ABSTRACT
Surgery is the first choice for the treatment of early non-small cell lung cancer(NSCLC),and lymph node metastasis is the most important factor influencing prognosis of resectable NSCLC.A large number of studies have identified the importance of systematic mediastinal lymph node(N2) dissection,which is also an important basis for the development of NCCN guidelines.But there are few reports about the dissection of intrapulmonary lymph node(N1),especially no detailed study on the dissection of the lymph nodes around the bronchi of non-primary tumor-bearing lobes and segments in lung cancer,and the NCCN guidelines were not detailed elaborate.This article will make a summary of the research on the correlation of intrapulmonary lymph node(N1) dissection.
ABSTRACT
Circulating tumor cells(CTCs)are essential for establishing metastasis and recurrence in non-small cell lung cancer(NSCLC). With the development of detection technique,results from recent studies suggest that CTC level could be a supplement for TNM staging system and a prediction marker of prognosis and therapeutic efficacy,and even could be applied for risk assessment of early NSCLC. Furthermore,as a non-invasiveliquid biopsy,detection of CTC can reflect the molecular biology and genetics characteristics of the primary tumor,and subsequently assist in selecting an optimal individualized treatment.
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In surgical operation of the non-small cell lung cancer (NSCLC),the resection of lymph node involvement is highly correlated with the prognosis of NSCLC patients.The precise estimation of localized lymph node involved and the determination of relevant pattern of lymphadenectomy are the significant predictors for the prognosis and postoperative treatment in NSCLC patients.Therefore to identify the lymph node metastasis earlier has more important significance for tumor clinical staging and making therapeutic schedule.In recent years,the value of sentinel lymph node (SIN) has attracted more and more researchers attention in detecting the occult lymph node micrometastases and surgical staging.
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Objective To examine the feasibility of olfactory detection of lung cancer by trained sniffer dogs. Methods Three police dogs, one Labrador Retriever and two Springer Spaniels, went through the same training course on detecting odor markers of cancer and were subsequently used to differentiate 52 lung cancer patients and 30 healthy subjects. The sensitivity(true-positive rate)and specificity(true-negative rate)of the olfactory detection were calculated. The consistency of the sniffing outcomes was also compared. Results The Labrador Retriever had a sensitivity of 88. 46% and a false-positive rate of 16. 60%. The two Springer Spaniels exhibited an equal ability to detect cancer patients with a sensitivity of 86. 54% and a false-positive rate of 20%. There was no statistically significant difference between the three dogs in detecting lung cancer(P =0. 994). Conclusion Olfactory detection of lung cancer by trained sniffer dogs may be used to assist clinical diagnosis andenhance diagnostic efficacy.
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Objective To establish a optimal method and threshold of 3-deoxy-3-fluorothymidine (FLT) PET-CT in delineating the biological target length of gross tumor in esophageal carcinoma, and to compare FLT PET-CT with other imaging modalities including esophagoseopy, esophagography, CT and flu-orodeoxyglucose (FDG) PET-CT. Methods Twenty-four patients with esophageal squamous cell carcinoma treated with radical surgery were enrolled. Before surgery, all the patients underwent FLT PET-CT, esepha-goscopy and esophagography. Twenty-two patients also received FDG PET-CT scan. Gross tumor volumes (GTV) were delineated using seven different threshold of FLT PET-CT: visual interpretation, standardized uptake value (SUV) 1.3, SUV 1.4, SUV 1.5, 20% of maximum standard uptake value (SUV_(max)), 25% SUV_(max), and 30% SUV_(max). Three different thresholds of FDG PET-CT were used, including visual interpre-tation, SUV 2.5, and 40% SUV_(max). The length of tumors on FLT PET-CT scan were measured and recorded as L_(FLTvis), L_(FLT1.3), L_(FLT1.4), L_(FLT1.5), L_(FLT20%), L_(FLT25%), and L_(FLT30%), respectively. The length of tumors on FDG PET-CT scan were recorded as L_(FDGvis), L_(FDG2.5), and L_(FDG40%), respectively. The length of tumors on CT, esophagography and esophagoscopy were recorded as L_(CT), L_(X-ray) and L_(Scopy). All of these results were com-pared with the length of gross tumor in the reseeted specimen measured by pathological examination (L_(Path)), Results The L_(Path) was (4.90±2.14) cm. The Length of tumors delineated by different methods, being from short to long, were L_(FDG40%), L_(Scopy), L_(X-ray),L_(FLT1.5),L_(CT),L_(FLT30%),L_(FLTvis),L_(FLT1.4),L_(FLT25%), L_(FDG2.5),L_(FDGvis),L_(FLT1.3),L_(FLT20%). The mean values were (3.85±1.52), (4.46±2.23), (4.63± 2.37), (4.64±2.38),(4.69± 1.85),(4.75±2.19) ,(4.85±2.33),(4.87±2.35),(5.05±2.20), (5.08± 2.19) ,(5.10±2.22), (5.21±2.40) and (5.53±2.17) cm,respectively. The correlation coefficients were 0.91,0.93,0.88, 0.95, 0.90, 0.81,0.96, 0.96, 0.80, 0.99, 0.99, 0.95 and 0. 79 , respective-ly. All the P values were 0. 000. L_(FLT1.4) of FLT PET-CT and L_(FDG2.5) of FDG PET-CT were found more ap-proximate to L_(Path). There was no significant difference between L_(FLT1.4) and L_(FDG2.5) (1= 1.23, P = 0.232), and the correlation coefficient was 0.96 (P = 0. 000). Conclusions Thresholds of SUV 1.4 on FLT PET-CT and SUV 2.5 on FDG PET-CT could optimally estimate the tumor length measured by pathological examina-tion, and could be objective and simple methods for semiquantitative analysis.
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Objective To evaluate the clinical value of 18FDG PET/CT in the diagnosis of lymph node metastasis and evaluation of node staging for esophageal carcinoma. Methods A prospective study was performed to access whether 18F FDG PET/CT can improve the diagnostic accuracy in lymph node metastasis for patients with esophageal carcinoma, 30 patients underwent esophagectomy with extensive dissection of lymph nodes. PET/CT findings were compared with that of CT. Results The pathological examination confirmed metastasis in 22 patients and 49 out of 243 excised lymph nodes. In PET/CT analysis, the sensitivity in the detection of lymph node metastasis was 93.9%, specificity was 91.2%, with a diagnostic accuracy of 91.8%. The positive and negative predictive value was 73.0% and 98.3%, respectively. CT resulted in a sensitivity of 40.8%, specificity of 96.9%, accuracy of 85.6%, the PPV was 76.9% and NPV 86.6%, respectively. The difference of sensitivity (P
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Objective To discuss the indication, the prevention and treatment of complications of the esophagectomy through left thoracic and neck approach. Methods 2?058 cases of esophageal carcinoma were analyzed retrospectively. Results The success rate of this procedure was 98.40%, and 33 cases died postoperatively, the mortality was 1.60%(33/2?058). Lymph node metastases were presenting 895 cases. The gross rate of lymph node metastasis was 43.49%(895/2?058), the rates of 1ymph nodes metastasis in neck, chest and abdomen were 5.12%(107/2?058), 42.50%(875/2?058) and 21.19%(436/2?058), respective1y. The occurrence rate of residual carcinoma was 1.51%(31/2?058). The complication rate was 15.74%(324/2?058). 1?870 cases were followed-up (90.86%). The overall 3-, 5-year survival rates were 61.22%(895/1?462) and 36.45%(384/1?053), respectively. Conclusion The advantages of this approach were relatively radical resection, 1ow incidence of residual carcinoma, less severe complications.
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Objective Wether preoperative freezing plus traditional operative resection would improve 5 year survival of patient with esophageal cancer was studied. Methods 50 patients admitted for esophageal cancer were divided equally at random.The treatment group (n=25) received cryotherapy before traditional surgery.The rest,without pretreatment,had surgery as controls.Their 1,3,5 year survival rates were contrasted. Results With pretreatment the 1,3,5 year survival rate reached 92,76,56 percent respectively,while that of the controls attained 80,40,and 28 percent accordingly.Statistically significant difference in survival did exist between groups by the end of 3 and 5 years after the combined therapy, yet no difference was detected within 1 year. Conclusion Preoperative cryotherapy could reduce the possibility of lymphatic metastasis,iatrogenic spread during operation and improve patient’ s immunological functions and life span.