Department of Gastroenterology, Shanghai First People's Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, PR China.
Tohoku J Exp Med. 2012 Sep;228(1):9-16. doi: 10.1620/tjem.228.9.
Accurate staging of gastric cancer is helpful to determine the most appropriate therapy, but no staging modality has been accepted as the standard. Objective is to evaluate the usefulness of endoscopic ultrasonograph (EUS) combined with position emission tomography and computed tomograph (PET-CT) in gastric cancer staging. A total of 124 patients confirmed with gastric cancer were subjected to staging with EUS and PET-CT scanning. The detection rate of primary tumor was 99.2% by combination use of two modalities and 97.6% by EUS alone (p = 0.6219), but the detection rate was 90.3% (112 of 124) by PET-CT alone (compared with the combination, p = 0.0027; compared with EUS alone, p = 0.0299). The locoregional lymph node invasion was identified in 84/124 (67.7%) by combined PET-CT and EUS, which was obviously higher than that with EUS (52.4%) or PET-CT (43.5%) alone (p = 0.0194 and p = 0.0002, respectively). There was no statistical difference in identification of celiac axis lymph node metastasis among three methods, but the combined examination or PET-CT alone was more effective than EUS alone in the detection of distant metastases (all p < 0.01). Furthermore, the combined EUS and PET-CT was more optimal than using EUS or PET-CT alone in the accurate T and N staging and the effect on change of treatment. The present study indicates that the combination of EUS and PET-CT is an ideal modality in the preoperative staging of gastric cancer and it provides beneficial guidance for the treatment of gastric cancer.
胃癌的准确分期有助于确定最合适的治疗方案，但尚无一种分期方法被公认为标准。本研究旨在评估内镜超声（EUS）联合正电子发射断层扫描和计算机断层扫描（PET-CT）在胃癌分期中的应用价值。对 124 例经组织学证实的胃癌患者进行 EUS 和 PET-CT 分期。两种方法联合使用时，原发肿瘤的检出率为 99.2%，EUS 单独使用时为 97.6%（p = 0.6219），但 PET-CT 单独使用时为 90.3%（112/124）（与联合使用相比，p = 0.0027；与 EUS 单独使用相比，p = 0.0299）。联合使用 PET-CT 和 EUS 可识别 84/124（67.7%）例局部区域淋巴结侵犯，明显高于 EUS（52.4%）或单独 PET-CT（43.5%）（p = 0.0194 和 p = 0.0002）。三种方法在识别腹腔干淋巴结转移方面无统计学差异，但联合检查或单独 PET-CT 比单独 EUS 更有效地检测远处转移（均 p < 0.01）。此外，EUS 和 PET-CT 联合检查比单独使用 EUS 或 PET-CT 更能准确分期 T 和 N 分期，并对治疗方案的改变产生影响。本研究表明，EUS 和 PET-CT 联合检查是胃癌术前分期的理想方法，为胃癌的治疗提供了有益的指导。
