食管癌患者术前放化疗引起的溃疡：在综合计算机断层扫描-正电子发射断层扫描成像中肿瘤反应评估的一个混杂因素。

Preoperative chemo-radiation-induced ulceration in patients with esophageal cancer: a confounding factor in tumor response assessment in integrated computed tomographic-positron emission tomographic imaging.

作者信息

Erasmus Jeremy J, Munden Reginald F, Truong Mylene T, Ho Jeremy J, Hofstetter Wayne L, Macapinlac Homer A, Correa Arlene M, Wu Tsung-Teh, Bruzzi John F, Marom Edith M, Sabloff Bradley S, Ajani Jaffer A, Komaki Ritsuko, Liao Zhongxing, Lee Jeffrey H, Fukami Norio, Bresalier Robert, Swisher Stephen G

机构信息

Department of Diagnostic Imaging, University of Texas M. D. Anderson Cancer Center, Houston, Texas 77030, USA.

出版信息

J Thorac Oncol. 2006 Jun;1(5):478-86.

PMID:17409902

Abstract

HYPOTHESIS

Positron emission tomography can be useful in predicting response of esophageal cancer after preoperative chemo-radiation therapy (CRT). We evaluated the use of integrated computed tomography (CT)-PET among patients with esophageal cancer being considered for resection after CRT.

METHODS

Three reviewers blinded to clinical and pathologic staging retrospectively reviewed the CT-PET scans of patients with esophageal cancer after preoperative CRT who underwent esophagectomy. [F]-fluoro-2-deoxy-D-glucose uptake for residual malignancy was determined by visual analysis and semi-quantitatively when standardized uptake value (SUV) was > or =4.

RESULTS

Forty-two patients underwent esophageal resection. Using visual analysis, CT-PET had a sensitivity of 47% and specificity of 58% in detecting residual malignancy. Using semi-quantitative analysis, 19 patients had a SUV > or =4 in the region of the primary esophageal tumor and were interpreted as having residual malignancy (sensitivity 43%, specificity 50%). Of these 19, six had complete pathologic response to CRT. These false-positive results, due to therapy-induced ulceration detected at endoscopy, limit the use of CT-PET alone in detecting residual malignancy. Similarly, sensitivity (25%) and specificity (73%) of endoscopy/biopsy in detecting residual malignancy were poor. However, the accuracy of CT-PET in detecting residual malignancy was improved when combined with endoscopic findings. In the absence of ulceration at endoscopy, 8 of 8 patients with SUV > or =4 after chemo-radiation had residual malignancy at surgery.

CONCLUSIONS

CRT-induced ulceration results in false-positive results on CT-PET and precludes accurate detection of residual esophageal tumor. However, CT-PET in combination with endoscopy is useful in identifying patients with a high risk of residual tumor post-CRT.

摘要

假设

正电子发射断层扫描在预测术前放化疗（CRT）后食管癌的反应方面可能有用。我们评估了在考虑CRT后进行切除的食管癌患者中综合计算机断层扫描（CT）-PET的应用。

方法

三位对临床和病理分期不知情的审阅者回顾性地审查了术前CRT后接受食管切除术的食管癌患者的CT-PET扫描。通过视觉分析确定残留恶性肿瘤的[F]-氟-2-脱氧-D-葡萄糖摄取情况，当标准化摄取值（SUV）≥4时进行半定量分析。

结果

42例患者接受了食管切除术。通过视觉分析，CT-PET检测残留恶性肿瘤的敏感性为47%，特异性为58%。通过半定量分析，19例患者在原发性食管肿瘤区域的SUV≥4，并被判定为有残留恶性肿瘤（敏感性43%，特异性50%）。在这19例患者中，6例对CRT有完全病理反应。这些假阳性结果是由于在内镜检查中发现的治疗引起的溃疡，限制了单独使用CT-PET检测残留恶性肿瘤。同样，内镜检查/活检检测残留恶性肿瘤的敏感性（25%）和特异性（73%）也很差。然而，当CT-PET与内镜检查结果相结合时，检测残留恶性肿瘤的准确性得到了提高。在内镜检查无溃疡的情况下，放化疗后SUV≥4的8例患者中有8例在手术时有残留恶性肿瘤。