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背景与目的正电子发射断层成像检查(positron emission tomography,PET)作为非小细胞肺癌无创分期的手段有逐年增加的趋势,但是它在纵隔淋巴结分期中的作用尚不明了。本文探讨了电视纵隔镜检查术在PET肺癌纵隔淋巴结显像阳性病例中的临床价值。方法2003年11月-2008年11月,对宣武医院收治的术前PET检查提示纵隔淋巴结转移的肺癌患者行电视纵隔镜检查术。对纵隔淋巴结进行病理学检查,病理来自纵隔镜或开胸清扫的纵隔淋巴结,分析纵隔镜诊断纵隔淋巴结转移的敏感性、特异性等。结果本组61例肺癌患者中,男38例,女23例,平均年龄60岁(年龄41岁-81岁)。其中右肺癌41例,左肺癌20例。45例肺癌患者手术病理证实有纵隔淋巴结转移,其中10例N3的患者接受化疗,38例N2的患者给予2个周期的新辅助化疗,并根据检查结果确定是否接受开胸手术。16例无纵隔淋巴结转移的患者翻身行开胸探查、肺癌切除、纵隔淋巴结清扫术。PET的阳性预测值为73.8%(45/61)。电视纵隔镜在肺癌纵隔淋巴结分期中的敏感性、特异性、准确性、阳性预测值和阴性预测值分别为93.8%(45/48)、100%(13/13)、95.1%(58/61)、100%(45/45)、81.3%(13/16)。结论PET在肺癌纵隔淋巴结分期中的阳性预测值较低,电视纵隔镜仍然是肺癌纵隔淋巴结分期的金标准。
BACKGROUND & OBJECTIVE: Positron emission tomography (PET) has been increasing year by year as a non-invasive staging method for non-small cell lung cancer. However, its role in the stage of mediastinal lymph node staging is still unclear. This article discusses the clinical value of mediastinoscopy in PET-positive cases of mediastinal lymph node imaging of lung cancer. Methods From November 2003 to November 2008, video-assisted mediastinoscopy was performed on patients with lung cancer who underwent preoperative PET examinations in Xuanwu Hospital and who had mediastinal lymph node metastases. Pathological examination of mediastinal lymph nodes, pathology from mediastinoscopy or thoracotomy mediastinal lymph nodes, mediastinal mirror diagnosis of mediastinal lymph node metastasis sensitivity, specificity and so on. Results 61 patients with lung cancer in this group, 38 males and 23 females, mean age 60 years (aged 41 years -81 years old). There were 41 cases of right lung cancer and 20 cases of left lung cancer. Forty-five patients with lung cancer underwent surgical pathology confirmed with mediastinal lymph node metastases. Ten patients with N3 were treated with chemotherapy, and 38 patients with N2 were given two cycles of neoadjuvant chemotherapy. According to the test results, they were given thoracotomy. Sixteen patients without mediastinal lymph node metastases underwent thoracotomy, lung resection and mediastinal lymph node dissection. The positive predictive value of PET was 73.8% (45/61). The sensitivity, specificity, accuracy, positive predictive value and negative predictive value of the mediastinoscopy in mediastinal lymph node staging of lung cancer were 93.8% (45/48), 100% (13/13), 95.1% (58/61 ), 100% (45/45), 81.3% (13/16). Conclusions The positive predictive value of PET in mediastinal lymph node staging of lung cancer is low, and mediastinoscopy is still the gold standard for mediastinal lymph node staging of lung cancer.