肺癌病期決定における頸部超音波診断の意義斜角筋前リンパ節生検による組織診断との対比

摘要

目的．今回頚部超音波検査の肺癌病期診断における意義を組織診断との対比により検討した．対象と方法．当科において1995年7月から2001年10月までに斜角筋前リンパ節生検と頚部超音波検査を施行した68例（136領域）を対象とした．病理学的に転移陽性の28領域と陰性108領域の超音波検査所見を比較検討した．陽性例における組織型の内訳は腺病16例，扁平上皮癌3例，大細胞癌3例であった．統討学的検定はt検定，カテゴリーデータの比較はFisher's testを用いた．結果．超音波でリンパ節径が測定できた52領域のうち転移陽性16領域と陰性36領域の最大径はそれぞれ13±6mm，12±4mmで有意な差を認めなかった．最小径/最大径比は陽性群0.68±0.17，陰性群0.42±0.21で有意差を認めた．リンパ節個数は陽性28領域中11領域（39.3％）が描出されず，10領域（35.7％）が1から3個であった．陰性108領域中71領域（65.7％）は描出されなかった．結論．転移陽性例は最小径/最大径比が比較的高く円形に近いことが推測された．今後，頚部超音波検査を用いた肺癌リンパ節転移診断において最小径/最大径比は補助的診断項目になりうると考えた．Objective. To examine the value of cervical ultrasonography for staging of lung cancer, we analyzedthe relationship between ultrasonography findings and pathological diagnosis. Material and Methods. Findings in 68 patients (136 stations) who underwent cervical ultrasonography and scalene node biopsy for staging of lung cancer from July 1995 to October 2001 were analyzed. We analyzed the difference in ultrasonographic findings between 28 stations with metastasis and 108 stations without metastasis. In the group with scalene nodes positive for metastasis, the his-tologic type of the tumor was adenocarcinoma in 16 cases, squamous cell carcinoma in three cases, and large cell carcinoma in three cases. Statistical analysis was performed using Student's t test and using Fisher's test for the nominal variable. Results. Of the 52 stations in which it was possible to make measurements of the lymph node diameter by ultrasonography, the maximum mean size of 16 positive stations was 13±6mm; and in 36 negative stations, it was 12±4mm. However, a significant difference was not recognized. Between scalene-positive nodes (mean 0.68±0.17mm) and scalene-negative nodes (mean 0.42±0.21mm), statistically significant differences in minimum/maximum ratio were seen. In the scalene positive group, it was not possible to detect lymph nodes by ultrasonography in 11 out of 28 stations (39.3%), and in 10 stations (35.7%) one to three lymph nodes were detected.