Sun Long, Su Xin-Hui, Guan Yong-Song, Pan Wei-Ming, Luo Zuo-Ming, Wei Ji-Hong, Zhao Long, Wu Hua
Department of Nuclear Medicine, the First Hospital of Xiamen, Fujian Medical University, Minnan PET Center, Xiamen, Fujian Province, China.
World J Gastroenterol. 2009 Apr 21;15(15):1836-42. doi: 10.3748/wjg.15.1836.
To evaluate the clinical usefulness of (18)F-fluorodeoxyglucose positron emission and computed tomography ((18)F-FDG PET/CT) in restaging of esophageal cancer after surgical resection and radiotherapy.
Between January 2007 and Aug 2008, twenty histopathologically diagnosed esophageal cancer patients underwent 25 PET/CT scans (three patients had two scans and one patient had three scans) for restaging after surgical resection and radiotherapy. The standard reference for tumor recurrence was histopathologic confirmation or clinical follow-up for at least ten months after (18)F-FDG PET/CT examinations.
Tumor recurrence was confirmed histopathologically in seven of the 20 patients (35%) and by clinical and radiological follow-up in 13 (65%). (18)F-FDG PET/CT was positive in 14 patients (68.4%) and negative in six (31.6%). (18)F-FDG PET/CT was true positive in 11 patients, false positive in three and true negative in six. Overall, the accuracy of (18)F-FDG PET/CT was 85%, negative predictive value (NPV) was 100%, and positive predictive value (PPV) was 78.6%. The three false positive PET/CT findings comprised chronic inflammation of mediastinal lymph nodes (n = 2) and anastomosis inflammation (n = 1). PET/CT demonstrated distant metastasis in 10 patients. (18)F-FDG PET/CT imaging-guided salvage treatment in nine patients was performed. Treatment regimens were changed in 12 (60%) patients after introducing (18)F-FDG PET/CT into their conventional post-treatment follow-up program.
Whole body (18)F-FDG PET/CT is effective in detecting relapse of esophageal cancer after surgical resection and radiotherapy. It could also have important clinical impact on the management of esophageal cancer, influencing both clinical restaging and salvage treatment of patients.
评估¹⁸F-氟脱氧葡萄糖正电子发射断层扫描及计算机断层扫描（¹⁸F-FDG PET/CT）在食管癌手术切除及放疗后再分期中的临床应用价值。
2007年1月至2008年8月期间，20例经组织病理学确诊的食管癌患者在手术切除及放疗后接受了25次PET/CT扫描（3例患者进行了2次扫描，1例患者进行了3次扫描）以进行再分期。肿瘤复发的标准参考是¹⁸F-FDG PET/CT检查后至少10个月的组织病理学确认或临床随访。
20例患者中有7例（35%）经组织病理学证实肿瘤复发，13例（65%）经临床及影像学随访证实。¹⁸F-FDG PET/CT检查结果为阳性的有14例（68.4%），阴性的有6例（31.6%）。¹⁸F-FDG PET/CT真阳性11例，假阳性3例，真阴性6例。总体而言，¹⁸F-FDG PET/CT的准确率为85%，阴性预测值（NPV）为100%，阳性预测值（PPV）为78.6%。PET/CT的3例假阳性结果包括纵隔淋巴结慢性炎症（2例）和吻合口炎症（1例）。PET/CT显示10例患者有远处转移。9例患者接受了¹⁸F-FDG PET/CT成像引导下的挽救性治疗。在将¹⁸F-FDG PET/CT引入常规治疗后随访方案后，12例（60%）患者的治疗方案发生了改变。
全身¹⁸F-FDG PET/CT对检测食管癌手术切除及放疗后的复发有效。它对食管癌的治疗管理也可能有重要的临床影响，对患者的临床再分期和挽救性治疗均有影响。
