Kato Hiroyuki, Kuwano Hiroyuki, Nakajima Masanobu, Miyazaki Tatsuya, Yoshikawa Minako, Ojima Hitoshi, Tsukada Katsuhiko, Oriuchi Noboru, Inoue Tomio, Endo Keigo
Department of Surgery I, Gunma University Faculty of Medicine, Maebashi, Japan.
Cancer. 2002 Feb 15;94(4):921-8.
The role and potential value of positron emission tomography (PET) scanning in certain tumors has been widely investigated in recent years. The authors retrospectively assessed the performance of 18-F-fluorodeoxyglucose (FDG)-PET in the assessment of esophageal squamous cell carcinoma (SCC).
The results using PET were compared with those using computed tomography (CT), and these were correlated with the pathologic findings. The authors studied 32 patients with thoracic esophageal SCC who had undergone radical esophagectomy.
Uptake of FDG in the primary tumor was found in 25 of the 32 (78.1%) cases. Comparison of the FDG uptake and the clinicopathologic findings showed that there was a significant association between the FDG uptake and each of the depth of tumor invasion (P < 0.05), occurrence of lymph node metastasis (P < 0.01), and lymphatic invasion (P < 0.01). The survival rate in cases with high FDG uptake (standardized uptake value [SUV], >3) was significantly lower than that in cases with low FDG uptake (SUV, < 3; P < 0.05). In the evaluation of lymph node staging by the detection of lymph node metastasis, FDG-PET showed 77.8% sensitivity, 92.9% specificity, and 84.4% accuracy, and CT scanning showed 61.1% sensitivity, 71.4% specificity, and 65.6% accuracy. Positron emission tomography scanning showed a high degree of accuracy in the neck, upper thoracic, and abdominal regions. However, in the mid- and lower thoracic regions, the sensitivity was very low. The smallest lymph node metastasis that was detected by FDG-PET imaging was 6 mm. The average size of lymph node metastasis that was undetected by FDG-PET scanning was 7.3 mm (range, 1-17 mm).
In conclusion, FDG-PET may be used as a noninvasive diagnostic technique in assessing the aggressiveness of the tumor and the prognosis in patients with esophageal SCC. During the preoperative diagnostic procedures, the sensitivity, specificity, and accuracy of lymph node staging is higher with FDG-PET than with CT imaging. In view of the high specificity of FDG-PET, it also gives useful information to guide the choice of treatment of esophageal carcinoma.
近年来，正电子发射断层扫描（PET）在某些肿瘤中的作用和潜在价值得到了广泛研究。作者回顾性评估了18F-氟脱氧葡萄糖（FDG）-PET在评估食管鳞状细胞癌（SCC）中的表现。
将PET检查结果与计算机断层扫描（CT）结果进行比较，并与病理结果相关联。作者研究了32例接受根治性食管切除术的胸段食管SCC患者。
32例患者中有25例（78.1%）的原发肿瘤发现有FDG摄取。FDG摄取与临床病理结果的比较显示，FDG摄取与肿瘤浸润深度（P < 0.05）、淋巴结转移发生率（P < 0.01）和淋巴管浸润（P < 0.01）均有显著相关性。FDG摄取高（标准化摄取值[SUV]，>3）的患者生存率显著低于FDG摄取低（SUV，< 3；P < 0.05）的患者。在通过检测淋巴结转移评估淋巴结分期方面，FDG-PET的敏感性为77.8%，特异性为92.9%，准确性为84.4%，而CT扫描的敏感性为61.1%，特异性为71.4%，准确性为65.6%。正电子发射断层扫描在颈部、上胸部和腹部区域显示出高度的准确性。然而，在胸段中下部区域，敏感性非常低。FDG-PET成像检测到的最小淋巴结转移为6 mm。FDG-PET扫描未检测到的淋巴结转移的平均大小为7.3 mm（范围，1 - 17 mm）。
总之，FDG-PET可作为一种无创诊断技术，用于评估食管SCC患者的肿瘤侵袭性和预后。在术前诊断过程中，FDG-PET在淋巴结分期方面的敏感性、特异性和准确性均高于CT成像。鉴于FDG-PET的高特异性，它也为指导食管癌的治疗选择提供了有用信息。
