陈旧性肺结核对非小细胞肺癌患者CT临床N分期的影响

Impact of Historic Tuberculosis on CT Evaluation of Lymph Node Staging in NSCLC Patients

【目的】通过对比分析合并陈旧性肺结核的非小细胞肺癌患者以CT为基础的淋巴结临床分期(N分期)和术后病理分期,探讨陈旧性肺结核对CT临床N分期的影响。【方法】回顾性分析2007年10月至2010年8月在本中心接受根治性手术治疗的73例合并陈旧性肺结核的非小细胞肺癌患者临床资料,对比CT临床N分期和术后病理分期的符合程度;并对CT常规所用的以形态学为主的预测指标(淋巴结直径、肿大淋巴结站数、淋巴结有无融合、淋巴结有无钙化)能否预测肺门纵隔淋巴结转移进行χ2检验。【结果】CT对非小细胞肺癌患者淋巴结转移预测的敏感性、特异性、阳性预测值、阴性预测值及准确性分别为61.1%、60.0%、33.3%、82.5%及60.3%,其中特异性(60.0%)明显低于文献报道中CT对非小细胞肺癌患者的总体评估(74%～85%);在对合并有陈旧性肺结核的非小细胞肺癌患者肺门纵隔淋巴结的分站分析中,CT预测显示出较高假阳性率及较低的假阴性率;单因素分析结果显示CT常规的预测指标(淋巴结直径、肿大淋巴结站数、淋巴结有无融合、淋巴结有无钙化)与肺门纵隔淋巴结转移之间没有明显相关性。【结论】陈旧性肺结核降低了CT预测肺门纵隔淋巴结状态的特异性,是影响CT对非小细胞肺癌患者N分期评估的重要影响因素。CT常规所用的以形态学为主的预测指标并不能有效预测肺门及纵隔淋巴结转移。

[ Objective ] In this study, we analyzed the preoperative CT staging and postoperative pathological staging for non-small cell lung cancer （NSCLC） patients complicated with previous pulmonary tuberculosis in order to determine the impact of previous pulmonary tuberculosis on CT evaluation of lymph node staging in NSCLC patients. [Methods] We retrospectively analyzed the results of preoperative CT N staging and postoperative pathological staging in 73 NSCLC patients complicated with previous pulmonary tuberculosis. These patients received surgical treatment in our medical center from 24 October 2007 to 25 August 2010. Chi square test was used to identify the possible factors that are associated with the CT prediction of hilar and mediastinal lymph node metastasis. [ Results ] The sensitivity, specificity, positive predictive value, negative predictive value and accuracy for the CT prediction of lymph node metastasis in NSCLC patients complicated with previous pulmonary tuberculosis was 61.1%, 60.0%, 33.3%, 82.5%, and 60.3%, respectively. The specificity was lower than that for the total population of NSCLC patients （74% - 85%）. CT evaluation showed high false positive rate and low false negative rate in hilar and mediastinal lymph node metastasis prediction. Univariate analysis showed that the conventional indicators of CT were not significantly associated with hilar and mediastinal lymph node metastasis. [ Conclusions ] Complication with historic pulmonary tuberculosis significantly reduced the specificity of CT N staging in NSCLC patients. The conventional factors of CT for predication were not significantly associated with hilar and mediastinal lymph node metastasis.