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目的探讨CT和纵隔镜在肺癌术前分期中的优势及其局限性。方法163例术前高度怀疑或已确诊为肺癌的患者,行胸CT和经颈纵隔镜检查术和/或扩大经颈纵隔镜检查术,对适合手术的108例患者行开胸手术和淋巴结清扫,然后比较CT和纵隔镜术对判断纵隔淋巴结转移的敏感度、特异度、准确率、阳性和阴性预测值;CT判断纵隔淋巴结阳性的标准为淋巴结短径≥1.0cm,长径≥1.5cm。结果CT检查对判断纵隔淋巴结转移的敏感度为74.4%,特异度为75.4%,准确率75.0%,阳性预测值63.0%,阴性预测值为83.9%。纵隔镜检查对判断纵隔淋巴结转移的敏感度为94.9%,特异度为100%,准确率96.3%,阳性预测值100%,阴性预测值97.2%。纵隔镜检查对判断纵隔淋巴结转移的敏感度、特异度、准确率、阳性预测值和阴性预测值等均明显优于CT检查(P<0.05、P<0.01)。结论纵隔镜对判断肺癌纵隔淋巴结转移明显优于CT,而且安全,具有无创性,易被患者接受,是术前的必要检查方法。
Objective To investigate the advantages and limitations of CT and mediastinoscopy in the preoperative staging of lung cancer. Methods One hundred and sixty-three patients with highly suspected or confirmed lung cancer before surgery underwent CT and transcervical mediastinoscopy and / or enlarged mediastinoscopy. Thoracotomy and lymph node dissection Then the sensitivity, specificity, accuracy, positive and negative predictive value of CT and mediastinoscopy in determining mediastinal lymph node metastasis were compared. The criteria of positive mediastinal lymph node metastasis by CT was lymph node short diameter≥1.0cm and long diameter≥1.5cm. Results The sensitivity, specificity and accuracy of CT were 74.4%, 75.4%, 75.0%, 63.0% and 83.9% respectively. Mediastinoscopy to determine the sensitivity of mediastinal lymph node metastasis was 94.9%, specificity was 100%, accuracy 96.3%, positive predictive value 100%, negative predictive value 97.2%. The sensitivity, specificity, accuracy, positive predictive value and negative predictive value of mediastinoscopy in judging mediastinal lymph node metastasis were significantly better than those of CT (P <0.05, P <0.01). Conclusion Mediastinoscopy is superior to CT in judging mediastinal lymph node metastasis of lung cancer, and is safe, noninvasive and easy to be accepted by patients. It is a necessary preoperative examination method.