CT表现为T1期高、低量化混合性磨玻璃样变肺癌肺内周围区淋巴结清扫意义

Significance of regional lymph node dissection in T1 stage lung cancer patients with CT manifestations of high and low quantified mixed ground-glass opacity

目的探讨术前高分辨CT下表现为50%≤实性成份<90%的高量化和10%≤实性成份<50%的低量化混合性磨玻璃样变(mixed ground glass opacity,m GGO)的T1期(肿瘤最大径d≤3 cm)原发性周围型非小细胞肺癌的淋巴结转移规律。方法回顾性分析2015年1月至2016年6月于大连医科大学附属大连市中心医院胸外科就诊,术前高分辨CT表现为混合型磨玻璃样变,并行肺癌根治术患者60例的临床资料。其中男24例,女36例,年龄34~76(58.40±7.93)岁。根据CT表现,测量计算并分为50%≤实性成份占比<90%的高量化组和10%≤实性成份占比<50%的低量化组,共两组。统计分析清扫淋巴结的数目和转移情况。结果60例患者共清扫淋巴结1038枚,平均每例患者18.54枚。其中转移淋巴结共计40枚,总体转移率为3.85%。m GGO高量化组转移率为6.80%;m GGO低量化组转移率为1.55%。本研究发现3例患者存在单纯的第12和(或)13和(或)14组淋巴结转移,检出率为5.00%。结论 CT表现为T1期混合性磨玻璃样变原发性周围型NSCLC,其淋巴结转移率与病灶内实性成份的占比以及肿瘤的病理类型有关。肺内周围区的第12、13、14组淋巴结病理活检有助于发现常规淋巴结清扫方式不能发现的单纯肺内淋巴结转移,对T1期原发性NSCLC的分期的准确划定和治疗方案的选择具有重要意义。

Objective To investigate lymph node metastasis in T1 stage(the maximum tumor diameter d≤3 cm)primary peripheral non small cell lung cancer(NSCLC)with preoperative high resolution CT manifestation of mixed ground glass opacity(mGGO)demonstrating 50%≤solid component<90%high quantization and 10%≤solid component<50%low quantization and to provide a basic reference for preoperative diagnosis,clear delineation of tumor staging and selection of reasonable treatment plan.Methods Sixty patients,who were treated by radical resection of pulmonary carcinoma from January 2015 to June 2016 in Department of thoracic surgery,Dalian Central Hospital Affiliated to Dalian Medical University with preoperative high-resolution CT showing mGGO,were retrospective analyzed.Among the patients,24 were males and 36 were females,ranging 34-76 years old(58.40±7.93).According to CT manifestation,the patients were divided into two groups,including high quantization group of 50%≤solid component<90%and low quantization group of 10%≤solid component<50%.The number and metastasis of lymph nodes were analyzed statistically.Results Of the 60 patients,1038 lymph nodes were cleaned,with an average of 18.54 lymph nodes per patient.Of them,there were a total of 40 metastatic lymph nodes,the overall metastatic rate was 3.85%.The metastatic rate was 6.80%in mGGO high quantification group and 1.55%in mGGO low quantification group,respectively.Three patients had simple 12th and(or)13th and(or)14th lymph node metastasis,the detection rate was 5.00%.Conclusion The lymph node metastasis rate of primary metaplastic NSCLC with CT manifestation of mGGO in T1 stage is related to the proportion of solid components in the lesion and the pathological type of the tumor.Pathological biopsy of the 12th,13th and 14th group of lymph nodes in the peripheral area of the lungs contributes to detect the simple pulmonary lymph node metastasis that can not be found by conventional lymph node dissection,which is of great importance in the accurate delineation of the primary NSCLC in T1 stage and the choice of treatment regimen.