非小细胞肺癌纵隔淋巴结分期诊断研究进展

Advances in mediastinal lymph node staging in patients with non-small cell lung cancer

目的肺癌是全球死亡率最高的恶性肿瘤之一,其中80%是非小细胞肺癌(non-small cell lung cancer,NSCLC)。本研究回顾总结国内外NSCLC纵隔淋巴结分期诊断的研究进展,为临床采取合适的检查方法及治疗方案提供一定指导。方法应用PubMed、中国知网、万方数据库、维普中文期刊服务平台等检索系统,以"NSCLC、术前、纵隔淋巴结分期、电子发射计算机体层显像-X线计算机体层(integrated positron emission tomography-computed tomography,PET-CT)、计算机断层成像(computed tomography,CT)、磁共振成像(magnetic resonance imaging,MRI)、纵隔镜、针吸活检术"为关键词,检索2000-07-27-2016-03-05相关文献,纳入标准:(1)NSCLC纵隔淋巴结的有创性外科检查方法;(2)NSCLC纵膈淋巴结的无创性影像学检查方法。结果根据纳入标准纳入分析40篇相关文献。总结出无创性影像学分期、有创性外科分期各检查的优缺点、灵敏度、特异度、准确度、假阳性率、假阴性率及临床应用情况。NSCLC纵隔淋巴结检查方法中,CT对纵隔淋巴结分期的灵敏度(61.1%)及特异性(71.1%)均较低;脱氧葡萄糖(fluorodeoxyglucose,FDG)PET-CT灵敏度和特异度分别是64%和83.3%,但其价格昂贵;磁共振扩散加权成像诊断NSCLC纵隔淋巴结转移的效能优于FDG PET-CT;纵隔镜灵敏度和特异度分别是78%和100%,存在一定的并发症(2%)和死亡率(0.08%);支气管内镜超声引导针吸活检操作方便,其灵敏度和特异度分别是92%和100%,不能取检主动脉旁及下纵隔淋巴结。结论 CT已作为评估NSCLC纵隔淋巴结分期的常规检查;FDG PET-CT是最准确的无创性检查方法;纵隔镜是目前诊断纵隔淋巴结分期的金标准,未来的趋势是各技术整合、优势互补以达到更准确的NSCLC纵隔分期。

OBJECTIVE Lung cancer is one of the most common causes of cancer death in the world, and non-small cell lung cancer （NSCLC） accounts for nearly 80% of those cases. This study aimed to summarize the current research and investigate the methods in mediastinal staging of NSCLC. METHODS ＂NSCLC, preoperative, mediastinal lymph node staging, integrated positron emission tomography-computed tomography（PET-CT）, computed tomography（CT）, magnetic resonance imaging（MRI）, mediastinoscopy, needle aspiration biopsy＂ were checked as key words in PuhMed, CNKI, WANFANG DATA, VIP data-bases between July 27th 2000 and March 5th 2016. Current invasive methods and non-invasive imaging techniques for detecting mediastinal lymph node metastases were available as the inclusion criteria. RESULTS 40 articles were analyzed according to the inclusion criteria. We compared the advantages, disadvantages,sensitivity, specificity, accuracy and clinical application of non-invasive imaging techniques and invasive methods. The sensitivity（61.1 %） and specificity （71.1 %） of CT were low for staging mediastinal lymph node. The sensitivity and specificity of fluorodeoxyglucose （FDG） PET-CT were 64% and 83.3 %, however its price was expensive. The performance of diffusion weighted imaging for diagnosis of mediastinal lymph node was superior to FDG PET-CT. The sensitivity and specificity of mediastinoscopy were 78% and 100%, its complications and mortality were 2% and 0.08%. The endobronchial ultrasound-guided transbronchial needle aspiration was convenient, its sensitivity and specificity were 92 % and 100%, however the para-aortic lymph nodes and inferior mediastinal lymph nodes were not available. CONCLUSIONS CT has been used as a routine inspection and PET-CT is the most accurate technique of non-invasive staging. Mediastinoscopy is the gold standard for mediastinal lymph node staging in patients with NSCLC. Integrating technique is the trend that could achieve a higher diagnostic rate for detecting mediastinal lymph node metastases in the future.