| Objective:To research the characteristics of lymph node metastasis in the station 12-14 in the stage T1 primary peripheral pulmonary adenocarcinoma patients with preoperative high-resolution CT manifestations of solid-nodule(SN),partial-solid nodule(PSN)and ground glass nodule(GGN).Methods:This retrospective study analyzed the stage T1 primary peripheral pulmonary adenocarcinoma patients who received Lung cancer surgery from January 2017 to October 2017 in thoracic surgery department of our hospital.We selected patients who met the following criteria:(1)pathological diagnosis is stage T1 primary peripheral pulmonary adenocarcinoma;(2)no signs of metastasis after preoperative examination;(3)all received the standard lung resection with systematic mediastinal lymph node dissection,and surgeon performed gross anatomy of the lung lobe to mark and dissect the station 12-14 intrapulmonary peripheral zone lymph node for pathologic examination.We finally selected 70 cases of patients.There were 20 males and 50females.Relevant clinical data of the patients were collected such as preoperative high-resolution CT manifestations of pulmonary nodules,diameter and size of the tumor,situation of station 12-14 lymph node metastasis in the lung,etc.Results:A total of 1116 lymph nodes were obtained by conventional mediastinal lymph node dissection and intrapulmonary lymph node dissection,with an average of 15.94LNs obtained per case.We get 294 lymph nodes in the station 12-14 with an average of4.20 LNs per case.There were 8 cases of intrathoracic lymph node metastasis among all 70 cases and the total detection rate was 11.43%(8/70).There are 33 lymph nodes with metastatic among the 1116 LNs,with a lymph node metastasis rate of 2.96%(33/1116)and 15 lymph nodes with metastatic in the station 12-14,with the Lymph node metastasis rate of 5.10%(15/294)in the peripheral zone.The station 12-14 lymph node metastasis rate was 13.33%(12/90)of the SN group while the number is 2.68%(3/112)in the PSN group,and there is no lymph node metastasis in the GGN group.The difference of station 12-14 lymph node metastasis rates between the three group of SN and PSN and GGN has statistical significance((3~2=16.583,P<0.001).5 cases showed simple station 12 and/or station 13 and/or station 14 lymph node metastasis with the detection rate of 7.14%(5/70),among which 2 cases were partial-solid nodules(PSN)with the detection rate of 7.41%(2/27)in PSN group,and 3 cases were solid nodules(SN),with the rate of 13.64%(3/22)in SN group.In the multivariate analysis,solid nodules(P=0.029,B=1.971,OR=7.175)within the stage T1 lung adenocarcinoma has remarkable effect on metastasis of station 12-14 peripheral zone lymph node and is the independent risk factors.Conclusion:The situation of station 12-14 lymph node metastasis was different while the CT nature of pulmonary nodules of the primary stage T1 peripheral lung adenocarcinoma showed differently.We should focus on the patients with solid nodules to perform the Intrapulmonary lymph node dissection and pathologic examination.The patients with CT performance for PSN should also receive the Intrapulmonary lymph node dissection to avoid lymph node metastasis false-negative,and the collection of Intrapulmonary lymph node could be ignored for the patient with a CT performance of GGN.As the positive rate of subsegmental station 14 is low and the process of collecting is time consuming,this station could be ignored when dissecting intrapulmonary peripheral lymph nodes.In addition,the results of the study showed that the lymph node metastasis in the station 12-14 was different with the change of tumor diameters and the pleural depression sign. |
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