超声内镜诊断肺癌纵隔淋巴结转移

Application of endoscopic ultrasonography in the diagnosis of mediastinal lymph node metastasis

目的 探讨超声内镜 (EUS)对肺癌纵隔淋巴结转移的诊断价值。 方法 2 1例肺癌患者术前行EUS检查 ,分别统计EUS检出及手术切除的纵隔淋巴结个数 ;对EUS发现、手术切除并行病理检查的 10 3枚淋巴结的声像图进行分析 ,寻找EUS下恶性淋巴结的特征及诊断方法 ,并与CT诊断的准确性比较。 结果 EUS对第 5、7、8、9组转移淋巴结的检出率高于非转移淋巴结 (χ2 =11 75 2 ,P=0 0 1)。EUS发现的恶性淋巴结较良性淋巴结大 (二者短径相比 :t=4 5 41,P =0 0 0 0 ;长径相比 :t=3 2 78,P =0 0 0 2 )。恶性淋巴结的特征有 :短径≥ 1 0cm ,长径≥ 1 5cm ,边界清楚。应用公式 :P( 1) =1/[1+e - ( -2 963 + 2 0 4 1X1+ 1 681X2 ) ],以P( 1) ≥ 0 5作为恶性淋巴结诊断标准 ,其准确率、灵敏度、特异度分别为 72 8%、72 7%、72 9% ;EUS对第 5、7、8、9组纵隔淋巴结诊断的准确性高于CT (χ2 =6 812 ,P=0 0 13)。以病理检查结果为金标准 ,EUS诊断肺癌纵隔淋巴结转移的准确率、灵敏度、特异度分别为 83 9%、80 0 %、87 5 % (χ2 =2 1 2 18,P =0 0 0 0 )。

Objectives To calculate the rate of detection for mediastinal lymph nodes and to set up a criteria for the diagnosis of metastatic mediastinal lymph nodes in lung neoplasm by means of endoscopic ultrasonography (EUS). Methods In 21 patients with lung cancer who underwent preoperative EUS on mediastinal lymph nodes, 103 lymph nodes detected by EUS were resected and confirmed pathologically all. The difference between benign and malignant lymph nodes was analysed statistically. Results The rates of metastatic lymph nodes detected by EUS were significantly higher than these of non-metastatic lymph nodes (χ 2=11.752,P=0.01) in levels 5,7,8,and 9 of mediastinal lymph node staging map (Union Internationale Contre le Cancer, 1997). The mean long and short axis of metastatic lymph nodes were significantly longer than those of non-metastatic lymph nodes(short axis: t=4.541, P=0.000;long axis: t=3.278,P=0.002). Metastatic lymph nodes showed some characteristic ultrasonographic features, including short axis≥1.0 cm, long axis≥1.5 cm, and clear boundary. According to the equation P (1)=1/[1+e -(-2.963+2.041 X1+1.681 X2)], the lymph nodes were assumed to be malignant when P (1)≥0.5. The accuracy, sensitivity, specificity of this methods were 72.8%, 72.7%, 72.9% respectively, and were superior to those of CT for the same nods in levels 5, 7, 8 and 9 (χ 2=6.812,P=0.013). Conclusion EUS is an effective method of diagnostic evaluation of mediastinal lymph nodes of lung cancer.