应用纵隔镜检查周围型T1N0M0非小细胞肺癌淋巴结转移的价值

Staging value of mediastinoscopy in patients with peripheral T1N0M0 non-small cell lung cancer

目的探讨常规应用纵隔镜检查周围型T1N0M0非小细胞肺癌纵隔淋巴结转移情况。方法2000年10月-2005年5月，23例临床诊断为周围型T1N0M0非小细胞肺癌的患者接受经颈纵隔镜检查，其中3例再行右斜角肌淋巴结活检；纵隔镜检查N2者行新辅助化疗，N3者仅行放、化疗。结果纵隔镜检查共发现1例N2患者，1例N3患者，阳性率为8．7％（2／23）；敏感度为66．7％，特异度为100．0％，准确率为95．7％。结论对周围型T1N0M0非小细胞肺癌患者术前常规行纵隔镜检查，有对侧纵隔淋巴结转移者可避免不必要的手术治疗。

Objective To evaluate routine mediastinoscopy in detecting mediastinal lymph nodes status in patients with peripheral T1N0M0 non-small cell lung cancer （NSCLC）. Methods A cervical mediastinoscopy was performed for 23 patients with clinical diagnosis of peripheral T1N0M0 NSCLC prior to thoracotomy from October 2000 to May 2005, and additional a right scalenus lymph nodes biopsy in 3 of 23 cases. Mediastinosopy-positive （N2 disease） patients were performed neoadjuvant chemotherapy,and N3 disease only received radiocbemotberapy. Results Two of 23 （8.7%） had mediastinosopy-positive, 1 of which in N2 and 1 in N3 disease. The sensitivity, specificity and accuracy of mediastinoscopy for these 23 cases were found to be 66.7%, 100.0% and 95.7% respectively. Conclusions Preoperative mediastinoscopy might be routinely performed in patients with peripheral T1N0M0 NSCLC. Mediastinoscopy facilitates the identification of the presence of N3 disease before primary surgery and can avoid unnecessary thoracotomies.