Evaluation of lymph node metastasis in lung cancer: who is the chief justice?
Evaluation of lymph node metastasis in lung cancer: who is the chief justice?
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DOI：
10.3978/j.issn.2072-1439.2015.11.63
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发表时间：
2015-07
影响因子：
2.5
通讯作者：
Yang Xia;Bin Zhang;H. Zhang;Wen Li;Ko-pen Wang;Huahao Shen
中科院分区：
文献类型：
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作者：
Yang Xia;Bin Zhang;H. Zhang;Wen Li;Ko-pen Wang;Huahao Shen
准确确定肺癌的诊断和分期对于确保为患者提供最佳治疗至关重要。然而，这个过程通常是复杂的。早期的研究认为，CT上大于1.0 cm的淋巴结（LN）被认为是转移性淋巴结，但这一标准的敏感性并不令人满意。随后，正电子发射断层扫描-计算机断层扫描（PET-CT）被证明是上级CT单独评估淋巴结的参与，并被广泛用于评估是否适合切除与治愈的意图，但可靠性也仍然存在争议。此外，经支气管针吸活检（TBNA）联合或不联合支气管内超声（EBUS）作为LN活检的公认微创方法，已被证明是评价CT和PET-CT阴性LN的有效工具。此外，影像学特征，包括磨玻璃/实性结节的比例，指的是影像学生物标志物，表明与转移。因此，我们强调了纵隔和肺门淋巴结的综合评估的重要性，我们建议仅通过放射学工具判断淋巴结可能不可靠，在某些情况下TBNA是必不可少的。
Accurate determination of the diagnosis and the stage of lung cancer play a critical role to ensure that patients are provided the optimal treatment. However, the process is usually beyond complex. Early studies have suggested lymph nodes (LNs) >1.0 cm in size on computed tomography (CT) are considered as metastatic nodes, while the sensitivity of this criterion is not satisfied. Subsequently, positron emission tomography-computed tomography (PET-CT) was shown to be superior to CT alone on assessment of nodal involvement and was widely used to estimate suitability for resection with curative intent, but the dependability also remains controversial. Furthermore, transbronchial needle aspiration (TBNA) with and without endobronchial ultrasound (EBUS), as a well-accepted minimally invasive approach for LN biopsy, has been documented as an efficient tool in evaluation of CT and PET-CT negative LNs. Additionally, radiographic features including ground-glass/solid nodules ratio, referring as imaging biomarker, were indicated to be correlated with metastasis. Hence, we highlight the importance of comprehensive estimation of mediastinal and hilar LNs, and we suggested the judgment of LNs by radiographic tools alone might not be reliable and TBNA is indispensable in certain circumstances.