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相關文獻
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題名 | Preoperative Computed Tomography for staging of Non-Small cell LungCancer=電腦斷層用於肺癌手術前分期之評估 |
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作者 | 謝聖怡; |
期刊 | 中華民國外科醫學會雜誌 |
出版日期 | 19930300、19930400 |
卷期 | 26:2 民82.03-04 |
頁次 | 頁1676-1682 |
分類號 | 416.224 |
語文 | eng |
關鍵詞 | 肺癌手術; 電腦斷層; CT scan; Lung cancer; |
中文摘要 | 目前電腦斷層已常規使用在術前分期非小細胞肺癌,但電腦斷層對於預測非小細胞性肺癌合併肺門或縱隔腔淋巴腺轉移之能力仍是爭論很多。過去十年來,有關之79種文章報告顯示其準確性變異從百分之三十五至百分之九十五不等。為了評估胸部電腦斷層預測肺癌的準確性,我們從1980一月至1990年七月回溯性研究總數897個組織學上證明是肺癌接受開胸手術的病人。其中只有598個有足夠術前電腦斷層及術後病理對N0、N1、N2等之分期,而從此研究結果計算他們之相關性對腫瘤本身及N0、N1、N2等之分期,其中440個病人 (73.6%)正確的預估區別T1、T2、T3及T4,有27個病人(4.5%)高估,而131個病人(21.9%) 低估了。對N0敏感性:73.5%,特異性:52.8% ,準確性58.2%,對N1敏感性:42.8%,特異性:87.0%,準確性74.7%,對N2敏感性:49.3%,特異性:90.3%:準確性74.7%。68個病人(11.1%)手術中發現廣泛性胸腔內轉移,術前電斷層評估可手術病人實際上腫瘤可切除率只有82%。 總之,胸部電腦斷層無法非常精確地根據TNM系統去分期原發性肺癌,研究結果顯示術前電腦斷層分期特異性高於敏感性而對肺癌淋巴腺轉移之預測低估多於高估。所以若要得到較明顯之進步,可能要較新之電腦斷層診斷技術或較適當之定義陽性淋巴結之大小。除非定義淋巴腺大小被可偵測淋巴腺病理之指標所代替,當電腦斷層檢查顯示無縱隔腔之淋巴腺轉移時則可直接實行開胸手術而侵犯性之縱隔腔鏡可以省略。 |
英文摘要 | Computed tomography (CT) has been routinely recommended for preoperative staging of non-small-cell lung cancer, but the ability of CT to detect hilar and mediastinal lymph node metastasis is highly controversial, with reported accuracies ranging from 35% to 95% over the past 10 years, according to some relevant 79 publications. To determine the accuracy of CT of the chest for staging lung cancer, 897 patients with histologically-proved lung cancer were studied retrospectively, all had undergone thoracotomy between January 1980 and July 1990. Among these, 598 cases had sufficient evidence of preoperative CT staging and postoperative pathologic staging for tumor and lymph node status, and were the subjects of this study; their correlation results showed that in 440 patients (73.6%), T1, T2, T3 and T4 were correctly differentiated. Twenty-seven patients (4.5%) were overestimated and 131 patients (21.9%) were underestimated. Records show for No, sensitivity: 73.5%; specificity: 52.8%; accuracy: 58.2%. For Nl, sensitivity: 42.8%; specificity: 87.0%; accuracy: 74.7%. For N2, sensitivity: 49.3%; specificity: 90.3%; accuracy: 74.7%. Sixty-eight patients (11.5%) had intrathoracic carcinomatosis by operative findings. The overall resection rate of operable tumor, as determined from preoperative CT finding, was 82.0%. In conclusion, CT of the chest can not very precisely stage lymph node status of primary lung cancer according to the TNM classification. The results showed preoperative CT staging had better specificity than sensitivity, and underestimated more than overestimated prediction of lymph node metastasis of lung cancer. Significant advances must await better CT techniques and more adequate CT-determined node size. No clinical importance can be attributed until lymph node size is replaced by a fundamentally different indicator of lymph node pathology. Based on these results, when no nodal metastasis of the mediastinum is detected by CT scan, direct thoracotomy is indicated and invasive mediastinoscopy can be avoided. |
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