非小细胞肺癌纵隔淋巴结转移 CT 与病理的一致性研究

摘要

To explore the consistency of CT and pathology in non - small cell lung cancer(NSCLC) mediastinal lymph node metastasis. Methods:Selected 178 NSCLC patients who received the surgical operation and CT scan before operation in thoracic surgeon department of the Second Affiliated Hospital of Dalian Medical University from 2009 to 2011. 107 of them showed the abnormal mediastinal lymph node. 75 males and 32 females. Age:42 - 80 years old,the median age 62 years old. Recorded the number of lymph node on CT and pathological positive number, then calculated the metastasis rate,and observed the true positive,true negative,false positive,false negative,sensitivi-ty,specificity,positive predictive value,negative predictive value,accuracy. Results:The relationship between lymph node size and metastasis rate:The metastasis rate was 17. 6% when length ﹤ 10mm,the metastasis rate was 31. 7%when length 10 - 14mm,the metastasis rate 58. 8% when length 15 - 19mm,the metastasis rate 93. 9% when length≥20 mm. Length≥15 mm was lymph node metastasis:false positive 21 cases,false negative 24 cases. Sensitiity was 57. 9% ,specificity 82. 6% ,positive predictive value 61. 1% ,negative predictive value 80. 6% ,accuracy 74. 7% . Ac-cording to the divided standard:False positive 15 cases,false negative 23 cases. Sensitivity 59. 6% ,specificity 87. 6% ,positive predictive value 69. 4% ,negative predictive value 82. 2% ,accuracy 78. 7% . Conclusion:Along with the increase of lymph node length,the metastasis rate is increasing gradually. The lymph node metastasis rate of adenocarcinoma is higher than squamous carcinoma,even when the lymph node length is small. The lymph node me-tastasis rate when CT ﹥ 2 abnormal lymph node is higher than ≤2 abnormal lymph node,even when the lymph node length is small.%目的：探讨非小细胞肺癌（NSCLC）纵隔淋巴结转移 CT 与病理的一致性，为靶区勾画提供依据。方法：选择2009年1月-2011年11月在大连医科大学附属第二医院胸外科住院并于我院行胸部 CT 检查的178例 NSCLC 病例，其中107例存在纵隔淋巴结异常。男性75例，女性32例。年龄42-80岁，中位年龄62岁。将 CT 显示的纵隔淋巴结按分区及大小记录，CT 显示异常淋巴结个数与病理阳性个数，计算淋巴结转移率，并观察真阳性、真阴性、假阳性、假阴性、敏感性、特异性、阳性预测值、阴性预测值及准确率。结果：全部病例淋巴结大小与转移的关系：长径﹤10mm 转移率17.6%，10-14mm 转移率31.7%，15-19mm 转移率58.8%，≥20mm 转移率93.9%。长径≥15mm 为阳性标准：假阳性21例，假阴性24例，CT 对纵隔淋巴结转移的敏感性57.9%，特异性58.0%，阳性预测值61.1%，阴性预测值54.7%，准确率57.9%。按分组标准判断：假阳性15例，假阴性23例，CT 对纵隔淋巴结转移的敏感性59.6%，特异性70.0%，阳性预测值69.4%，阴性预测值60.3%，准确率64.5%。结论：随着淋巴结长径的增大，淋巴结转移率逐渐升高。腺癌较鳞癌的淋巴结转移率高，且长径较小时转移率就较高。CT 异常淋巴结﹥2个较≤2个淋巴结转移率高，且长径较小时转移率就较高。