Department of Gastroenterological Surgery, Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama University, Okayama, Japan.
Clin Nucl Med. 2011 Oct;36(10):854-9. doi: 10.1097/RLU.0b013e318217adc9.
Evaluating the status of disease progression is critical for planning a therapeutic strategy for esophageal cancer. In this regard, F-18 fluorodeoxyglucose-labeled positron emission tomography (PET) is one of the most useful diagnostic modalities. However, there is room to improve its diagnostic performance, such as distinguishing lymph nodal metastases from false positives. In this study, we examined the diagnostic accuracy of fluorodeoxyglucose PET accompanied by computed tomography imaging (PET/CT) to detect regional lymph nodal metastasis from esophageal squamous cell carcinoma (ESCC).
A total of 102 patients diagnosed as ESCC were subjected to this study. These patients had a preoperative PET/CT examination to evaluate the existence of metastasis. The values of maximum standardized uptake value (SUVmax) in primary tumors and in metastasized lymph nodes were measured to analyze their relationship with various clinicopathologic characteristics including the status of tumor cell proliferation, which was assessed by immunohistochemistry for Ki-67.
The SUVmax of the primary tumor was positively correlated with tumor size and vessel invasion, and was positively related with the SUVmax of lymph nodal metastasis, especially in cases of poorly differentiated ESCC. The SUVmax of metastasized lymph nodes was higher in larger-sized metastasized lymph nodes, whereas the Ki-labeling index of lymph nodal metastasis was positively related with the SUVmax per unit area (SUVmax/mm). The diagnostic accuracy of PET/CT (87.3%) was higher than that of conventional CT scans (78.4%).
The improved diagnostic accuracy of PET/CT can be explained by its ability to detect actively progressive metastasis at an early phase regardless of size.
评估疾病进展状况对于制定食管癌治疗策略至关重要。在这方面，18F 氟代脱氧葡萄糖标记的正电子发射断层扫描（PET）是最有用的诊断方式之一。然而，其诊断性能仍有提升空间，例如区分淋巴结转移与假阳性。在本研究中，我们检验了氟代脱氧葡萄糖 PET 联合计算机断层扫描成像（PET/CT）在诊断食管鳞状细胞癌（ESCC）区域淋巴结转移中的准确性。
共有 102 例被诊断为 ESCC 的患者参与了本研究。这些患者接受了术前 PET/CT 检查以评估转移的存在。测量原发肿瘤和转移淋巴结中最大标准化摄取值（SUVmax），以分析其与包括肿瘤细胞增殖状态在内的各种临床病理特征的关系，肿瘤细胞增殖状态通过 Ki-67 免疫组化进行评估。
原发肿瘤的 SUVmax 与肿瘤大小和血管侵犯呈正相关，与淋巴结转移的 SUVmax 呈正相关，尤其是在分化不良的 ESCC 中。转移淋巴结的 SUVmax 与淋巴结转移灶的大小呈正相关，而淋巴结转移灶的 Ki-67 标记指数与单位面积 SUVmax（SUVmax/mm）呈正相关。PET/CT 的诊断准确性（87.3%）高于常规 CT 扫描（78.4%）。
PET/CT 诊断准确性的提高可以通过其在早期阶段检测活跃进展性转移的能力来解释，而与转移灶的大小无关。
