Rice T W
Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic Foundation, Ohio, USA.
Chest Surg Clin N Am. 2000 Aug;10(3):471-85.
CT is readily available to all patients. It is relatively inexpensive and fees are usually reimbursed. It provides exquisite anatomic detail of the chest and abdomen in patients with esophageal cancer. The only reliable use of CT in the determination of T is the exclusion of T4 tumors, which is suggested by the preservation of fat planes. Enlarged lymph nodes are suspicious for metastatic disease but require further study or tissue sampling if nodal metastases will determine treatment. Its major use is in the detection of distant metastatic disease; however, 30% to 60% of distant metastases may be radiographically occult. There is a significant learning curve for EUS staging of esophageal cancer. It is suggested that this study be performed at institutions where there is a dedicated, experienced endoscopic ultrasonographer with adequate instrumentation that allows specialty imaging and EUS-FNA. EUS is the best means of clinically determining T. The addition of EUS-FNA to routine EUS evaluation of lymph nodes allows an accuracy similar to the EUS determination of T. EUS has no purpose in assessment of non-nodal distant metastatic disease; however, the serendipitous finding of distant metastases in adjacent structures visualized during the evaluation of the primary tumor and lymph nodes has, on occasion, detected M1b disease. FDG-PET represents an advance over CT scanning in the screening for distant metastases. The major problems with FDG-PET staging of esophageal cancer is failure to detect metastatic deposits less than 1 cm in diameter and lack of anatomic definition. It is unable to determine T and has been inaccurate in the detection of lymph node metastases. Because this test is not readily available, is expensive, and is not routinely reimbursed, its use in staging esophageal cancer continues to be limited. Today, CT and EUS are the mainstays in the clinical staging of esophageal carcinoma. When possible, FDG-PET should be added to CT to improve the evaluation of non-nodal M1b disease. Results of these studies should determine the necessity for invasive staging techniques and direct their use.
所有患者都可方便地进行CT检查。它相对便宜，费用通常可报销。对于食管癌患者，它能提供胸部和腹部精细的解剖细节。CT在确定T分期方面唯一可靠的用途是排除T4肿瘤，脂肪平面的保留提示可能为T4肿瘤。肿大的淋巴结怀疑有转移，但如果淋巴结转移将决定治疗方案，则需要进一步检查或组织取样。其主要用途是检测远处转移疾病；然而，30%至60%的远处转移在影像学上可能隐匿。食管癌的超声内镜分期存在显著的学习曲线。建议在有专门的、经验丰富的内镜超声检查医师且具备允许进行特殊成像和超声内镜引导下细针穿刺活检（EUS-FNA）的适当设备的机构进行这项检查。超声内镜是临床确定T分期的最佳方法。在常规超声内镜评估淋巴结时增加EUS-FNA，其准确性与超声内镜确定T分期相似。超声内镜对评估非淋巴结远处转移疾病没有作用；然而，在评估原发肿瘤和淋巴结时偶然发现的相邻结构中的远处转移，有时能检测到M1b期疾病。氟脱氧葡萄糖正电子发射断层扫描（FDG-PET）在筛查远处转移方面比CT扫描有所进步。食管癌FDG-PET分期的主要问题是无法检测到直径小于1厘米的转移灶且缺乏解剖定位。它无法确定T分期，在检测淋巴结转移方面也不准确。由于这项检查不易获得、费用昂贵且通常不能报销，其在食管癌分期中的应用仍然有限。如今，CT和超声内镜是食管癌临床分期的主要方法。如有可能，应在CT检查基础上增加FDG-PET，以改善对非淋巴结M1b期疾病的评估。这些检查结果应确定是否需要采用侵入性分期技术并指导其应用。
