Wakabayashi H, Akamoto S, Yachida S, Okano K, Izuishi K, Nishiyama Y, Maeta H
First Department of Surgery, Faculty of Medicine, Kagawa University, Miki-cho, Kita-gun, Kagawa 761-0793, Japan.
Eur J Surg Oncol. 2005 Dec;31(10):1175-9. doi: 10.1016/j.ejso.2005.05.012. Epub 2005 Jul 12.
This study was performed to evaluate the significance of positron emission tomography using fluorodeoxyglucose (FDG-PET) in diagnosing malignancy in patients with biliary stricture by comparing the sensitivity and specificity of FDG-PET with those of CT scans and cytological examination of the bile.
Thirty patients who underwent FDG-PET for differential diagnosis of the disease causing biliary stricture were included in this study. The sites of the strictures were as follows: in the intrahepatic bile duct in five patients, in the peripheral extrahepatic bile duct in 17 patients, and in the distal extrahepatic bile duct in eight patients. The sensitivity and specificity (%) of FDG-PET in diagnosing malignancies were evaluated and compared with those of CT scans and cytological examination using obtained bile. Final diagnoses were based on surgical or biopsy findings. Data was collected and analysed in a retrospective fashion.
Malignant diseases were diagnosed in 21 patients, as follows: cholangiocarcinoma including Klatskin tumour in 10 patients, gallbladder cancer in eight, duodenal and ampulla cancer in two, and pancreatic cancer in one. In diagnosing malignancy in patients with biliary stricture, overall sensitivity and specificity were 85.7 (18/21) and 55.6 (5/9), respectively, for CT, 64.7 (11/17) and 100 (7/7), respectively, for cytological examination of the bile, and 90.5 (19/21) and 77.8 (7/9), respectively, for FDG-PET.
In diagnosing malignant diseases in patients with biliary stricture, FDG-PET was superior to CT examination in both sensitivity and specificity, and superior to cytological examination of the bile in sensitivity. However, in patients with inflammatory disease, such as primary sclerosing cholangitis and cholecystitis, false positive rates were found. Therefore, a multidisciplinary diagnostic approach using FDG-PET in conjunction with conventional modalities seems essential to a precise differential diagnosis.
本研究旨在通过比较氟脱氧葡萄糖正电子发射断层扫描（FDG-PET）与CT扫描及胆汁细胞学检查的敏感性和特异性，评估FDG-PET在诊断胆道狭窄患者恶性肿瘤中的意义。
本研究纳入了30例行FDG-PET以鉴别引起胆道狭窄疾病的患者。狭窄部位如下：肝内胆管5例，肝外胆管周围17例，肝外胆管远端8例。评估FDG-PET诊断恶性肿瘤的敏感性和特异性（%），并与CT扫描及胆汁细胞学检查的结果进行比较。最终诊断基于手术或活检结果。以回顾性方式收集和分析数据。
21例患者被诊断为恶性疾病，具体如下：胆管癌（包括肝门部胆管癌）10例，胆囊癌8例，十二指肠和壶腹癌2例，胰腺癌1例。在诊断胆道狭窄患者的恶性肿瘤时，CT的总体敏感性和特异性分别为85.7（18/21）和55.6（5/9），胆汁细胞学检查分别为64.7（11/17）和100（7/7），FDG-PET分别为90.5（19/21）和77.8（7/9）。
在诊断胆道狭窄患者的恶性疾病时，FDG-PET在敏感性和特异性方面均优于CT检查，在敏感性方面优于胆汁细胞学检查。然而，在患有原发性硬化性胆管炎和胆囊炎等炎症性疾病的患者中发现了假阳性率。因此，将FDG-PET与传统方法结合使用的多学科诊断方法对于精确的鉴别诊断似乎至关重要。
