CT 对原发性肺癌合并肺门、纵隔淋巴结转移的诊断价值

Diagnostic Value of CT in the Evaluation of Lymph Node Metastasis in Lung Cancer

本文报告50例原发性肺癌病人肺门、纵隔等处摘出的210个淋巴结的病理诊断与胸部CT对照研究,探讨CT诊断肺癌淋巴结转移的价值和转移淋巴结的大小阀值。结果表明CT对诊断肺癌淋巴结转移有重要价值,但在发现某些部位的淋巴结肿大和判断转移的特异性方面有一定限制。在CT上显影的164个淋巴结中,若以长径>15mm作为淋巴结转移的阀值,则敏感性为57％,特异性为91％,准确性为81％,阳性预期值(PPV)71％,阴性预期值(NPV)84％。有46个淋巴结(22％)在CT上未能显示,主要是叶支气管周围及肺韧带淋巴结。作者指出,对肺癌合并肺门、纵隔淋巴结转移的诊断要慎重。

For evaluating the role of CT in the diagnosis of lymph node metastasis and their diagnostic criteria, 50 cases of primary lung cancer with 210 lymph nodes which were removed from the hilar region and mediastinum were analyscd and comparison was made between CT and pathologic findings. The results showed that 164 lymph nodes were detectable by CT and 46, which mainly situated in the pulmonary ligament or around the bronchi were missed. Assuming that lymph node with maximum diameter larger than 15mm as the threshold of metastasis, their sensitivity, specificity, accuracy, PPV and NPV were 57%, 91%, 81%, 71% and 84% respectively. It is emphasized that CT diagnosis of lymph node metastasis in case of lung cancer should be handled carefully, especially in instances when adenocarcinoma or lymph nodes are situated in pulmonary ligaments or around the hilum.