胸部CT扫描应作为T2期肾癌术前常规检查

发布时间：2018-06-19 08:32

  本文选题：T2期肾细胞癌 + 胸部CT扫描　； 参考：《北京协和医学院》2013年硕士论文

【摘要】：目的探讨T2期肾细胞癌肺转移的术前诊断方法,以提高患者的生存率。方法 回顾性分析70例T2N0期原发性肾细胞癌患者的临床资料。患者年龄20～75岁,平均年龄55岁；男54例,女16例；全部患者术前均接受胸部X线正侧位片及胸部CT扫描检查。按照2009年UICC/AJCC提出的新TNM分期系统,术前诊断均归为T2期,其中T2aN0期59例,T2bN0期11例。67例患者均在中国医学科学院肿瘤医院行根治性肾切除术,3例未行手术治疗,在B超引导下行肾肿瘤穿刺活检,70例患者均获得病理。2例患者后续治疗行肺转移灶手术切除,病理证实来源于肾的转移性透明细胞性肾细胞癌。根据统计学分析,计算出Kappa值。结果70例患者均经中国医学科学院肿瘤医院病理科诊断,病理提示：透明细胞性肾细胞癌64例,乳头状肾细胞癌3例,嫌色细胞癌3例。70例患者中,经胸部X线正侧位片和胸部CT扫描检查诊断肺转移患者21例,占总病例数的30%(21/70),其中T2aN0期患者19例,占T2aN0期病例数的32.2%(19/59),T2bN0期患者2例,占T2bN0期病例数的18.2%(2/11)。59例术前的胸部X线正侧位片和胸部CT扫描检查的结果是一致的,其中49例的两项检查均未发现肺转移灶；另外10例两项检查均发现肺转移灶,其中T2aN0期8例,T2bN0期2例,即胸片和CT扫描均发现肺转移灶。其余11例患者两项检查结果不一致,即胸部X线正侧位片检查未发现肺转移灶,而胸部CT扫描检查提示肺结节影,诊断肺转移瘤,11例均为T2aN0期。70例患者中没有胸部X线正侧位片检查发现肺转移灶,而胸部CT扫描检查未发现肺转移灶的病例。术前胸部X线正侧位片检查正常,而胸部CT扫描检查发现异常,检出肺转移瘤的病例数,占所有病例数的比例,约为15.7%。计算出Kappa值为0.56,达到中度一致性。在59例T2aN0期患者中,术前胸部X线正侧位片检查正常,胸部CT扫描检出肺转移瘤的病例数为11例,占T2aN0期病例数的比例,约为18.6%。所有21例经胸部CT扫描确诊肺转移的患者,原发灶病理均为透明细胞性肾细胞癌。结论 胸部CT扫描检查较胸部X线正侧位片检查,能够明显提高肺转移瘤的检出率和诊断准确率。有必要通过胸部CT扫描判断有无肺转移,以明确T2N0期肾癌术前分期。推荐胸部CT扫描作为T2N0期肾癌的术前常规检查。
[Abstract]:Objective to investigate the preoperative diagnosis of lung metastasis in stage T 2 renal cell carcinoma (RCC) and to improve the survival rate. Methods the clinical data of 70 patients with T 2 N 0 primary renal cell carcinoma were retrospectively analyzed. The age of the patients was 20 to 75 years with an average age of 55 years, 54 males and 16 females. All the patients were examined by chest radiography and CT before operation. According to the new TNM staging system proposed by UICC / AJCC in 2009, the preoperative diagnosis was classified as T2 stage. Among them, 59 patients with T2aN0 stage T2bN0, 11 patients with T2bN0 stage and 67 patients with T2bN0 stage, all underwent radical nephrectomy (3 patients without surgery) in the Oncology Hospital of the Chinese Academy of Medical Sciences. Renal tumor biopsy guided by B-ultrasound was performed in 70 patients, all of whom were treated with pathology. 2 cases were treated with lung metastases, which were confirmed by pathology as metastatic clear cell renal cell carcinoma (RCC). According to statistical analysis, the Kappa value was calculated. Results all the 70 patients were diagnosed by the Department of Pathology, Cancer Hospital, Chinese Academy of Medical Sciences. Pathological findings showed that 64 cases of clear cell renal cell carcinoma, 3 cases of papillary renal cell carcinoma, 3 cases of chromophobe cell carcinoma. 21 cases of pulmonary metastasis were diagnosed by chest X-ray and CT scan, accounting for 3021 / 70% of the total cases. Among them, 19 cases were in stage T2aN0, 2 cases were in stage T2aN0, and 2 cases were in stage T2bN0 of T2aN0. The results of chest radiographs and chest CT scans in 59 patients with T _ 2bN _ 0 were consistent with those of chest X-ray and CT scans. In 49 cases, lung metastasis was not found in two examinations, while in 10 cases, lung metastases were found in both examinations. There were 8 cases of T _ 2a N _ 0 stage and 2 cases of T _ 2b N _ 0, both chest radiographs and CT scans showed pulmonary metastases. In the other 11 patients, the results of two examinations were not consistent, that is, the positive and lateral chest radiography showed no metastasis of the lung, and the CT scan of the chest showed the pulmonary nodule shadow. In 11 cases of pulmonary metastases, there were no positive and lateral chest radiographs in all the patients with T _ 2a N _ 0 stage and no lung metastases were found by chest CT scan. The positive and lateral chest X-ray examination was normal before operation, but the chest CT scan was abnormal, and the number of cases of lung metastasis was 15.7% of all cases. The Kappa value was 0.56, which reached moderate consistency. In 59 patients with stage T _ 2a N _ 0, the positive and lateral chest radiographs were normal before operation, and 11 cases of lung metastases were detected by chest CT scanning, accounting for 18.6% of the cases in stage T _ 2a _ N _ 0. All 21 cases of lung metastasis confirmed by chest CT scan, the primary lesions were clear cell renal cell carcinoma. Conclusion chest CT scan can significantly improve the detection rate and diagnostic accuracy of pulmonary metastases. It is necessary to determine the lung metastasis by chest CT scan in order to determine the preoperative staging of stage T 2 N 0 renal cell carcinoma. Chest CT scan is recommended as preoperative routine examination of T 2 N 0 renal cell carcinoma.
【学位授予单位】：北京协和医学院
【学位级别】：硕士
【学位授予年份】：2013
【分类号】：R737.11;R730.44
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本文编号：2039270