阴性预测值(分别为100%、95.06%、95.06%、92.59%、100%)明显高于增强CT(分别为72%、93.83%、65.83%、87.80%、84.44%)。两种方法在确定肺癌TNM分期准确性的差异存在统计学意义(P<0.01)。结论与增强CT相比,超声在原发性肺癌锁骨上淋巴结转移方面具有较高的准确性、敏感性和特异性,并且能够更加准确地确定原发性肺癌的TNM分期。

Background and objective Primary lung cancer has been common malignant tumors. Accurate pre-operative N staging can avoid unnecessary surgical operations, and patients with N3 has non-surgical treatment of indica-tions. hTe aim of this study is to investigate the clinical value of ultrasound in the diagnosis of supraclavicular lymph node metastasis and staging of primary lung cancer. Methods We retrospectively analyzed 131 patients who were pathologically diagnosed with lung cancer from October 2012 to November 2013. All patients received ultrasound and contrast-enhanced computed tomograohy （CT） examination of the supraclavicular area, and those who were with positive results underwent ultrasound-guided biopsy. hTe accuracy of the two methods was compared according to their consistency with the patho-logical results. hTe pathological diagnosis was used as the diagnosis standard of lymph node metastasis. Results hTere were 50 cases of patients who were conifrmed supraclavicular lymph node metastasis pathologically in a total of 131 cases of patients with lung cancer. Fitfy-four cases were tested positive by ultrasound, and 50 cases were pathologically proven to be with lymph node metastasis. For comparison, the ratio was 36 out of 41 for contrast-enhanced CT. hTe sensitivity, speciifc-ity, You den＆#39;s index, the positive predictive value and the negative predictive value of ultrasound （100%, 95.06%, 95.06%, 92.59%, 100%） was signiifcantly higher than that of contrast-enhanced CT （72%, 93.83%, 65.83%, 87.80%, 84.44%）. hTe differences of accuracy of the two methods in TNM staging of lung cancer had statistically signiifcance （P〈0.01）. Conclu-sion Compared with enhanced CT, ultrasound examination has high accuracy, sensitivity and speciifcity for primary su-praclavicular lymph node metastasis in lung cancer, and at the same time can determine the TNM staging of primary lung cancer more accurately.