The Clinical Study Of VM And CT In The Diagnosis Of Mediastinal Disease And N Staging Of Preoperative Lung Cancer

Objective: To explore the value of VM and CT in the diagnosis of mediastinal disease and N staging of preoperative lung cancer, and discuss the difference between the 2 methods.Method: From May 2003 to December 2007, 68 cases VM were used on the patients diagnosed of mediastinal disease or lung cancer by CT or PET-CT. 61 patients were examined by CVM, and 7 patients were examined by PM. To the mediastinal disease patients, we compare the diagnosis from VM with which from CT or PET-CT to speculate the diagnose accordance rate and misdiagnosis rate of CT. To the lung cancer patients , direct operation was performed on the negative ones; patients with N2 received 2 courses of neoadjuvant chemotherapy before operation; patients with N3 received radiotherapy or chemotherapy. The sensitivity, specificity, validity, positive predictive value and negative predictive value of VM and CT were speculated according to the postoperative pathological reports, and the difference between VM and CT in the diagnosis of lung cancer with mediastinal lymphnodes metastasis was discussed.Result:(1)Under the examination of VM on the 48 patients with lung cancer, 31 patients with the negative outcome received the direct operation , 14 patients with N2 received 2 courses of neoadjuvant chemotherapy before operation,3 patients with N3 received chemotherapy and/or radiotherapy. The postoperative pathological reports showed 2 cases of tuberculoma, 1 case of inflammatory pseudotumor, 1 case of sclerosing hemangioma, 41 cases of lung cancer. The 20 patients with mediastinal diseases were clarified diagnosed under VM, including 1 case of big cell cancer, 1 case of spermatogenous cell carcinoma, 1 case of signet-ring cell carcinoma, 1 case of neuroendocrine carcinoma, 1 case of extraintestinal type intestinal malignant interstitialoma, 4 cases of thymoma, 3 cases of mediastinal lymphnode tuberculosis, 4 cases of mediastinal lymphnoditis, 4 cases of nodule disease.(2)In the mediastinal disease group, the diagnose accordance rate of CT after the examination of VM is 55%(11/20), and the misdiagnosis rate of CT is 45%(9/20). In the preoperative diagnosis of lung cancer group, 41 cases with final diagnosis of lung cancer were used as samples to speculate the sensitivity, specificity, validity, positive predictive value and negative predictive value of VM. They were 93.3%, 100%, 97.6%, 100%, 96.3%, which of CT were 66.7%, 53.8%, 58.5%, 45.5%, 73.7%. P﹤0.05(XC2=4.083), the difference between VM and CT was statistically significant. (3)In this group, the complications of VM incidence rate is 2.94%(2/68), including 1 case of pneumothorax, which was cured after thoracic close drainage, 1 case of recurrent laryngeal nerve paralysis, which relieved after 2 months without any treatment.Conclusion :VM is superior to CT in the diagnosis of mediastinal disease and N staging of preoperative lung cancer, it is safe and effective, and there will be a wide perspective for VM in thoracic surgery.