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 Clinical 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( the 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. 170178, 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 positive.,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 Tomographic 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 Lung 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 nodes,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 metastatic 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,