非小细胞肺癌淋巴结大小与转移的关系

Lymph Node Size and Metastaic Infiltration in Non-small Cell Lung Cancer

目的评估非小细胞肺癌淋巴结大小与转移的相关性。方法从形态测量学角度,分析258例非小细胞肺癌患者纵隔和肺门的淋巴结。记录每例淋巴结数目、最大径及病理结果。计算转移频数与淋巴结大小的相关性。回顾性分析其中80例患者术前CT扫描的淋巴结所见,与组织病理学诊断相对照。结果检查258例标本的2892枚淋巴结。140例患者为pN0期,118例为淋巴结阳性。2487枚淋巴结(86.0%)无转移,405枚淋巴结(14.0%)有转移。无转移淋巴结平均直径是(7.05±3.7)mm,转移淋巴结是(10.7±4.7)mm,(P<0.005)。1954枚无转移淋巴结(78.5%)和180枚转移淋巴结(44.3%)直径<10mm。140例无转移淋巴结的患者中,102例(72.9%)至少有一枚淋巴结>10mm。118例转移患者中,13.0%淋巴结<10mm。80例CT扫描评估的敏感性是57.0%,特异性80.2%。结论淋巴结大小不能作为评估非小细胞肺癌转移浸润的可靠参数。

Objective: To evaluate the correlation of lymph node size and their infiltration by metastases in lung cancer. Methods: In a morphometric study, hilar and mediastinal lymph nodes from 258 patients with non-small cell lung cancer (NSCLC) were analyzed. The lymph nodes were counted, the largest diameter of each lymph node was measured, and each lymph node was analyzed for metastatic involvement by histopathologic examination. The frequency of metastatic involvement was calculated and correlated with lymph node size. Preoperative CT scans of 80 patients were retrospectively analyzed. Lymph node size was measured, and lymph nodes were evaluated due to radiologic criteria. The radiologic evaluation was compared to the histopathologic diagnosis. Results: A total of 2 892 lymph node were present in the 258 specimens examined for this study. One hundred forty patients had a pNO status, whereas 118 patients had lymph nodes that were positive for cancer. Two thousand four handred eighty-seven lymph nodes (86%) were tumor-free, while 405 (14%) showed metastatic involvement on histopathologic examination. The mean diameter of the nonmetastatic lymph nodes was 7.05±3.7mm, whereas infiltrated nodes had a diameter of 10.7±4.7mm (P<0.005). One thousand nine hundred fifty-four of the tumor-free lymph nodes (78.5%) and 180 of the metastatic lymph nodes (44.3%) were <10mm in diameter. Of 140 patients with no metastatic lymph node involvement, 102 (73%) had at least one lymph node that was >10 mm iniameter. Of 118 patients with metastatic lymph node involvement, 13% had no lymph node that was >10 mm. The independent radiologic evaluation of the CT scans of 80 patients yielded a sensitivity of 57% and a specificity of 80.2%. Conclusion: Lymph node size is not a reliable parameter for the evaluation of metastatic involvment in patients with NSCLC.