Yang Gary Y, Wagner Timothy D, Jobe Blair A, Thomas Charles R
Department of Radiation Medicine, Roswell Park Cancer Institute, Buffalo, New York.
Gastrointest Cancer Res. 2008 Jan;2(1):3-9.
The most common methods for staging esophageal cancer are endoscopic ultrasonography (EUS) and computed tomography (CT). EUS is well established in differentiating between early tumor stages and more advanced primary lesions. When combined with fine needle aspiration, EUS has become an important tool in assessing the regional lymph nodes, as well. EUS has its limitations, esophageal obstruction makes passage of the endoscope beyond the tumor nearly impossible and with a narrow field of evaluation, it is not useful for detecting metastatic disease. CT allows for assessment of local tumor invasion while simultaneously providing information regarding distant disease. Its usefulness locally, however, is limited. CT and EUS yield anatomic visualization. Fluorodeoxyglucose (FDG)-positron emission tomography (PET) can provide functional information and is an effective diagnostic modality in esophageal cancer. Its role in the management of esophageal cancer includes staging as well as potential utility in the evaluation of neoadjuvant therapy response and in follow-up after definitive therapy. FDG-PET will likely be more readily used in combination with anatomical imaging like CT to provide additional diagnostic information to aid radiation oncologists in target delineation and planning. In addition, FDG-PET has also been shown to have prognostic value that can be applied to patient management and aid in development of emerging therapies.
食管癌分期最常用的方法是内镜超声检查（EUS）和计算机断层扫描（CT）。EUS在区分早期肿瘤阶段和更晚期的原发性病变方面已得到充分确立。当与细针穿刺相结合时，EUS也已成为评估区域淋巴结的重要工具。EUS有其局限性，食管梗阻使得内镜难以通过肿瘤部位，而且评估视野狭窄，对检测转移性疾病无用。CT可以评估局部肿瘤浸润情况，同时提供有关远处疾病的信息。然而，其在局部的作用有限。CT和EUS可实现解剖可视化。氟脱氧葡萄糖（FDG）-正电子发射断层扫描（PET）能够提供功能信息，是食管癌有效的诊断方式。其在食管癌管理中的作用包括分期，以及在评估新辅助治疗反应和确定性治疗后的随访中的潜在用途。FDG-PET可能会更广泛地与CT等解剖成像相结合，以提供额外的诊断信息，帮助放射肿瘤学家进行靶区勾画和治疗计划制定。此外，FDG-PET也已被证明具有预后价值，可应用于患者管理并有助于新兴疗法的开发。
