Abstract

OBJECTIVES

This study was conducted to verify the optimal extent of lymph node dissection or sampling during lung cancer surgery based on the sentinel node (SN) map created by computed tomography (CT) lymphography.

METHODS

From April 2010 to January 2015, patients with clinical stage I non-small-cell lung cancer, who were candidates for lobectomy or segmentectomy with standard hilar and mediastinal lymph node dissection, and in whom bronchus reached the tumour, were enrolled. An ultrathin bronchoscope was inserted to the target bronchus under the guidance of virtual bronchoscopic navigation images. CT images of the chest were obtained 30 s after 2.5 ml of iopamidol was injected. SNs were identified when the maximum CT attenuation value of the lymph nodes on postcontrast CT images increased by 30 Hounsfield units or more compared with the precontrast images. Patients underwent lobectomy with standard lymph node dissection.

RESULTS

SNs were identified in 36 (87.8%) of the 41 patients. The average number of SNs was 1.6 (range, 1–4). There was 1 false negative case; therefore, the accuracy of SN identification was 97.2% (35/36). In 5 (13.9%) of 36 patients, SNs were outside the lobe-specific lymph node station range (#11i from right S¹, #7 from right S¹, #4R from right S⁸, #12u from right S⁸, #7 and #12l from left S^1 + 2).

CONCLUSIONS

CT lymphography demonstrated the diversity of lymphatic spreading patterns and there were cases in which lymph flows are found outside the lymph node dissection range.

中文翻译：

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CT淋巴造影显示肺癌患者淋巴流动的多样性

摘要

目标

本研究旨在根据计算机断层扫描 (CT) 淋巴成像创建的前哨淋巴结 (SN) 图验证肺癌手术期间淋巴结清扫或取样的最佳范围。

方法

2010 年 4 月至 2015 年 1 月，入组临床 I 期非小细胞肺癌患者，这些患者适合肺叶切除或肺段切除，标准肺门和纵隔淋巴结清扫，支气管到达肿瘤。在虚拟支气管镜导航图像的引导下，将超薄支气管镜插入目标支气管。注射 2.5 ml 碘帕醇 30 s 后获得胸部 CT 图像。当增强后 CT 图像上淋巴结的最大 CT 衰减值与增强前图像相比增加 30 Hounsfield 单位或更多时，识别出 SN。患者接受了肺叶切除术和标准淋巴结清扫术。

结果

在 41 名患者中的 36 名（87.8%）中发现了 SN。SN 的平均数量为 1.6（范围，1-4）。有1例假阴性；因此，SN识别的准确率为97.2%（35/36）。在 36 名患者中的 5 名 (13.9%) 中，SN 位于叶特异性淋巴结站范围之外（#11i 来自右侧 S ¹，#7 来自右侧 S ¹，#4R 来自右侧 S ⁸，#12u 来自右侧 S ⁸， #7 和 #12l 从左起 S ^{1 + 2}）。

结论

CT 淋巴造影显示淋巴扩散模式的多样性，并且在淋巴结清扫范围之外发现淋巴流动的情况。