Wakabayashi Hisao, Nishiyama Yoshihiro, Otani Tsuyoshi, Sano Takanori, Yachida Shinichi, Okano Keiichi, Izuishi Kunihiko, Suzuki Yasuyuki
Department of Gastroenterological Surgery, Kagawa University, Miki-cho, Kita-gun, Kagawa 761-0793, Japan.
World J Gastroenterol. 2008 Jan 7;14(1):64-9. doi: 10.3748/wjg.14.64.
To evaluate the role of positron emission tomography using 18F-fluorodeoxyglucose (FDG-PET) in the surgical management of patients with pancreatic cancer, including the diagnosis, staging, and selection of patients for the subsequent surgical treatment.
This study involved 53 patients with proven primary pancreatic cancer. The sensitivity of diagnosing the primary cancer was examined for FDG-PET, CT, cytological examination of the bile or pancreatic juice, and the serum levels of carcinoembrionic antigens (CEA) and carbohydrate antigen 19-9 (CA19-9). Next, the accuracy of staging was compared between FDG-PET and CT. Finally, FDG-PET was analyzed semiquantitatively using the standard uptake value (SUV). The impact of the SUV on patient management was evaluated by examining the correlations between the SUV and the histological findings of cancer.
The sensitivity of FDG-PET, CT, cytological examination of the bile or pancreatic juice, and the serum levels of CEA and CA19-9 were 92.5%, 88.7%, 46.4%, 37.7% and 69.8%, respectively. In staging, FDG-PET was superior to CT only in diagnosing distant disease (bone metastasis). For local staging, the sensitivity of CT was better than that of FDG-PET. The SUV did not correlate with the pTNM stage, grades, invasions to the vessels and nerve, or with the size of the tumor. However, there was a statistically significant difference (4.6 +/- 2.9 vs 7.8 +/- 4.5, P = 0.024) in the SUV between patients with respectable and unresectable disease.
FDG-PET is thus considered to be useful in the diagnosis of pancreatic cancer. However, regarding the staging of the disease, FDG-PET is not considered to be a sufficiently accurate diagnostic modality. Although the SUV does not correlate with the patho-histological prognostic factors, it may be useful in selecting patients who should undergo subsequent surgical treatment.
评估采用18F-氟脱氧葡萄糖的正电子发射断层扫描（FDG-PET）在胰腺癌患者外科治疗中的作用，包括诊断、分期以及选择后续手术治疗的患者。
本研究纳入53例经证实的原发性胰腺癌患者。对FDG-PET、CT、胆汁或胰液细胞学检查以及癌胚抗原（CEA）和糖类抗原19-9（CA19-9）血清水平诊断原发性癌的敏感性进行了检测。接下来，比较FDG-PET和CT分期的准确性。最后，使用标准摄取值（SUV）对FDG-PET进行半定量分析。通过检查SUV与癌症组织学结果之间的相关性，评估SUV对患者管理的影响。
FDG-PET、CT、胆汁或胰液细胞学检查以及CEA和CA19-9血清水平的敏感性分别为92.5%、88.7%、46.4%、37.7%和69.8%。在分期方面，FDG-PET仅在诊断远处疾病（骨转移）方面优于CT。对于局部分期，CT的敏感性优于FDG-PET。SUV与pTNM分期、分级、血管和神经侵犯或肿瘤大小均无相关性。然而，可切除和不可切除疾病患者的SUV存在统计学显著差异（4.6±2.9对7.8±4.5，P = 0.024）。
因此，FDG-PET被认为对胰腺癌诊断有用。然而，关于疾病分期，FDG-PET不被认为是一种足够准确的诊断方式。虽然SUV与病理组织学预后因素无相关性，但它可能有助于选择应接受后续手术治疗的患者。
