Himeno Shinji, Yasuda Seiei, Shimada Hideo, Tajima Tomoo, Makuuchi Hiroyasu
Department of Surgery, Tokai University School of Medicine, Isehara, Kanagawa, Japan.
Jpn J Clin Oncol. 2002 Sep;32(9):340-6. doi: 10.1093/jjco/hyf073.
A retrospective study was performed to determine the indications for positron emission tomography (PET) using [(18)F]fluorodeoxyglucose (FDG) in patients with esophageal cancer, including those with early cancer, and to investigate whether the tumor-to-normal ratio (T/N ratio) could be used as a substitute for the standardized uptake value (SUV).
Thirty-six patients were included in the study. Thirty-one patients who had 36 biopsy-proven lesions (35 squamous cell carcinomas and one small cell carcinoma) underwent PET study prior to treatment. PET images were evaluated visually and the relationship between the depth of invasion and the PET findings were examined in 22 lesions of 19 patients from whom specimens were obtained from the primary tumor by surgery or endoscopic mucosal resection. PET results were also compared with computed tomography (CT) and endoscopic ultrasonography (EUS) for detection of regional lymph node metastases in 18 patients who underwent extended lymph node dissection. Five patients underwent PET studies for the detection of recurrence and the PET findings were compared with their CT findings. The T/N ratio and the SUV were calculated for 20 primary tumors.
Among the 15 tumors that were pT1b or greater, all 15 were positive on PET and all seven of the lesions confined to the mucosa (Tis or T1a) were negative. The sensitivity, specificity and accuracy of detecting nodal involvement were, respectively, 37.5, 96.1 and 88.3% by CT, 30.8, 88.5 and 81.0% by EUS and 41.7, 100 and 92.2% by PET. More sites of recurrence were detected by PET than by CT. There was no statistically significant correlation between the SUV and the T/N ratio.
PET imaging can detect primary esophageal cancer with a depth of invasion of T1b or greater, but Tis and T1a tumors are undetectable. PET seems to be more accurate than CT or EUS for diagnosing lymph node metastasis. The T/N ratio cannot be used as a substitute for the SUV.
进行一项回顾性研究以确定正电子发射断层扫描（PET）使用[（18）F]氟脱氧葡萄糖（FDG）在食管癌患者（包括早期癌症患者）中的适应证，并研究肿瘤与正常组织比值（T/N比值）是否可作为标准化摄取值（SUV）的替代指标。
36例患者纳入本研究。31例有36个经活检证实病变（35例鳞状细胞癌和1例小细胞癌）的患者在治疗前行PET检查。对PET图像进行视觉评估，并在19例患者的22个病变中检查浸润深度与PET表现之间的关系，这些患者通过手术或内镜黏膜切除术从原发肿瘤获取标本。还将18例行扩大淋巴结清扫术患者的PET结果与计算机断层扫描（CT）和内镜超声检查（EUS）进行比较以检测区域淋巴结转移。5例患者因检测复发而行PET检查，并将PET表现与其CT表现进行比较。计算20个原发肿瘤的T/N比值和SUV。
在15个pT1b及以上的肿瘤中，所有15个在PET上呈阳性，而所有7个局限于黏膜（Tis或T1a）的病变均为阴性。CT检测淋巴结受累的敏感性、特异性和准确性分别为37.5%、96.1%和88.3%，EUS分别为30.8%、88.5%和81.0%，PET分别为41.7%、100%和92.2%。PET检测到的复发部位比CT更多。SUV与T/N比值之间无统计学显著相关性。
PET成像可检测浸润深度为T1b及以上的原发性食管癌，但Tis和T1a肿瘤无法检测到。PET在诊断淋巴结转移方面似乎比CT或EUS更准确。T/N比值不能用作SUV的替代指标。
