纵隔镜与CT评估非小细胞肺癌术前纵隔淋巴结状态的前瞻性研究

Prospective comparison of CT versus mediastinoscopy in preoperative evaluation of mediastinal lymph node status in patients with non-small cell lung cancer

目的比较cT与纵隔镜评估非小细胞肺癌（NSCLC）术前纵隔淋巴结状态的价值。方法152例I-Ⅲ期NSCLC患者术前均接受cT和纵隔镜检查。以病理结果为参照，分别计算CT与纵隔镜评估NSCLC术前纵隔淋巴结状态的敏感度、特异度、阳性预测值、阴性预测值和准确度。采用Pearson X^2检验比较CT与纵隔镜的准确度，采用ROC诊断曲线比较CT与纵隔镜诊断效果。结果CT诊断NSCLC纵隔淋巴结转移的敏感度、特异度、阳性预测值、阴性预测值和准确度分别为73.8％、70.1％、64.9％、78.2％和71.7％，纵隔镜分别为83.1％、100.0％、100.0％、88.8％和92.8％，纵隔镜检查的准确度和诊断效果优于CT（P〈0.001）。纵隔镜检查的并发症发生率为4.6％，假阴性的发生率为7.2％。结论CT单独评估NSCLC术前纵隔淋巴结状态的准确度不足，纵隔镜是评估NSCLC术前纵隔淋巴结状态准确和安全的方法。

Objective To compare the value of CT and mediastinoseopy in assessment of mediastinal lymph node status in potentially operable non-small cell lung cancer （NSCLC）. Methods From Oct. 2000 to Jun. 2007, 152 consecutive patients with pathologically proven and stage Ⅰ-Ⅲ NSCLC were enrolled into the study. Of the 152 cases, there were 118 males and 34 females, with a median age of 58 years （range, 24-79 years）. Compared with the final pathology, the sensitivity, specificity, positive and negative predictive values and accuracy of CT and mediastinoscopy for preoperative evaluation of mediastinal lymph node status were calculated, respectively. The accuracy and diagnostic efficacy of CT and mediastinoscopy was compared by Pearson X^2 test and ROC curve, respectively. Results The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of detection of mediastinal metastasis was 73.8% , 70.1% , 64.9% , 78.2% and 71.7% by CT, respectively, versus 83.1% , 100.0% , 100.0% , 88.8% and 92.8% by mediastinoscopy, respectively. Both the accuracy and diagnostic efficacy of mediastinoscopy were superior to CT （ Pearson X^2 test, P〈0.001 ; Z test of the areas under the ROC curve,P 〈0.001 ）. The complication rate of mediastinoseopy was 4.6%, and the false negative rate was 7.2%. Conclusion Mediastinoscopy is safe and effective in preoperative assessment of mediastinal lymph node status in potentially operable NSCLC, while CT alone is inadequate.