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The Journal of Cardiovascular Surgery 2001 February;42(1):119-24

language: English

Mediastinal lymph node evaluation by computed tomographic scan in lung cancer

Kamiyoshihara M., Kawashima O., Ishikawa S. *, Morishita Y. *

From the Depart­ment of Sur­gery, ­National San­a­torium ­Nishi-­Gunma Hos­pital, Shib­u­kawa, ­Gunma, ­Japan
*­Second Depart­ment of Sur­gery, ­Gunma Uni­ver­sity ­School of Med­i­cine, Mae­bashi, ­Gunma, ­Japan


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Back­ground. Com­puted tomog­raphy (CT) has ­been ­widely ­used for pre­op­er­a­tive med­i­as­tinal ­lymph ­node eval­u­a­tion in ­lung ­cancer. But its accu­racy has ­remained con­tro­ver­sial. We ­studied the pre­dict­ability of N-­staging by CT ­scan.
­Methods. ­From 1981 to 1996, 546 ­patients had pre­op­er­a­tive CT ­scan and under­went a sur­gical resec­tion ­with med­i­as­tinal ­lymph ­node dis­sec­tion for pri­mary pul­mo­nary aden­o­car­cinoma and squa­mous ­cell car­ci­noma. ­Nodes ­larger ­than 1.0 cm at ­short ­axis ­were con­sid­ered ­abnormal. The dis­crep­ancy ­between clin­ical and path­o­logic find­ings in N ­factor was ana­lyzed.
­Results. Sen­si­tivity (ST), spec­i­ficity (SP) and accu­racy (AC) ­were 33.0%, 90.4% and 78.9%, respec­tively. No sta­tis­ti­cally sig­nif­i­cant dif­fer­ence in the ­results is ­detected for indi­vidual ­years or ­types of scan­ning ­device. ­There ­were sta­tis­ti­cally sig­nif­i­cant dif­fer­ences as fol­lows: ST and SP by his­to­logic ­type, SP by ­gender, SP and AC by ­tumor ­size, SP by ­Brinkman ­index, ST by ­tumor loca­tion, and AC by ­serum CEA ­value.
Con­clu­sions. We ­should pay atten­tion to ­false pos­i­tive ­nodes in ­heavy ­smokers (or ­males), and pos­i­tive ­nodes in aden­o­car­cinoma, ­tumor ­larger ­than 3 cm or ­rising of ­serum CEA ­value, regard­less of neg­a­tive ­lymph ­node on CT ­scan.

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