非小细胞肺癌纵隔淋巴结临床检测技术研究的现状

Clinical detecting techniques of mediastinal lymph node of non-small cell lung cancer

目的:总结纵隔淋巴结检测的各种临床方法及其临床价值。方法:应用PubMed、维普检测系统,以"非小细胞肺癌"、"纵隔淋巴结"和"检测方法"等为检索词,检索1997-2013年的相关文献。纳入标准:1)非小细胞肺癌(NSCLC)相关进展;2)纵隔淋巴结转移的生存现状;3)纵隔淋巴结各种临床检测手段。根据纳入标准分析文献31篇。结果:CT和PET-CT诊断纵隔淋巴结的准确性不高,无法获得明确病理诊断,但它能提供准确的胸部解剖。纵隔镜仍是诊断纵隔淋巴结转移的金标准,其准确率>90%,但存在较高的手术并发症,限制了其发展。随腔内内镜超声的发展,食管镜超声引导针吸活检和气管镜超声引导针吸活检的准确率也能到达90%,但都有其检查的盲点,对于这些地方则无能为力。结论:联合检测可以提高纵隔淋巴结检出率和准确性,特别是在影像学的定位下,食管镜超声引导针吸活检和气管镜超声引导针吸活检联合使用可能成为检测纵隔淋巴结的新选择。

A total of 105 articals on non-small cell lung cancer published between 1997--2013 were retrieved in Pubmed and Weipu with the keywords of ＂non-small cell lung cancer, mediastinal lymph node, test method＂. Inclusion criteria： 1）The progress of non-small cell lung cancer; 2）Survival state of mediastinal lymph node metastasis;3）Multiple clinical test method of mediastinal lymph node. Totally 31 papers were collected. RESULTS： The accuracy rate of CT and PET-CT in the diagnosis of mediastinal lymph nodes is not high, and they unable to obtain definite pathological diagnosis, but can provide an accurate anatomy of the chest. Mediastinoscope remains the gold standard in the diagnosis of mediasti- nal lymph node metastasis, and its accuracy is above 90 %, but with high surgical complications and that limited its devel- opment. Along with the development of the intraductal-ultra sonography, EUS-FNA and EBUS-TBNA accuracy can reach 90% ,but has its blind spot examination, for these places are powerless. CONCLUSION.. Combined with various clinical test method can improve qletection rate and accuracy, Especially under the orientation of imaging, EUS-FNA in combina- tion with Et3US-TBNA maybe become a new trend in test mediastinal lymph node.