Evaluation of Mediastinal Lymph Node Metastasis in Lung Cancer: Factors influencing the Diagnostic Accuracy ofCT.
10.3348/jkrs.1998.38.3.445
- Author:
Du Hwan CHOE
1
;
Tae Hyun LEE
;
Kie Hwan KIM
;
Soo Yil CHIN
;
Jae Ill ZO
;
Kyung Ja CHO
Author Information
1. Department of Diagnostic Radiology, Korea Cancer Center Hospital.
- Publication Type:Original Article
- Keywords:
Lung neoplasms, CT;
Lung neoplasms, staging;
Mediastinum, neoplasms
- MeSH:
Adenocarcinoma;
Axis, Cervical Vertebra;
Carcinoma, Non-Small-Cell Lung;
Carcinoma, Squamous Cell;
Humans;
Lung Neoplasms*;
Lung*;
Lymph Node Excision;
Lymph Nodes*;
Neoplasm Metastasis*;
Pneumonia;
Retrospective Studies;
Sensitivity and Specificity;
Tomography, X-Ray Computed
- From:Journal of the Korean Radiological Society
1998;38(3):445-451
- CountryRepublic of Korea
- Language:Korean
-
Abstract:
PURPOSE: To evaluate factors influencing the CT assessment of mediastinal lymph node metastasis in patientswith non-small cell lung cancer. MATERIALS AND METHODS: CT scans of 198 patients who had undergone thoracotomyand mediastinal lymph node dissection for non-small cell lung cancer were retrospectively evaluated using a sizecriterion of > or = 10mm in the short axis. To evaluate the accuracy of CT in diagnosing lymph node metastasis on anodal station-by-station basis, CT and pathological results were correlated. Analysis included a comparison of thesensitivity and specificity of CT according to 1) cell type of tumor, squamous cell carcinoma versusadenocarcinoma (excluding bronchioloalveolar cell carcinoma) ; 2) histologic differentiation;3) tumor size;4)central and peripheral of the tumor;5) the presence or absence of obstructive pneumonitis and/or atelectasis;6)the presence or absence of prior granulomatous disease. RESULTS: The overall sensitivity, Specificity, positive predictive value, and negative predictive value of CT in diagnosing mediastinal lymph node metastasis were 65%,84%, 43%, and 93%, respectively. Sensitivity for squamous cell carcinoma (72%) was significantly higher than thatfor adenocarcinoma(44%)(p<0.01). Higher specificities were noted in patients without obstructive pneumonitisand/or atelectasis(91% versus 75%)(P<0.01), and with a peripherally located tumor (90% versus 82%)(P<0.01).sensitivity and specificity were not appreciably altered by other variables. CONCLUSION: In the CT assessment ofmediastinal lymph node metastasis the cell type of adenocarcinoma adversely affected sensitivity, with a highfrequency of normal-sized metastatic nodes. Obstructive pneumonitis caused by central tumor adversely affectedspecificity with the frequent occurrence of hyperplastc nodes.
