Combining machine and deep transfer learning for mediastinal lymph node evaluation in patients with lung cancer

Background The prognosis and survival of patients with lung cancer are likely to deteriorate with metastasis.Using deep-learning in the detection of lymph node metastasis can facilitate the noninvasive calculation of the likelihood of such metastasis,thereby providing clinicians with crucial information to enhance diagnostic precision and ultimately improve patient survival and prognosis.Methods In total,623 eligible patients were recruited from two medical institutions.Seven deep learning models,namely Alex,GoogLeNet,Resnet18,Resnet101,Vgg16,Vgg19,and MobileNetv3(small),were utilized to extract deep image histological features.The dimensionality of the extracted features was then reduced using the Spearman correlation coefficient(r≥0.9)and Least Absolute Shrinkage and Selection Operator.Eleven machine learning methods,namely Support Vector Machine,K-nearest neighbor,Random Forest,Extra Trees,XGBoost,LightGBM,Naive Bayes,AdaBoost,Gradient Boosting Decision Tree,Linear Regression,and Multilayer Perceptron,were employed to construct classification prediction models for the filtered final features.The diagnostic performances of the models were assessed using various metrics,including accuracy,area under the receiver operating characteristic curve,sensitivity,specificity,positive predictive value,and negative predictive value.Calibration and decision-curve analyses were also performed.Results The present study demonstrated that using deep radiomic features extracted from Vgg16,in conjunction with a prediction model constructed via a linear regression algorithm,effectively distinguished the status of mediastinal lymph nodes in patients with lung cancer.The performance of the model was evaluated based on various metrics,including accuracy,area under the receiver operating characteristic curve,sensitivity,specificity,positive predictive value,and negative predictive value,which yielded values of 0.808,0.834,0.851,0.745,0.829,and 0.776,respectively.The validation set of the model was assessed using clinical decision curves,calibration curves,and confusion matrices,which collectively demonstrated the model's stability and accuracy.Conclusion In this study,information on the deep radiomics of Vgg16 was obtained from computed tomography images,and the linear regression method was able to accurately diagnose mediastinal lymph node metastases in patients with lung cancer.

Exploration and optimization of surgical techniques for laparoscopic transhiatal lower mediastinal lymph node dissection for adenocarcinoma of esophagogastric junction: A prospective IDEAL 2a study with qualitative design

Objective: To explore the change and feasibility of surgical techniques of laparoscopic transhiatal(TH)-lower mediastinal lymph node dissection(LMLND) for adenocarcinoma of the esophagogastric junction(AEG)according to Idea, Development, Exploration, Assessment, and Long-term follow-up(IDEAL) 2a standards.Methods: Patients diagnosed with AEG who underwent laparoscopic TH-LMLND were prospectively included from April 14, 2020, to March 26, 2021. Clinical and pathological information as well as surgical outcomes were quantitatively analyzed. Semistructured interviews with the surgeon after each operation were qualitatively analyzed.Results: Thirty-five patients were included. There were no cases of transition to open surgery, but three cases involved combination with transthoracic surgery. In qualitative analysis, 108 items under three main themes were detected: explosion, dissection, and reconstruction. Revised instruction was subsequently designed according to the change in surgical technique and the cognitive process behind it. Three patients had anastomotic leaks postoperatively, with one classified as Clavien-Dindo Ⅲa.Conclusions: The surgical technique of laparoscopic TH-LMLND is stable and feasible;further IDEAL 2b research is warranted.

Distribution of splenic artery lymph nodes and splenic hilar lymph nodes

BACKGROUND Total gastrectomy with splenectomy is the standard treatment for advanced proximal gastric cancer with greater-curvature invasion.As an alternative to splenectomy,laparoscopic spleen-preserving splenic hilar lymph node(LN)dissection(SPSHLD)has been developed.With SPSHLD,the posterior splenic hilar LNs are left behind.AIM To clarify the distribution of splenic hilar(No.10)and splenic artery(No.11p and 11d)LNs and to verify the possibility of omitting posterior LN dissection in laparoscopic SPSHLD from an anatomical standpoint.METHODS Hematoxylin&eosin-stained specimens were prepared from six cadavers,and the distribution of LN No.10,11p,and 11d was evaluated.In addition,heatmaps were constructed and three-dimensional reconstructions were created to visualize the LN distribution for qualitative evaluation.RESULTS There was little difference in the number of No.10 LNs between the anterior and posterior sides.For LN No.11p and 11d,the anterior LNs were more numerous than the posterior LNs in all cases.The number of posterior LNs increased toward the hilar side.Heatmaps and three-dimensional reconstructions showed that LN No.11p was more abundant in the superficial area,while LN No.11d and 10 were more abundant in the deep intervascular area.CONCLUSION The number of posterior LNs increased toward the hilum and was not neglectable.Thus,surgeons should consider that some posterior No.10 and No.11d LNs may remain after SPSHLD.

Perioperative considerations in patients with non small cell lung cancer and metastases in mediastinal lymph nodes

Since the latest revision of the TNM system reclassified T3N0 tumours into the ⅡB stage, N2 lesions became the major determinant of the ⅢA stage. Concerning the minority of patients with T3N1 tumours in this stage,

Solitary mediastinal lymph node recurrence after curative resection of colon cancer

We report two cases of solitary mediastinal lymph node recurrence after colon cancer resection. Both cases had para-aortic lymph node metastasis at the time of initial surgery and received adjuvant chemotherapy for 4 years in case 1 and 18 mo in case 2. The time to recurrence was more than 8 years in both cases. After resection of the recurrent tumor, the patient is doing well with no recurrence for 6 years in case 1 and 4 mo in case 2. Patients should be followed up after colon cancer surgery considering the possibility of solitary mediastinal lymph node recurrence if they had para-aortic node metastasis at the time of initial surgery.

Video-assisted Thoracoscopic Surgery for the Treatment of Mediastinal Lymph Node Tuberculous Abscesses

The mediastinal lymph node tuberculous abscesses（MLNTAs） are secondary to mediastinal tuberculous lymphadenitis. Surgical excision is often required when cold abscesses form. This study was aimed to examine video-assisted thoracoscopic surgery（VATS） for the treatment of MLNTA. Clinical data of 16 MLNTA patients who were treated in our hospital between December 1, 2013 and December 1, 2015 were retrospectively analyzed. All of the patients underwent the radical debridement and drainage of abscesses, and intrathoracic lesions were removed by VATS. They were also administered the intensified anti-tuberculosis treatment（ATT）, and engaged in normal physical activity and follow-up for 3 to 6 months. The results showed that VATS was successfully attempted in all of the 16 MLNTA patients and they all had good recovery. Two patients developed complications after surgery, with one patient developing recurrent laryngeal nerve injury, and the other reporting poor wound healing. It was concluded that VATS is easy to perform, and safe, and has high rates of success and relatively few side-effects when used to treat MLNTA.

A CLINICOPATHOLOGICAL STUDY OF MEDIASTINAL LYMPH NODE METASTASIS OF LUNG CANCER

Objective: To investigate pathologically the characteristics of lung cancer metastasis by mediastinal lymph node ways (N2). Methods: Of 398 lung cancer patients who underwent radical pulmonectomy and extensive lymph node dissection, 160 patients were diagnosed as with N2 metastasis, their 352 groups of mediastinal lymph nodes invaded were subject to the pathological study. Results: Evidences showed that the N2 metastasis of lung cancer was very active. It appears as single group or multi-group or jumping-form metastasis, rating 41.2%, 58.8% and 29.3% respectively. In addition, the extension of N2 metastasis was large, the most concentrated site was the 7th group lymph node (48.8%), then the 4th, 3rd and 5th group, rating 45.6%, 31.3% and 25.6% respectively. The occurrence of N2 metastasis was highly correlated with the site, size, histopathological type and the grade of differentiation of the cancer. An another feature of N2 metastasis was the invasion of metastasized lymph node into the bronchial wall, especially in adenocarcinoma. Conclusion: In order to achieve the radical removal of tumor, it is necessary to dissect the lymph nodes of the hilar and upper and lower mediastinum at the homolateral thoracic cavity actively and completely; beside, attention may be paid to the bronchial wall invasion caused by the lymph nodes metastasized.

Solitary recurrence of hilar cholangiocarcinoma in a mediastinai lymph node two years after curative resection

We recently encountered an unusual case of hilar cholangiocarcinoma in which a solitary recurrence in a mediastinal lymph node occurred two years after curative resection of the primary tumor. A 64-year old woman was admitted to our hospital with a complaint of right hypochondrial discomfort. After imaging studies demonstrated a hilar cholangiocarcinoma in the left hepatic duct, a curative resection of the tumor was performed, consisting of a left hepatic lobectomy along with caudate lobectomy, regional lymph node dissection, and resection of the extrahepatic bile duct. No nodal metastasis was observed histologically. Two years after surgery, the patient was found to have a nodule in the posterior mediastinum, which was thoracoscopically resected. No other swollen lymph nodes, local recurrence, or distant metastasis were noted. Histologically, the nodule proved to be a metastatic lymph node, and adjuvant chemoradiation therapy was initiated. The patient remained well for the four years following her first operation and had no evidence of disease recurrence 28 mo after her second operation. To our knowledge, this case is the first report of solitary recurrence in a mediastinal lymph node after curative resection of hilar cholangiocarcinoma.

Surgical Treatment for Mediastinal Lymph Node Carcinoma of Unknown Primary

Carcinoma of unknown primary (CUP) is occasionally encountered in clinical oncology. Wide variation exists in CUP. We herein report a rare case of CUP of a mediastinal lymph node. A 61-year-old man with dermatomyositis was referred to our hospital for treatment of mediastinal adenopathy and gastric cancer. Biopsy of both lesions showed that they were histologically different from each other. Mediastinal lymphadenectomy and total gastrectomy were performed for a definitive diagnosis and radical cure. Pathological examination revealed two distinctly different disease processes. The patient underwent postoperative chemotherapy for residual gastric cancer. Twenty months postoperatively, he is alive with cancer. Although CUP usually has a poor prognosis, surgical treatment of metastatic mediastinal lymph node CUP is a feasible therapeutic option.

Current status of Radiologic Diagnosis for Mediastinal Lymph Node Metastases of Non-Small-Cell Lung Cancer: Retrospective Study of pN2 Cases

Objective: Advances in diagnostic imaging techniques, such as 18F-fluorodeoxyglucose positron emission tomography (FDG-PET), have led to greater accuracy in preoperative mediastinal staging for patients with non-small-cell lung cancer (NSCLC), but surgical staging remains the “gold standard” for diagnosis. A proper understanding of the current accuracy of diagnostic imaging is needed for further improvements. Methods: Forty-three patients who underwent resection for NSCLC involving mediastinal lymph node (MLN) metastasis at our hospital between June 2003 and May 2011 were enrolled in this study. We conducted a retrospective study of the radiological and pathological findings for 53 metastatic MLNs in the 43 patients. Results: The preoperative imaging modality was computed tomography (CT) alone for 18 patients (22 MLNs) and CT and FDG-PET for 25 patients (31 MLNs). The sensitivities of CT and FDG-PET were 41.5% and 58.0%, respectively. The sensitivity of CT did not differ according to any clinicopathological factors, but the sensitivity of FDG-PET tended to be higher for primary tumors with high SUVmax values and for non-adenocarcinomas. In the lymph nodes, all micrometastatic foci ≤ 2 mm were PET-negative, but 4 lymph nodes with metastatic foci larger than 10 mm were also PET-negative. Conclusions: For the diagnostic imaging of MLN, FDG-PET has a greater sensitivity than contrast-enhanced CT based on “size criteria”, but it is still not sufficiently sensitive and is influenced by various factors. At present, histological confirmation of MLNs is necessary when making decisions regarding treatment plans and the type of surgical procedure that should be performed.

Impact of lymph node micrometastasis in hilar bile duct carcinoma patients

AIM- To immunohistochemicaUy examine micrometastasis and VEGF-C expression in hilar bile duct carcinoma （HBDC） and to evaluate the clinical significance of the results. METHODS： A total of 361 regional lymph nodes from 25 patients with node-negative HBDC were immunostained with an antibody against cytokeratins 8 and 18 （CAM 5.2）, and immunohistochemical staining of VEGF-C was performed in 34 primary resected tumors. RESULTS： Lymph node micrometastasis was detected in 6 （24%） of the 25 patients and 10 （2.8%） of the 361 lymph nodes. Patients with micrometastasis showed significantly poorer survival rates than those without （P= 0.025）. VEGF-C expression was positive in 17 （50%） of 34 HBDC, and significantly correlated with lymph node metastasis （P=0.042） and microscopic venous invasion （P=0.035）. CONCLUSIONS： It is suggested that immunohistochemically detected lymph node micrometastasis has an impact on the outcome of HBDC. VEGF-C expression is highly correlated with lymph node metastasis in HBDC and might therefore be a useful predictor.

Mediastinal lymphadenopathy in COVID-19: A review of literature

A novel coronavirus disease 2019(COVID-19)is a progressive viral disease that affected people around the world with widespread morbidity and mortality.Patients with COVID-19 infection typically had pulmonary manifestation but can also present with gastrointestinal,cardiac,or neurological system dysfunction.Chest imaging in patients with COVID-19 commonly show bilateral lung involvement with bilateral ground-glass opacity and consolidation.Mediastinal lymphadenopathy can be found due to infectious or non-infectious etiologies.It is commonly found to be associated with malignant diseases,sarcoidosis,and heart failure.Mediastinal lymph node enlargement is not a typical computer tomography of the chest finding of patients with COVID-19 infection.We summarized the literature which suggested or investigated the mediastinal lymph node enlargement in patients with COVID-19 infection.Further studies are needed to better characterize the importance of mediastinal lymphadenopathy in patients with COVID-19 infection.

Endobronchial Ultrasound Elastography for Diagnosing Mediastinal and Hilar Lymph Nodes

Background： Pathophysiological processes, such as malignancy, can lead to the formation of stiffer tissue in lung cancers. Endobronchial ultrasound rEBUS） elastography is a novel technique for measuring tissue stiffness during EBUS-guided transbronchial needle aspiration （EBUS-TBNA）. The current study was conducted to investigate the diagnostic value of EBUS elastography tbr mediastinal and hilar lymph node metastasis in lung cancers. Methods： From January 2014 to January 2015, 40 patients suspected of lung cancer were enrolled, and a total of 68 lymph nodes were evaluated by EBUS-TBNA. EBUS-guided elastography of lymph nodes was perfornaed prior to EBUS-TBNA. Standard EBUS characteristics were also described. Pathological determination of malignant or benign lymph nodes was used as the gold standard for this study. If EBUS-TBNA did not result in a tbrmal pathological diagnosis of malignancy, patients were referred for a surgical procedure. Comparisons of elastography and standard EBUS characteristics were made between benign and malignant lymph nodes. Results： Elastography grading scores and strain ratios showed significant differences between benign and malignant lymph nodes （P = 0.000）. The elastography strain ratio was more sensitive and specific for determining malignant lymph nodes than elastography grading score or standard EBUS criteria. The receiver operating characteristic curve for the elastography strain ratio showed an area under the curve of 0.933. The best cut-off point of the strain ratio for differentiating malignant from benign lymph nodes was 32.07. The elastography strain ratio had a sensitivity of 88.1%, the specificity of 80.8%, positive predictive value of 88.1%, and negative predictive value of 80.8% for distinguishing malignant from benign nodes. The overall accuracy of elastography strain ratio was 85.3%. The strain ratio of malignant and benign lymph nodes positively correlated with the elastography grading score （r = 0.561, P = 0.000）. Conclusions： EBUS elastography can be effectively used to predict mediastinal and hilar lymph node metastases in lung cancer. This noninvasive technique may thus complement standard EBUS and help guide EBUS-TBNA procedures.

Station 10 lymph node dissections in laparoscopic-assisted spleen-preserving radical gastrectomy for advanced proximal gastric cancer

D2 gastric resection has been increasingly recognized as the optimal surgical treatment for advanced gastric cancer. Dissection of the station 10 splenic lymph nodes is required in the treatment of advanced proximal gastric cancer. Based on vascular anatomy and anatomical plane of fascial space, integrated with our experience in station 10 splenic lymph node dissection in open surgery and proven skills of laparoscopic operation, we have successfully mastered the surgical essentials and technical keypoints in laparoscopic-assisted station 10 lymph node dissection.

Short-term efficacy of robotic and laparoscopic spleen-preserving splenic hilar lymphadenectomy via Huang’s three-step maneuver for advanced upper gastric cancer: Results from a propensity scorematched study

BACKGROUND Robotic surgery has been considered to be significantly better than laparoscopic surgery for complicated procedures.AIM To explore the short-term effect of robotic and laparoscopic spleen-preserving splenic hilar lymphadenectomy(SPSHL)for advanced gastric cancer(GC)by Huang’s three-step maneuver.METHODS A total of 643 patients who underwent SPSHL were recruited from April 2012 to July 2017,including 35 patients who underwent robotic SPSHL(RSPSHL)and 608 who underwent laparoscopic SPSHL(LSPSHL).One-to-four propensity score matching was used to analyze the differences in clinical data between patients who underwent robotic SPSHL and those who underwent laparoscopic SPSHL.RESULTS In all,175 patients were matched,including 35 patients who underwent RSPSHL and 140 who underwent LSPSHL.After matching,there were no significant differences detected in the baseline characteristics between the two groups.Significant differences in total operative time,estimated blood loss(EBL),splenic hilar blood loss(SHBL),splenic hilar dissection time(SHDT),and splenic trunk dissection time were evident between these groups(P<0.05).Furthermore,no significant differences were observed between the two groups in the overall noncompliance rate of lymph node(LN)dissection(62.9%vs 60%,P=0.757),number of retrieved No.10 LNs(3.1±1.4 vs 3.3±2.5,P=0.650),total number of examined LNs(37.8±13.1 vs 40.6±13.6,P=0.274),and postoperative complications(14.3%vs 17.9%,P=0.616).A stratified analysis that divided the patients receiving RSPSHL into an early group(EG)and a late group(LG)revealed that the LG experienced obvious improvements in SHDT and length of stay compared with the EG(P<0.05).Logistic regression showed that robotic surgery was a significantly protective factor against both SHBL and SHDT(P<0.05).CONCLUSION RSPSHL is safe and feasible,especially after overcoming the early learning curve,as this procedure results in a radical curative effect equivalent to that of LSPSHL.

转移灶降钙素分泌指数与甲状腺髓样癌上纵隔淋巴结转移相关研究

目的探讨转移灶降钙素分泌指数(CIM)与甲状腺髓样癌(MTC)患者颈部淋巴结转移,特别是上纵隔淋巴结转移的潜在联系。方法回顾性分析了2010年1月1日至2023年12月31日江苏省肿瘤医院61例MTC患者的CIM值与颈部淋巴结特别是上纵隔淋巴结的转移情况。运用统计学方法分析CIM值与患者年龄、性别、同侧、对侧、上纵隔淋巴结转移、TNM分期、复发率之间的关系。结果CIM值与侧颈淋巴结转移及上纵隔淋巴结转移均存在相关性(P<0.05)。进一步分析确定了CIM值的最佳临界值分别为71.2 ng/(L·mm^(3))、145.4 ng/(L·mm^(3))。结论CIM值预测MTC患者颈部及上纵隔淋巴结转移具有一定的参考价值。

术前多排螺旋CT三期增强扫描对非小细胞肺癌纵隔淋巴结转移的诊断价值

目的探讨多排螺旋CT(MSCT)三期增强扫描对非小细胞肺癌(NSCLC)纵隔淋巴结转移(MLNM)中的术前诊断价值。方法回顾性分析80例NSCLC患者的临床资料,术前均行MSCT三期增强扫描,以术后病理结果为金标准,使用Kappa一致性检验评价MSCT三期增强扫描在术前诊断MLNM的诊断效能。结果术后病理检查证实80例NSCLC患者中,N0期31例,N1期24例,N2期25例,其中MLNM 25例(31.25%);术前MSCT诊断N0期34例,N1期24例,N2期22例,术前MSCT对NSCLC患者N分期诊断与术后病理一致性一般(Kappa=0.735);25例合并MLNM患者中,术前MSCT确诊19例,其对NSCLC患者MLNM的诊断与病理结果一致性一般(Kappa=0.531),其诊断的灵敏度、特异度、准确度、阳性预测值和阴性预测值分别为76.00%、80.00%、78.75%、63.33%和88.00%;纵隔淋巴结转移率在不同肿瘤直径、胸膜凹陷与否、不同肿大淋巴结位置、累及粗大肺静脉与否以及不同淋巴结短径的NSCLC患者间比较均有统计学意义(P<0.05)。结论术前MSCT三期增强扫描诊断NSCLC患者MLNM具有一定的准确性,结合原发病灶大小、胸膜凹陷、肿大淋巴结位置、累及粗大肺静脉等多方面信息可为淋巴结清扫提供重要参考。

宽体能谱CT参数在鉴别诊断肺癌纵隔转移、非转移淋巴结与反应性增生淋巴结中的价值

目的探讨宽体能谱CT在肺癌纵隔转移淋巴结、非转移淋巴结与反应性增生淋巴结的鉴别诊断价值。方法回顾性分析64例肺癌患者和28例肺部炎性病变患者临床及影像资料,所有患者均行平扫、增强双期能谱CT扫描,分别在70 keV单能量图像及碘基图像上测量转移、非转移、炎性反应性增生三组淋巴结大小、密度、三期IC、NIC、λHU,并用单因素方差、Kruskal-Wallis H秩和检验方法分析比较其差异。结果转移淋巴结短径比非转移淋巴结及反应性增生淋巴结大(P<0.001)。反应性增生淋巴结平扫密度比转移淋巴结高(P<0.001),而与非转移淋巴结差异无统计学意义(P=0.325);增强扫描反应性增生淋巴结动脉期、静脉期CT值均比转移、非转移淋巴结高(P<0.05)。除了动脉期NIC,反应性增生淋巴结与转移淋巴结在平扫IC、NIC、λHU,动脉期IC、λHU,静脉期IC、NIC、λHU均有统计学意义(P<0.05),而反应性增生淋巴结与非转移淋巴结在平扫、动脉期及静脉期的IC、NIC、λHU差异均无统计学意义(P>0.05)。结论肺癌纵隔转移淋巴结碘的定量及能谱曲线斜率基本低于反应性增生淋巴结,能谱CT定量参数鉴别两者有一定诊断效能,而非转移淋巴结与反应性增生淋巴结能谱参数无差异。

256层CT灌注成像联合半乳糖凝集素-3在术前肺癌纵隔淋巴结转移诊断中的应用

目的:分析256层CT灌注成像参数(CTPI)联合半乳糖凝集素-3(Gal-3)在术前肺癌纵隔淋巴结转移诊断中的应用价值。方法:回顾性分析2022年4月-2023年4月收治的87例肺癌患者的临床资料,根据纵隔淋巴结转移情况分为转移组(n=45)和未转移组(n=42)。另选取2022年4月-2023年4月进行体检的健康人群作为对照组(n=40)。对所有受试者进行血清Gal-3水平检测,并采用Brilliance iCT扫描仪进行CT灌注扫描。比较三组CTPI[表面通透性(PS)、灌注值(PV)、肺动脉血流量(PAF)、血容量(BV)、平均通过时间(MTT)、强化峰值(PEI)、支气管动脉血流量(BAF)]和血清Gal-3水平,并采用受试者工作特征(ROC)曲线评估CTPI、血清Gal-3水平及联合检测在术前肺癌纵隔淋巴结转移中的诊断效能。结果:转移组PS,PV和Gal-3均高于未转移组和对照组,未转移组PS,PV和Gal-3均高于对照组,差异有统计学意义(P<0.05)。ROC曲线分析显示,PS值、PV及Gal-3水平联合检测肺癌纵隔淋巴结转移的线下面积高于各项单独检测,差异有统计学意义(P<0.05)。结论:256层CTPI联合血清Gal-3检测对术前肺癌纵隔淋巴结转移具有较高的诊断价值,可为肺癌患者术前评估提供重要依据。

DCE-MRI定量参数联合血清CEA、Cyfra21-1诊断非小细胞肺癌纵隔淋巴结转移的回顾性研究

目的探讨动态对比增强磁共振成像(DCEMRI)定量参数联合血清癌胚抗原(CEA)、细胞白蛋白19片段(Cyfra21-1)诊断非小细胞肺癌纵隔淋巴结转移(MLNM)的价值。方法回顾性分析2020年5月至2022年12月贵港市人民医院收治的147例非小细胞肺癌患者的临床资料,根据术后病理诊断结果分为MLNM组(44例)和非MLNM组(103例)。检测非小细胞肺癌患者术前DCE-MRI定量参数和血清CEA、Cyfra21-1水平。采用受试者工作特征(ROC)曲线分析DCE-MRI定量参数联合血清CEA、Cyfra21-1诊断非小细胞肺癌患者发生MLNM的价值。结果MLNM组Ktrans、Kep、Ve,血清CEA、Cyfra21-1水平高于非MLNM组(P<0.05)。Ktrans、Kep、Ve、CEA、Cyfra21-1诊断非小细胞肺癌发生MLNM的曲线下面积分别为0.758、0.618、0.609、0.643、0.730,联合Ktrans、Kep、Ve、CEA、Cyfra21-1诊断非小细胞肺癌发生MLNM的曲线下面积为0.872,高于单独诊断。结论非小细胞肺癌MLNM患者的DCE-MRI参数Ktrans、Kep、Ve增加,血清CEA、Cyfra21-1水平升高,联合DCE-MRI参数和血清CEA、Cyfra21-1检测可提高对MLNM的诊断效能。