肺癌の術中胸膜浸潤診断の正確性についての検討 [in Japanese] Intraoperative diagnosis of pleural invasion of lung cancer patients: Evaluation of accuracy [in Japanese]
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腫瘍径2 cm以下であっても胸膜浸潤を有する症例は予後不良であり，縮小手術の適応についてコンセンサスは得られていない．術中所見で胸膜浸潤をどれだけ正確に診断できるのか検討した．呼吸器外科に所属する医師12名を対象に，臨床問題形式でデータを収集した．症例は胸膜変化を認めた肺癌手術症例30例で，平均年齢は66.8歳，男性14例，女性16例，平均腫瘍径は27 mm，組織型は腺癌22例，扁平上皮癌7例，その他1例で，pl0が22例，pl1以上が8例であった．回答者は①術前CT，②組織型，③胸膜変化を捉えている術中動画から胸膜浸潤なし（PL0），あり（PL1以上）を判断し，病理学的胸膜浸潤に対する感度，特異度，正診率を算出した．胸膜浸潤診断の感度66.7%，特異度61.4%，正診率62.8%であった．術中の胸膜浸潤診断の精度は高くないため，術式選択の基準に採用できる新たな診断法の開発が望まれる．
Since lung cancer patients with visceral pleural invasion show a poorer prognosis even with a tumor size of 2 cm or smaller, these patients are not suitable candidates for sublobar resection. Therefore, we evaluated the accuracy of the intraoperative diagnosis of visceral pleural invasion. Twelve doctors who belong to the Department of Thoracic Surgery answered clinical questions and the data were collected. Of the 30 eligible patients who showed pleural changes, 14 were male and 16 were female, and the mean age was 66.8 years (range, 41-81 years). The mean tumor size was 22.7 mm (range, 16-57 mm). The histologic type was adenocarcinoma in 22 patients, squamous cell carcinoma in 7 patients, and another cell type in 1 patient. There were 22 patients with (pl 1≤) and 8 patients without (pl 0) visceral pleural invasion. The doctors were given the following information: 1. Preoperative CT, 2. Histologic type, and 3. Thoracoscopic movies showing pleural changes, and they answered whether or not there was visceral pleural invasion (PL≤1 or PL 0). Sensitivity, specificity, and accuracy were calculated from the data. The overall average sensitivity, specificity, and accuracy were 66.7% (range, 37.5-87.5%), 61.4% (range, 45.5-86.4%), and 62.8% (range, 53.3-80.0%), respectively. The accuracy of intraoperative diagnosis for visceral pleural invasion is not high; therefore, novel diagnostic procedures are expected in the future.
- The Journal of the Japanese Association for Chest Surgery
The Journal of the Japanese Association for Chest Surgery 29(5), 576-581, 2015
The Japanese Association for Chest Surgery