CT判断非小细胞肺癌纵隔淋巴结转移的价值

Clinical significance of computed tomographic scanning in diagnosing mediastinal node metastasis in non small cell lung cancer

目的 探讨 CT扫描在诊断肺癌纵隔淋巴结转移方面价值。方法 回顾性分析 35 1例非小细胞肺癌病人的临床资料及放射学资料。结果 肿瘤位置是导致假阳性的重要因素 ,在中央型肺癌 ,假阳性率达 2 8%。血清 CEA水平及肿瘤大小是导致假阴性的重要因素 ,CEA高于正常者假阴性率为 18% ,肿瘤直径 >4 cm者假阴性率为 2 0 %。结论 仅靠胸部 CT来判定有无纵隔淋巴结转移是不够的 ,有一定的假阳性和假阴性率。

Objective To assess the effect of CT in diagnosing mediastinal node involvement in non small cell lung cancer. Methods From August 1999 to August 2001, 351 patients with non small cell lung cancer were included in this study. We used major lung resection and systematic lymph node dissection. Some clinical and radio logic factors were retrospectively studied. We identified significant factors responsible for the false positive and false negative results by using univariate and multivariable analysis. Results Central tumor location was a significant factor for false positive scans. Elevated carcinoembryonic antigen level and tumor dimension were significant factors for false negative scans. The patients with a central tumor, the false positive was 28%. IN the patients with an elevated CEA level, the false negative rate was 20%. In the patients with a tumor 40mm or larger, it was 18%. Conclusion It is not reliable to accurately diagnose N2 by using lymph node size on computed tomographic scanning alone, especially in patients with a central tumor, an elevated serum CEA level, or a tumor of 40mm or larger.