CAJ | 학술논문

背景与目的原发性肺癌是常见的恶性肿瘤之一，术前准确的局部淋巴结（N）分期可避免不必要的手术创伤，N3期已非手术治疗指征。本研究旨在探讨超声在诊断原发性肺癌锁骨上淋巴结转移及确定其分期中的应用价值。方法回顾性分析2012年10月-2013年11月经病理确诊为肺癌患者131例，所有患者均在术前行锁骨上区域的超声和增强计算机断层扫描（computed tomography, CT），对检查结果为阳性的患者行超声引导下穿刺活检，将组织病理学诊断作为淋巴结转移的诊断标准，对比两种检查方法与病理结果的一致性。结果131例肺癌患者中经病理证实共有50例为锁骨上淋巴结转移，经超声检查阳性者54例，转移者50例；增强CT检查阳性者41例，其中36例为恶性。超声的灵敏度、特异度、正确指数、阳性预测值及阴性预测值（分别为100%、95.06%、95.06%、92.59%、100%）明显高于增强CT（分别为72%、93.83%、65.83%、87.80%、84.44%）。两种方法在确定肺癌TNM分期准确性的差异存在统计学意义（P<0.01）。结论与增强CT相比，超声在原发性肺癌锁骨上淋巴结转移方面具有较高的准确性、敏感性和特异性，并且能够更加准确地确定原发性肺癌的TNM分期。
배경여목적원발성폐암시상견적악성종류지일，술전준학적국부림파결（N）분기가피면불필요적수술창상，N3기이비수술치료지정。본연구지재탐토초성재진단원발성폐암쇄골상림파결전이급학정기분기중적응용개치。방법회고성분석2012년10월-2013년11월경병리학진위폐암환자131례，소유환자균재술전행쇄골상구역적초성화증강계산궤단층소묘（computed tomography, CT），대검사결과위양성적환자행초성인도하천자활검，장조직병이학진단작위림파결전이적진단표준，대비량충검사방법여병리결과적일치성。결과131례폐암환자중경병리증실공유50례위쇄골상림파결전이，경초성검사양성자54례，전이자50례；증강CT검사양성자41례，기중36례위악성。초성적령민도、특이도、정학지수、양성예측치급음성예측치（분별위100%、95.06%、95.06%、92.59%、100%）명현고우증강CT（분별위72%、93.83%、65.83%、87.80%、84.44%）。량충방법재학정폐암TNM분기준학성적차이존재통계학의의（P<0.01）。결론여증강CT상비，초성재원발성폐암쇄골상림파결전이방면구유교고적준학성、민감성화특이성，병차능구경가준학지학정원발성폐암적TNM분기。
Background and objective Primary lung cancer has been common malignant tumors. Accurate pre-operative N staging can avoid unnecessary surgical operations, and patients with N3 has non-surgical treatment of indica-tions. hTe aim of this study is to investigate the clinical value of ultrasound in the diagnosis of supraclavicular lymph node metastasis and staging of primary lung cancer. Methods We retrospectively analyzed 131 patients who were pathologically diagnosed with lung cancer from October 2012 to November 2013. All patients received ultrasound and contrast-enhanced computed tomograohy (CT) examination of the supraclavicular area, and those who were with positive results underwent ultrasound-guided biopsy. hTe accuracy of the two methods was compared according to their consistency with the patho-logical results. hTe pathological diagnosis was used as the diagnosis standard of lymph node metastasis. Results hTere were 50 cases of patients who were conifrmed supraclavicular lymph node metastasis pathologically in a total of 131 cases of patients with lung cancer. Fitfy-four cases were tested positive by ultrasound, and 50 cases were pathologically proven to be with lymph node metastasis. For comparison, the ratio was 36 out of 41 for contrast-enhanced CT. hTe sensitivity, speciifc-ity, You den's index, the positive predictive value and the negative predictive value of ultrasound (100%, 95.06%, 95.06%, 92.59%, 100%) was signiifcantly higher than that of contrast-enhanced CT (72%, 93.83%, 65.83%, 87.80%, 84.44%). hTe differences of accuracy of the two methods in TNM staging of lung cancer had statistically signiifcance (P<0.01). Conclu-sion Compared with enhanced CT, ultrasound examination has high accuracy, sensitivity and speciifcity for primary su-praclavicular lymph node metastasis in lung cancer, and at the same time can determine the TNM staging of primary lung cancer more accurately.