Corvera Carlos U, Blumgart Leslie H, Akhurst Timothy, DeMatteo Ronald P, D'Angelica Michael, Fong Yuman, Jarnagin William Robert
Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY 10021, USA.
J Am Coll Surg. 2008 Jan;206(1):57-65. doi: 10.1016/j.jamcollsurg.2007.07.002. Epub 2007 Oct 1.
Although (18)F-fluorodeoxyglucose positron emission tomography (PET) has widespread clinical use, its role in cancers of the biliary tract is ill-defined. The aim of this study was to determine if preoperative PET provided additional staging information in patients with biliary tract cancer, beyond that obtained through conventional anatomic imaging. The role of PET in detecting disease recurrence after resection was also examined.
Between March 2001 and October 2003, 126 patients with biopsy-proved or presumed biliary tract cancer (intrahepatic or extrahepatic cholangiocarcinoma and gallbladder carcinoma) underwent PET in addition to standard imaging evaluation. Histologic confirmation of the diagnosis was used as the reference standard with which PET results were compared. Patient followup information and serial imaging were reviewed for progression of lesions detected by PET.
Of the 126 study patients, 93 (74%) underwent preoperative staging PET scans, the results of which changed the stage and treatment in 22 patients (24%): 15 of 62 (24%) with cholangiocarcinoma and 7 of 31 (23%) with gallbladder carcinoma. When used to assess for cancer recurrence (n=33), PET identified disease in 86% of patients but altered treatment in only 9%. So, of the entire study group, the findings of PET influenced management in 20% of patients (24% preoperative staging and 9% cancer recurrence). The sensitivity of PET for identifying the primary tumor was 80% overall: 78% for cholangiocarcinoma, 86% for gallbladder carcinoma.
Most biliary tract cancers are (18)F-fluorodeoxyglucose avid tumors. In patients with potentially resectable tumors based on conventional imaging, PET identified occult metastatic disease and changed management in nearly one-fourth of all patients. PET also helped confirm recurrent cancer after resection.
尽管（18）F - 氟脱氧葡萄糖正电子发射断层扫描（PET）在临床中广泛应用，但其在胆道癌中的作用仍不明确。本研究的目的是确定术前PET是否能为胆道癌患者提供超出传统解剖成像的额外分期信息。同时也探讨了PET在检测切除术后疾病复发中的作用。
在2001年3月至2003年10月期间，126例经活检证实或疑似胆道癌（肝内或肝外胆管癌及胆囊癌）的患者除接受标准成像评估外，还接受了PET检查。以组织学确诊作为参考标准来比较PET结果。回顾患者的随访信息和系列成像，以观察PET检测到的病变进展情况。
126例研究患者中，93例（74%）接受了术前分期PET扫描，其中22例（24%）的扫描结果改变了分期和治疗方案：62例胆管癌患者中有15例（24%），31例胆囊癌患者中有7例（23%）。当用于评估癌症复发时（n = 33），PET在86%的患者中检测到疾病，但仅在9%的患者中改变了治疗方案。因此，在整个研究组中，PET的结果影响了20%患者的治疗管理（术前分期为24%，癌症复发为9%）。PET识别原发肿瘤的总体敏感性为80%：胆管癌为78%，胆囊癌为86%。
大多数胆道癌是（18）F - 氟脱氧葡萄糖摄取性肿瘤。对于基于传统成像可能可切除的肿瘤患者，PET在近四分之一的患者中识别出隐匿性转移疾病并改变了治疗管理。PET还有助于确认切除术后的复发性癌症。
