PET/CT Centre, Department of Nuclear Medicine, Radiology, Medical Physics, 'Santa Maria della Misericordia' Hospital, Via Tre Martiri 140, 45100 Rovigo, Italy.
Eur J Radiol. 2012 Jan;81(1):21-30. doi: 10.1016/j.ejrad.2010.10.018. Epub 2010 Nov 4.
Oesophageal cancer (OC) is a highly aggressive tumour with unfavorable prognosis due to early stages metastases. Treatment and survival rates are highly correlated with tumour wall invasion, lymphatic involvement and metastatic spread. Thus, an accurate staging at initial diagnosis is fundamental for optimal management. In the present review article the potential role of the FDG-PET in the staging of OC is discussed.
A systematic review of all papers published in PubMed until June 2010 was performed.
Endoscopic ultrasound (EUS) is helpful for T and N staging but not for M staging. CT plays a complementary role to EUS in T staging, especially in excluding T4 disease. However, in N staging, CT relies on "size criteria" (<1cm=benign, >1cm=malignant) which reduces its sensitivity and specificity. FDG-PET has been demonstrated to be a very helpful tool in staging and re-staging OC. Most OCs demonstrate high FDG accumulation and are usually well detected with PET. Unfortunately, PET cannot reveal very small lesions due to its limited spatial resolution, therefore limiting the usefulness of PET in T staging. In N staging, an FDG positive node is highly likely to contain disease. However, FDG-PET cannot reliably separate the primary site from closely adjacent nodes. The real and unquestionable additional diagnostic value of FDG-PET in comparison to CT and EUS is in evaluating distant metastases.
It appears reasonable to include FDG PET/CT in the diagnostic algorithm of patients with OC in order to better define the optimal therapeutic approach.
食管癌（OC）是一种侵袭性很强的肿瘤，由于早期转移，预后不佳。治疗和生存率与肿瘤壁侵犯、淋巴受累和转移扩散密切相关。因此，在初始诊断时进行准确分期对于最佳治疗至关重要。在本文中，讨论了 FDG-PET 在 OC 分期中的潜在作用。
对截至 2010 年 6 月在 PubMed 上发表的所有论文进行了系统回顾。
内镜超声（EUS）有助于 T 和 N 分期，但不用于 M 分期。CT 在 T 分期方面对 EUS 具有补充作用，特别是在排除 T4 疾病方面。然而，在 N 分期中，CT 依赖于“大小标准”（<1cm=良性，>1cm=恶性），这降低了其敏感性和特异性。FDG-PET 已被证明是分期和再分期 OC 的非常有用的工具。大多数 OC 显示出高 FDG 积累，通常用 PET 很好地检测到。不幸的是，由于其空间分辨率有限，PET 无法检测到非常小的病变，因此限制了 PET 在 T 分期中的有用性。在 N 分期中，FDG 阳性的淋巴结极有可能含有疾病。然而，FDG-PET 不能可靠地将原发部位与相邻的淋巴结分开。与 CT 和 EUS 相比，FDG-PET 在评估远处转移方面具有真正且无可置疑的附加诊断价值。
似乎有理由将 FDG PET/CT 纳入 OC 患者的诊断算法中，以更好地确定最佳治疗方法。
