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1、1,纵隔淋巴结,2,纵隔淋巴结解剖,特点 ： 纵隔淋巴结平均数目为64个，大多数位于气管， 支气管附近和大血管及食道周围 主要是位于气管旁的淋巴结 A 主要是位于大血管旁的淋巴结 主要是位于支气管旁的淋巴结 P 主要是位于食管周围淋巴结,3,Classification of Regional Lymph Nodes in Japan,Japan Society of Clinical Oncology(ed), Kanehara, Tokyo, 2002.,4,Classification of Regional Lymph Nodes in Japan,Japan Society of C
2、linical Oncology(ed), Kanehara, Tokyo, 2002.,5,Classification of Regional Lymph Nodes in Japan,Japan Society of Clinical Oncology(ed), Kanehara, Tokyo, 2002.,6,7,8,Mountain and Dresler classification system,Schema of Mountain and Dresler classification system,1997年,Mountain 修订了肺癌胸内淋巴分区 系统被美国癌症联合会( t
3、he American Joint Committee on Cancer, AJCC)和国际抗癌联盟 ( the Union International Contrele Cancer, U ICC) 广泛采纳,但其只是根据外科解剖情况定义 各组淋巴结界线,并未在横断面上详细描述 各组淋巴结的边界。,Chest 1997;111;1718-1723,9,Mountain and Dresler classification system,l区最高位纵隔气管前淋巴结 2区气管旁淋巴结 3区气管前、后或后纵隔（3P） 前纵隔（3a）淋巴结 4区气管与支气管交界处淋巴结 5区主动脉或Botallo
4、淋巴结 6区主动脉（升主动脉）旁淋巴结 7区隆突下淋巴结,8区隆突下食管旁淋巴结 9区下肺韧带淋巴结 10区肺门（主支气管）淋巴结 11区肺叶间淋巴结 12区叶（上、中、下叶）支气管淋巴结 13区段支气管淋巴结 14区段以下远支气管淋巴结,10,CT-based Definition of Thoracic Lymph Node Stations: an atlas from the university of Michigan,Olvier Chapet et al. Int. J. Radiation Oncology Biol. Phys., Vol. 63, No. 1, pp. 17
5、0178, 2005,11, 下界 :到隆突下约3 cm。 前界:到左右主支气管前壁水平线 或右肺动脉后缘; 后界:椎体前缘 左外界:在奇静脉外缘; 右外界:在右主支气管和右中间段支气 管内侧,26,27,区 （paraeosphageal nodes ）,区食管旁淋巴结 上界:同7区,是3P向下的延续; 下界:沿食管至膈肌食管裂孔,28,29,区（Pulmonary ligament nodes）,区 下肺韧带淋巴结 未提,30,区（hilar nodes ） 区（ interlobar nodes ）,统称肺门淋巴结。 上界为上叶支气管开口层面; 下界为下叶段支气管开口以上。,31,头臂静
6、脉弓水平,头臂静脉弓水平,主动脉弓水平,奇静脉弓水平,隆突水平,上叶支气管开口水平,下叶支气管开口水平 OR 隆突下cm,R,R,R,R,L,L,L,-,左上叶支气管开口水平,32,33,各区肿大淋巴结,34,左上腔静脉,35,主动脉瘤,36,Prospective evaluation of computed tomography andmediastinoscopy in mediastinal lymph node staging,Eur Respir J 1997; 10: 15471551,n=100 LNs larger than 1 cm were considered CT p
7、ositive.,37,Mediastinal Lymph Node Staging With FDG-PET Scan in Patients With Potentially Operable Non-smallCellLungCancer,N=50 LNs larger than 1.5 cm were considered CT positive,Chest 1997;112;1480-1486,PET blinded to CT were significantly better (p=0.004):,38,Meta-Analysis of Positron Emission Tom
8、ographic and Computed Tomographic Imaging in Detecting Mediastinal Lymph Node Metastases in Non-small Cell Lung Cancer,Ann Thorac Surg 2005;79:375 81,39,Meta-Analysis of Positron Emission Tomographic and Computed Tomographic Imaging in Detecting Mediastinal Lymph Node Metastases in Non-small Cell Lu
9、ng Cancer,Ann Thorac Surg 2005;79:375 81,FDG PET,CT,Sensitivity range,66% 100%,overall sensitivity,83%,Specificity range,81% 100%,Overall specificity,92%,20% 81%,44% 100%,59%,78%,40,Lymph Node Size and Metastatic Infiltration in Non-small Cell Lung Cancer,Chest 2003;123;463-467,Nonmetastatic lymph n
10、odes,Metastatic lymph nodes,n,2486 (86%),405 (14%),size,7.05 3.75 mm,10.7 4.7 mm (p 0.005).,size 10 mm,1953 (79%),170 (44%),size 10-14 mm,404 (16%),137( 34%),size 15 mm,130 (5%),87( 22%),256 patients 2,891 lymph nodes,Conclusion: Lymph node size is not a reliable parameter for the evaluation of meta
11、static involvement in patients with NSCLC.,41,Real-time endobronchial ultrasound guided transbronchial needle aspiration for sampling mediastinal lymph nodes,Thorax 2006;61;795-798;,Sensitivity was 94%, specificity 100%, and the positive predictive value was 100% No complications occurred.,42,THANK YOU,
