Katsoulis I E, Wong W L, Mattheou A K, Damani N, Chambers J, Livingstone J I
Upper Gastrointestinal Surgery Unit, Watford General Hospital, 60 Vicarage Road, Watford, Hertfordshire WD18 0HB, UK.
Int J Surg. 2007 Dec;5(6):399-403. doi: 10.1016/j.ijsu.2007.05.009. Epub 2007 Jun 3.
The pre-operative staging in oesophageal cancer is often challenging and underestimation of the extent of the disease may lead to unnecessary surgery.
To audit the use and assess the value of fluorine-18 fluorodeoxyglucose positron emission tomography ((18)F FDG-PET) as a staging tool for thoracic oesophageal and gastro-oesophageal junction (GOJ) cancers in our oncological surgical practice.
Over a 3 year period, between 2002 and 2004, 134 patients with thoracic oesophageal or GOJ cancer were referred to our unit for treatment. The standard preoperative staging investigation in all cases was CT (thorax, abdomen and pelvis). A preoperative FDG-PET scan was further requested in 22 patients. The case notes of all the patients that underwent a FDG-PET scan were reviewed and compared with the preoperative imaging, the operative findings and the histopathology of the resected tumours.
Eighteen men and 4 women with a median age of 65 (range 43-79) years were studied. After FDG-PET, 13 out of 22 patients (59%) were deemed suitable for tumour resection. Twelve of the 13 patients were fit to undergo surgery. At laparotomy, 2 of those (17%) were found inoperable due to widespread disease. The sensitivity of CT versus FDG-PET to detect infiltrated lymph nodes was 29% (95% CI: 3-70) versus 71% (95% CI: 29-96) (P=0.0412), whereas both tests had 67% specificity (95% CI: 9-99) in detecting lymph nodes. The sensitivity and the specificity of CT versus FDG-PET to detect distant organ metastases (M1b) were 33% (95% CI: 4-77) and 88% (95% CI: 47-99) versus 50% (95% CI: 6-93) and 100% (95% CI: 69-100), respectively (P>0.05). The FDG-PET regarding the N and M status differed from the CT in 11 patients and led to modification of the planned management in 5 of them.
FDG-PET is more accurate than CT in defining N and M status. It can result in a reduction of unnecessary surgery in a significant number of patients. The combined PET-CT scan as a single imaging modality is expected to further improve diagnostic accuracy of FDG-PET.
食管癌的术前分期通常具有挑战性，对疾病范围的低估可能导致不必要的手术。
在我们的肿瘤外科实践中，审核氟-18氟脱氧葡萄糖正电子发射断层扫描（(18)F FDG-PET）作为胸段食管癌和胃食管交界（GOJ）癌分期工具的使用情况并评估其价值。
在2002年至2004年的3年期间，134例胸段食管癌或GOJ癌患者被转诊至我科接受治疗。所有病例的标准术前分期检查为CT（胸部、腹部和盆腔）。另外22例患者被要求进行术前FDG-PET扫描。对所有接受FDG-PET扫描的患者的病历进行了回顾，并与术前影像学检查、手术发现以及切除肿瘤的组织病理学结果进行了比较。
研究对象为18名男性和4名女性，中位年龄65岁（范围43 - 79岁）。FDG-PET检查后，22例患者中有13例（59%）被认为适合进行肿瘤切除。这13例患者中有12例适合手术。在剖腹手术中，其中2例（17%）因疾病广泛而被发现无法手术。CT与FDG-PET检测浸润性淋巴结的敏感性分别为29%（95%CI：3 - 70）和71%（95%CI：29 - 96）（P = 0.0412），而两种检查在检测淋巴结方面的特异性均为67%（95%CI：9 - 99）。CT与FDG-PET检测远处器官转移（M1b）的敏感性和特异性分别为33%（95%CI：4 - 77）和88%（95%CI：47 - 99）以及50%（95%CI：6 - 93）和100%（95%CI：69 - 100）（P>0.05）。FDG-PET在N和M状态方面与CT不同的有11例患者，其中5例因此改变了计划的治疗方案。
FDG-PET在确定N和M状态方面比CT更准确。它可以使相当数量的患者避免不必要的手术。PET-CT联合扫描作为一种单一的成像方式有望进一步提高FDG-PET的诊断准确性。
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