非小细胞肺癌纵隔淋巴结转移的影像学评估现状

纵隔淋巴结有无转移决定着非小细胞肺癌后续治疗方案的制定,无创性准确评估非小细胞肺癌纵隔淋巴结有无转移在临床治疗上至关重要.近年来,CT、MRI、PET/CT、支气管内镜超声、影像组学等影像检查方法对非小细胞肺癌纵隔淋巴结的转移评估都有了不同程度进展;本文对这些影像检查方法的进展进行综述,以便临床更好地选择非小细胞肺癌纵...     

MSCT联合肿瘤标志物检查对中央型小细胞肺癌及非小细胞肺癌的鉴别诊断价值

目的 分析中央型小细胞肺癌和非小细胞肺癌的MSCT表现,并联合肿瘤标志物,探讨二者之间的鉴别诊断价值.方法 搜集2014年2月至2015年2月间经本院病理证实72例中央型肺癌患者(其中小细胞肺癌25例、非小细胞肺癌47例)的临床资料,分析两组患者的MSCT表现及与肿瘤标志物的相关性.用SPSS 17.0统计软件行单因素x2检验、成组t检验.结果 (1)胸膜腔积液、淋巴结融合征象以及支气管截断征在两组中差异有统计学意义(P＜0.05),中央型小细胞肺癌在前二者的出现率高于非小细胞肺癌,支气管截断征的出现率低于非小细胞肺癌;心包腔积液、胸膜转移、远处转移、血管受侵、肿瘤坏死,纵隔肺门及远处淋巴结肿大在两组间差异无统计学意义(P＞0.05).(2)血清肿瘤标志物CA125、CYFRA21-1、NSE、ProGRP、SCC在小细胞肺癌与非小细胞肺癌中的阳性率,组间比较具有统计学意义(P＜0.05),其中小细胞肺癌组的NSE、ProGRP阳性表达率高于非小细胞肺癌组;非小细胞肺癌组的CA125、CYFRA21-1、SCC阳性表达率高于小细胞肺癌组.(3)中央型小细胞肺癌组中有无心包积液的CYFRA21-1的阳性表达率差异具有统计学意义(P＜0.05);有无胸膜转移、有无肿瘤坏死、有无纵隔肺门及远处淋巴结肿大的CEA的阳性表达率差异具有统计学意义(P＜0.05);有无纵隔肺门淋巴结肿大的SCC阳性表达率差异有统计学意义(P＜0.05).(4)中央型非小细胞肺癌组中有无胸膜转移的CA125的阳性表达率差异具有统计学意义(P＜0.05);有无胸腔积液的NSE的阳性表达率差异具有统计学意义(P＜0.05);有无肿瘤坏死的SCC阳性表达率差异具有统计学意义(P＜0.05).结论 中央型小细胞肺癌与非小细胞肺癌有不同的MSCT表现,结合肿瘤标志物分析,有助于二者的鉴别诊断.     

低剂量CT灌注联合影像组学评估非小细胞肺癌的纵隔淋巴转移

目的:探究基于低放射剂量CT灌注影像提取CT灌注参数以及影像组学参数联合评估非小细胞肺癌(NSCLC)纵隔淋巴转移的效能.方法:纳入2017年3月-2020年5月经病理证实为纵隔淋巴转移的NSCLC患者以及非纵隔淋巴转移的NSCLC患者,所有患者于术前行低剂量CT灌注扫描.术中系统性清扫患者N1及N2站淋巴结,并取肿瘤...     

非小细胞肺癌30例术中应用~(99m)Tc标记前哨淋巴结的临床观察

目的探讨非小细胞肺癌术中应用99mTc探测肺癌前哨淋巴结,以提高术中清除前哨淋巴结的准确性。方法 30例非小细胞肺癌患者,术中将99mTc硫胶体溶液在肺部肿瘤环周的4～6个部位分别注射,用便携式γ射线探测器探测肺门及纵隔各部位淋巴结的放射活性计数值。常规行肺癌肺叶切除、淋巴结清除术并行常规病理检查。结果 30例患者共清除淋巴结395枚,其中前哨淋巴结即阳性转移淋巴结112枚,阳性转移率为28.3%。前哨淋巴结的99mTc放射活性计数值为15321.85±5945.28,阴性淋巴结的计数值为8479.26±3201.37(P<0.01)。结论对于非小细胞肺癌患者,术中应用99mTc标记前哨淋巴结能够更准确地提示肺癌纵隔转移淋巴结,有效提高转移淋巴结的检出率。     

能谱CT对非小细胞肺癌纵隔淋巴结转移的临床价值

目的 探讨能谱CT对非小细胞肺癌(NSCLC)纵隔淋巴结转移的临床诊断价值.方法 76例NSCLC患者,均进行平扫及双期增强CT扫描,计算纵隔淋巴结的双期能谱参数[如碘基值(IC)、水基值(WC)等],鉴别转移及非转移性,与病理结果进行一一对应,并与淋巴结短轴大小进行比较.结果 纵隔淋巴结110枚,其中转移57枚,良性...     

周围型小细胞肺癌和非小细胞肺癌CT表现对比分析

目的 探讨周围型小细胞肺癌CT表现特征.方法 应用配比病例对照研究的方法 ,回顾性分析经病理证实的、原发灶≤3 cm的周围型小细胞肺癌和非小细胞肺癌各30例的临床资料和CT表现.结果 30例周围型小细胞肺癌CT表现为分叶征(23/30)、边缘光滑锐利(22/30)、毛刺或棘突征(8/30)、胸膜凹陷征(7/30)、血管连接征(2/30)等.30例周围型非小细胞肺癌CT表现为分叶征(16/30)、边缘光滑锐利(6/30)、毛刺或棘突征(24/30)、胸膜凹陷征(24/30)、血管连接征(8/30)、空泡或空洞或支气管征(13/30)等.经卡方检验发现小细胞肺癌和非小细胞肺癌中的分叶征发生频率差异无统计学意义(χ2=3.5897,P=0.0581),其它征象的差异有统计学意义.30例周围型小细胞肺癌发现肺门和纵隔淋巴结肿大22例(73.3%),30例周围型非小细胞肺癌发现肺门和纵隔淋巴结肿大5例(16.7%),经统计学分析差异有统计学意义(χ2=19.4613,P<0.001).结论 原发灶≤3 cm的周围型小细胞肺癌主要CT表现为边缘光滑锐利的密实结节.原发灶较小时即可伴有明显的肺门、纵隔淋巴结肿大(转移).     

基于脉图非小细胞肺癌疗效评价应用研究

目的 探索非小细胞肺癌发生发展和治疗过程中脉图参数的变化趋势.方法 采集自2016年10月至2017年11月于上海中医药大学附属曙光医院体检中心进行体检的250例健康志愿者(健康组)和上海中医药大学附属中西医结合岳阳医院肿瘤科门诊及住院部治疗的247例非小细胞肺癌术后患者(肺癌组)的脉图数据.分析非小细胞肺癌患者病理类...     

第二原发非小细胞肺癌病理特点与临床分析

 目的 为第二原发非小细胞肺癌的诊断及规范治疗提供参考.方法 收集我院1995-01至2010-10期间收治的44例第二原发非小细胞肺癌患者的临床资料,总结其发病及临床病理特点,分析第二原发肺癌的诊断、治疗及预后影响因素.结果 44例第二原发非小细胞肺癌患者中,男24例,女20例;第二原发肺癌的发病中位年龄为54岁;同时性癌12例,异时性癌32例,两次原发癌的中位间隔时间为28个月.肺部新发结节表现为“毛刺、分叶及纵隔淋巴结融合肿大”等影像学特征及TTF-1(+),CK7 +/CK20-等病理学特征有助于鉴别诊断.第二原发非小细胞肺癌的治疗与初诊肺癌相同,根据分期选择治疗手段,目前有19例患者仍存活,最长生存期86个月;12例患者在不同的治疗阶段接受EGFR-TKIs治疗,中位生存期达26.5个月,优于未接受EGFR-TKIs治疗的患者(中位生存期为15个月,P=0.038).结论 第二原发非小细胞肺癌的确诊依赖于病理学诊断,治疗原则及预后与原发性肺癌相同,多种治疗手段的综合应用有助于延长患者的生存期.     

透明质酸与骨形态发生蛋白在非小细胞肺癌骨转移中的应用价值观察

目的观察分析透明质酸(HA)与骨形态发生蛋白(BMP)在非小细胞肺癌骨转移中的应用价值。方法随机选取我院收治的59例非小细胞肺癌骨转移患者,同时选取60例非小细胞肺癌患者作为对照组,通过γ免疫计数器放射免疫方法检测HA和BMP通过放射免疫方法检测,骨转移的诊断及随访通过SPECT以及其他影像方法或随访获得。结果非小细胞肺癌骨转移患者血清HA>48 ng/ml(97%)明显高于对照组非小细胞肺癌未发生骨转移患者(8%),差异有统计学意义(P<0.05);非小细胞肺癌骨转移患者血清BMP2、4、5、6检测值均明显高于对照组非小细胞肺癌未发生骨转移患者BMP2、4、5、6检测值,差异有统计学意义(P<0.05)。结论HA及BMP预测非小细胞肺癌骨转移患者预后效果,方法较为简单,前期投入并不昂贵,患者检测的成本较低,适用于广大基层医院对非小细胞肺癌患者骨转移的诊治和监测的工作,具有推广和应用价值。     

培美曲塞单药化疗二线治疗老年晚期非小细胞肺癌近期疗效观察

肺癌是最常见的肺原发性恶性肿瘤,大约80%的肺癌患者属于非小细胞肺癌(non-small cell lung cancer,NSCLC)。非小细胞肺癌患者主要是外科治疗,但约有30%~40%的非小细胞肺癌患者在诊断时已是晚期,而且多数为老年患者,不适宜手术,因此化疗是其主要治疗手段之一。肺癌患者的一线化疗总缓解率不是很高,很多患者在化疗中或化疗后出现疾病进展,需要进行二线治疗。我院采     

术前CT诊断NSCIC纵膈淋巴结转移的研究

目的：探讨术前CT检查对非小细胞肺癌（non-small cell lung cancer NSCLC）患者肺门纵隔淋巴结转移的诊断价值。方法：分析我院52例行手术治疗的NSCLC患者,均有术前CT肺门纵隔淋巴结描述以及术后病理检查淋巴结转移的结果。结果：CT检查对NSCLC肺门纵隔淋巴结转移诊断的灵敏性为67.4%、特异性为84.4%和诊断符合率为80.8%。结论：CT是评价NSCLC患者肺门纵隔淋巴结转移的重要检查手段,根据淋巴结直径大小能够提供有效的纵隔淋巴结转移信息。     

Usefulness of 201Tl SPECT in the predication of mediastinal lymph nodes metastasis in patients with non small cell lung carcinoma (NSCLC)

Predictivity of mediastinal lymph nodes metastasis of 201Tl SPECT were examined before operation in 113 patients with non-small cell lung cancer (69 adenocarcinoma, 31 squamous cell carcinoma, 10 large cell carcinoma, 2 bronchiolo-alveolar carcinoma, 1 neuroendocrine cell carcinoma). Patients were classified into two groups, with or without lymph nodes metastasis according to the pathological diagnosis. We calculated parameters of 201Tl SPECT early ratio, delayed ratio, retention index (RI) and maximal diameters. In addition, we calculated optimal cut-off value of RI to estimate the mediastinal lymph nodes metastasis. Mediastinal lymph nodes metastasis was confirmed pathologically in 62 patients. ER and DR did not show any statistical significance between two groups. Maximal diameters of primary tumor were also comparable between two groups. RI was significantly higher in mediastinal lymph node metastasis positive group compared to that in mediastinal lymph node metastasis negative group. The sensitivity (Sen), specificity (Spe), positive predictive value (PPV), negative predictive value (NPV) and accuracy (Acc) of 201Tl SPECT were 82.2%, 82.3%, 85.0%, 79.2% and 82.3%. These parameters were similar of higher than 72.6%, 82.4%, 83.3%, 71.2% and 77.0% of chest CT. The RI of 201Tl SPECT was useful tool for predicting lymph nodes metastasis in non-small cell lung cancer. The optimum cut-off value of RI in the prediction of mediastinal lymph nodes metastasis was 35%. We should take into account of upstaging in cases with higher RI (>35%).     

Computed tomography for preoperative evaluations of lung cancer

Computed tomography was evaluated for its accuracy in diagnosing mediastinal node metastases, direct chest wall invasion, and direct mediastinal invasion by lung cancer among 61 patients who subsequently underwent surgery. Using 15-mm diameter or larger mediastinal lymph nodes as the criterion for metastasis, the sensitivity was 36% (8/22); the specificity was 92% (34/37). The accuracy for direct chest wall invasion was relatively high, with a sensitivity of 100% (7/7) and a specificity of 92% (22/24). Direct mediastinal invasion had a sensitivity of 67% (4/6) and a specificity of 91% (10/11). These results suggest that the ability of computed tomography to diagnose mediastinal lymph node metastasis when such nodal size is used as a criterion is limited.     

Differentiation of metastatic versus non-metastatic mediastinal lymph nodes in patients with non-small cell lung cancer using respiratory-triggered short inversion time inversion recovery (STIR) turbo spin-echo MR imaging

OBJECTIVES: To differentiate between metastatic and non-metastatic lymph nodes in patients with non-small cell lung cancer using respiratory-triggered short inversion time inversion recovery (STIR) turbo spin-echo (SE) MR imaging. METHODS AND PATIENTS: One hundred and forty mediastinal lymph nodes were detected in 25 patients with non-small cell lung cancer who underwent respiratory-triggered STIR turbo SE imaging. Ratios of signal intensity of lymph nodes to 0.9% saline phantoms (lymph node-saline ratio) were compared by Student's t-test using the pathological diagnosis as the gold standard. The threshold value of the lymph node-saline ratio was determined for a positive test, and tested for its capability to provide a differential diagnosis. RESULTS: One hundred and forty lymph nodes were diagnosed and classified into two groups: metastatic lymph node (n=21) and non-metastatic lymph node (n=119). The mean lymph node-saline ratio in the non-metastatic lymph node group (0.42+/-0.01; mean+/-standard error) was significantly lower than that of the metastatic lymph node group (0.77+/-0.02, P<0.0001). When 0.6 was adapted as the threshold for a positive test, sensitivity, specificity, and accuracy for differentiating metastatic lymph node from non-metastatic lymph node per lymph nodes were 100, 96, and 96%, and sensitivity, specificity, and accuracy for differentiating metastatic lymph node from non-metastatic lymph node per patients were 100, 75, and 88%, respectively. CONCLUSIONS: Both metastatic and non-metastatic lymph nodes in patients with non-small cell lung cancer were well differentiated using respiratory-triggered STIR turbo SE imaging.     

The usefulness of FDG positron emission tomography for the detection of mediastinal lymph node metastases in patients with non-small cell lung cancer: a comparative study with X-ray computed tomography

We evaluated the usefulness of fluorine-18-fluoro-2-deoxy-d-glucose positron emission tomography (FDG PET) in the detection of mediastinal lymph node metastases in patients with non-small cell lung cancer and then compared the findings with the results of X-ray CT by region based on the histological diagnoses. We examined 29 patients with non-small cell lung cancer. One hundred and thirty-two mediastinal lymph nodes were surgically removed and the histological diagnoses were confirmed. FDG PET images, including 146 mediastinal regions, were visually analysed and the mediastinal lymph nodes were scored as positive when the FDG uptake was higher than that in the other mediastinal structures. On the X-ray CT scans, any mediastinal lymph nodes with a diameter of 10 mm or larger were scored as positive. All three examinations were successfully performed on 71 regions. For FDG PET, we found a sensitivity of 76%, a specificity of 98% and an accuracy of 93%. On the other hand, for X-ray CT a sensitivity of 65%, a specificity of 87% and an accuracy of 82% were observed. A significant difference was observed in respect of both specificity and accuracy (P<0.05). Based on the above findings, FDG PET is suggested to be superior to X-ray CT when used for the detection of mediastinal lymph node metastases in patients with non-small cell lung cancer.     

320排CT双入口灌注参数预测肺癌纵隔淋巴结转移的应用价值

目的:探讨肺癌原发灶的双入口技术灌注成像参数与纵隔淋巴结转移的关系及其诊断效能.方法:对61例经术后病理证实的肺癌患者行320排CT灌注成像(CTPI)检查,运用双入口(dual-input,DI)模式对图像进行后处理,采用两独立样本t检验分析纵隔淋巴结转移与肺癌原发灶的DI-CTPI参数的关系,并运用ROC曲线分析DI-CTP参数对肺癌合纵隔淋巴结转移的诊断效能.结果:有淋巴结转移组(27例)支气管动脉血流量(BAF)高于无淋巴结转移组(34例),差异有统计学意义(t=4.173,P＜0.001);有淋巴结转移组的灌注指数(PI)低于无淋巴结转移组,差异有统计学意义(t=-3.378,P=0.001);两组肺动脉血流量(PAF)间的差异无统计学意义(P＞0.05).三个参数中,BAF的ROC曲线下面积(AUC)最大(0.773),以BAF＞56.42mL/(min·100mL)作为预测肺癌纵隔淋巴结转移的临界值时,敏感度为74.1％,特异度为76.5％;PI的AUC为0.739,以PI＜41.57％作为预测纵隔淋巴结转移的临界值时,敏感度为82.4％,特异度为66.7％.结论:肺癌DI-CTPI参数对术前预测肺癌是否发生纵隔淋巴结转移有重要参考价值,从而可为肺癌的术前分期及治疗方案的制定等提供参考.     

The mediastinum in non-small cell lung cancer: CT-surgical correlation

Computed tomography was used to evaluate the mediastinum preoperatively in 60 patients with non-small cell lung cancer; 49 of these patients had thorough surgical-pathologic determination of mediastinal node status. Mediastinal lymph nodes were located by CT using the node-mapping scheme suggested by the American Thoracic Society and were considered abnormal when larger than 100 mm2 in cross-sectional area. The sensitivity of CT was 95% in detecting malignant mediastinal adenopathy; however, specificity was only 64%. Receiver operating characteristic (ROC) curve analysis showed that the optimal size criterion for diagnosing malignant mediastinal adenopathy is 1.0-1.5 cm when the short axis of a node is measured. CT staging of the mediastinum in patients with non-small cell lung cancer is clinically useful; negative mediastinal CT makes mediastinoscopy unnecessary, whereas positive CT should lead to biopsy of the enlarged node.     

Mediastinal lymph node involvement in non-small cell lung cancer: evaluation with 99mTc-tetrofosmin SPECT and comparison with CT.

In patients with non-small cell lung cancer (NSCLC), surgical resection offers the best chance of cure. The preoperative assessment of mediastinal lymph node involvement is crucial to selecting those patients for whom surgery is indicated. METHODS: To evaluate the possible clinical role of (99m)Tc-tetrofosmin scintigraphy in the presurgical detection of mediastinal node metastases from NSCLC, we performed a prospective comparative study with CT on 83 patients (48 men, 35 women; age range, 38-81 y) with primary NSCLC (36 adenocarcinomas, 39 epidermoid squamous cell carcinomas, and 8 large cell anaplastic carcinomas). They underwent chest SPECT 20 min after (99m)Tc-tetrofosmin injection (740 MBq intravenously). The metastatic involvement of mediastinal nodes was assessed by histologic examination after mediastinoscopy or thoracotomy. Both chest CT and (99m)Tc-tetrofosmin scintigraphy were performed within 2 wk before the surgical staging. RESULTS: Metastatic mediastinal lymph nodes were found in 35 patients. (99m)Tc-Tetrofosmin imaging in assessing the mediastinal involvement yielded a sensitivity of 85.7%, a specificity of 89.6%, and an accuracy of 88.0%; CT results were 68.6%, 75.0%, and 72.3%, respectively. SPECT accuracy was significantly higher than CT accuracy (P < 0.05). However, precise anatomic localization of (99m)Tc-tetrofosmin uptake in the mediastinum was not always present on SPECT images. (99m)Tc-Tetrofosmin SPECT precisely detected the presence or absence of lymph node metastases in 33 of the 36 patients with positive CT findings (enlarged mediastinal nodes with a short axis > or =1 cm), with an accuracy (91.7%) significantly higher (P < 0.05) than that of CT (66.7%). CONCLUSION: (99m)Tc-Tetrofosmin SPECT is a useful presurgical noninvasive method to assess mediastinal lymph node involvement in NSCLC. In particular, it could play a clinical role in reducing the number of invasive staging surgical procedures in selected patients, especially in those with enlarged lymph nodes at CT. Fusing SPECT with CT images could further improve the interpretation of the scintigraphic data.