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验证前纵隔肿瘤诊断策略

已有 39 次阅读2019-11-29 01:21 |个人分类:TET学习|系统分类:医学科学

验证前纵隔肿瘤诊断策略
Verification of the diagnostic strategy for anterior mediastinal tumors
Abstract
BACKGROUND:
For thymic epithelial tumors (TETs), the National Comprehensive Cancer Network guideline has suggested that complete excision of the tumor should be performed without a preoperative biopsy when resectable. However, little evidence has been provided to support this strategy. The purpose of this study was to review our diagnostic process and to evaluate the validity of radical resection of anterior mediastinal masses (AMMs) without pathological confirmation.
The NCCN guidelines recommend that a surgical biopsy be avoided if resectable thymoma is strongly suspected based on clinical and radiological features.
METHODS:
A total of 254 patients underwent surgical resection for AMMs between 2004 and 2015. This study included 181 patients with likely TETs according to clinical features, serum levels of tumor markers and autoimmune-antibodies, and radiological findings. In addition, AMMs likely TETs were classified into resectable or unresectable tumors. We retrospectively reviewed the diagnostic process of those patients and validated surgical resection of AMMs without a definitive diagnosis.

RESULTS:
Among 254 patients, 181 were suspected of having a TET based on the serum levels of tumor markers and autoimmune-antibodies and the radiological findings. Of them, 157 patients were deemed resectable and underwent surgical resection without histological confirmation, and 144 (92%) were diagnosed with TETs in the final pathological examinations. In 13 patients with non-TETs, the tumors were difficult to differentiate from TETs by imaging and clinical findings alone.

CONCLUSIONS:
A total of 92% of patients suspected of having a TET and who underwent complete resection without pathological confirmation were accurately diagnosed and properly treated. Surgical resection without a definitive diagnosis was feasible in patients suspected of having a TET when they were considered resectable.
92%疑似患有TET而无病理学证实的患者进行了肿瘤全切,结果证明这些患者得到了准确诊断和恰当的治疗。因此, 对疑似患有TET且可以手术切除的患者,在没有明确诊断前施行手术切除是可行的。

Fig. 1 A schematic illustration of the diagnosis and treatment strategy for AMMs. AMM anterior mediastinal mass, MG myasthenia gravis, ARAb antiacetylcholine receptor antibody, AFP alpha-fetoprotein,β-hCG beta human chorionic gonadotropin, GCT germ cell tumor, TET thymic epithelial tumor

KEYWORDS:

Anterior mediastinum mass; Preoperative diagnosis; Thymic epithelial tumor; Thymoma

Hakiri S, Kawaguchi K, Fukui T, Nakamura S, Ozeki N, Mori S, Goto M, Hashimoto K, Ito T, Yokoi K. Verification of the diagnostic strategy for anterior mediastinal tumors. Int J Clin Oncol. 2019 Apr;24(4):385-393. doi:10.1007/s10147-018-1362-8. Epub 2018 Oct 29. PubMed PMID: 30374687.

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