Sun Long, Su Xin-Hui, Guan Yong-Song, Pan Wei-Ming, Luo Zuo-Ming, Wei Ji-Hong, Wu Hua
Minnan PET Center and Department of Nuclear Medicine, the First Hospital of Xiamen, Fujian Medical University, Xiamen, Fujian Province, China.
World J Gastroenterol. 2008 Aug 7;14(29):4627-32. doi: 10.3748/wjg.14.4627.
To evaluate the clinical role of (18)F-fluorodeoxyglucose positron emission and computed tomography ((18)F-FDG PET/CT) in detection of gastric cancer recurrence after initial surgical resection.
In the period from January 2007 to May 2008, 23 patients who had previous surgical resection of histopathologically diagnosed gastric cancer underwent a total of 25 (18)F-FDG PET/CT scans as follow-up visits in our center. The standard of reference for tumor recurrence consisted of histopathologic confirmation or clinical follow-up information for at least 5 mo after PET/CT examinations.
PET/CT was positive in 14 patients (61%) and negative in 9 (39%). When correlated with final diagnosis, which was confirmed by histopathologic evidence of tumor recurrence in 8 of the 23 patients (35%) and by clinical follow-up in 15 (65%), PET/CT was true positive in 12 patients, false positive in 2, true negative in 8 and false negative in 2. Overall, the accuracy of PET/CT was 82.6%, the negative predictive value (NPV) was 77.7%, and the positive predictive value (PPV) was 85.7%. The 2 false positive PET/CT findings were actually chronic inflammatory tissue lesions. For the two patients with false negative PET/CT, the final diagnosis was recurrence of mucinous adenocarcinoma in the anastomosis in one patient and abdominal wall metastasis in the other. Importantly, PET/CT revealed true-positive findings in 11 (47.8%) patients who had negative or no definite findings by CT. PET/CT revealed extra-abdominal metastases in 7 patients and additional esophageal carcinoma in one patient. Clinical treatment decisions were changed in 7 (30.4%) patients after introducing PET/CT into their conventional post-operative follow-up program.
Whole body (18)F-FDG PET/CT was highly effective in discriminating true recurrence in post-operative patients with gastric cancer and had important impacts on clinical decisions in a considerable portion of patients.
评估（18）F-氟脱氧葡萄糖正电子发射断层显像及计算机断层扫描（（18）F-FDG PET/CT）在胃癌初次手术切除后复发检测中的临床作用。
2007年1月至2008年5月期间，23例曾接受组织病理学确诊的胃癌手术切除患者在本中心接受了总共25次（18）F-FDG PET/CT扫描作为随访检查。肿瘤复发的参考标准包括PET/CT检查后至少5个月的组织病理学确诊或临床随访信息。
PET/CT检查结果阳性14例（61%），阴性9例（39%）。与最终诊断相关时，23例患者中有8例（35%）经肿瘤复发的组织病理学证据确诊，15例（65%）经临床随访确诊，PET/CT真阳性12例，假阳性2例，真阴性8例，假阴性2例。总体而言，PET/CT的准确率为82.6%，阴性预测值（NPV）为77.7%，阳性预测值（PPV）为85.7%。2例假阳性PET/CT结果实际为慢性炎症组织病变。2例假阴性PET/CT患者中，1例最终诊断为吻合口黏液腺癌复发，另1例为腹壁转移。重要的是，PET/CT在11例（47.8%）CT检查结果为阴性或无明确结果的患者中发现了真阳性结果。PET/CT发现7例患者有腹外转移，1例患者合并食管癌。将PET/CT引入常规术后随访方案后，7例（30.4%）患者的临床治疗决策发生了改变。
全身（18）F-FDG PET/CT在鉴别胃癌术后患者的真正复发方面非常有效，并且对相当一部分患者的临床决策有重要影响。
