Leung Universe, Pandit-Taskar Neeta, Corvera Carlos U, D'Angelica Michael I, Allen Peter J, Kingham T Peter, DeMatteo Ronald P, Jarnagin William R, Fong Yuman
Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, USA.
HPB (Oxford). 2014 Nov;16(11):1023-30. doi: 10.1111/hpb.12282. Epub 2014 Jun 4.
Current pre-operative staging methods for gallbladder cancer (GBC) are suboptimal in detecting metastatic disease. Positron emission tomography (PET) may have a role but data are lacking.
Patients with GBC and PET assessed by a hepatobiliary surgeon in clinic between January 2001 and June 2013 were retrospectively reviewed. Computed tomography (CT)/magnetic resonace imaging (MRI) were correlated with PET scans and analysed for evidence of metastatic or locally unresectable disease. Medical records were reviewed to determine if PET scanning was helpful by preventing non-therapeutic surgery or enabling resection in patients initially deemed unresectable.
There were 100 patients including 63 incidental GBC. Thirty-eight patients did not proceed to surgery, 35 were resected and 27 patients were explored but had unresectable disease. PET was positive for metastatic disease in 39 patients (sensitivity 56%, specificity 94%). Five patients definitively benefitted from PET: in 3 patients PET found disease not seen on CT, and 2 patients with suspicious CT findings had negative PET and successful resections. In a further 12 patients PET confirmed equivocal CT findings. Three patients had additional invasive procedures performed owing to PET avidity in other sites. Utility of PET was higher in patients with suspicious nodal disease on CT [odds ratio (OR) 7.1 versus no nodal disease, P = 0.0004], and in patients without a prior cholecystectomy (OR 3.1 versus post-cholecystectomy, P = 0.04).
Addition of PET to conventional cross-sectional imaging has a modest impact on management pre-operatively particularly in patients without a prior cholecystectomy and to confirm suspicious nodal disease on CT.
目前胆囊癌（GBC）的术前分期方法在检测转移性疾病方面并不理想。正电子发射断层扫描（PET）可能有一定作用，但相关数据不足。
对2001年1月至2013年6月期间在门诊由肝胆外科医生评估进行PET检查的GBC患者进行回顾性研究。将计算机断层扫描（CT）/磁共振成像（MRI）与PET扫描结果进行对比，并分析有无转移性或局部不可切除疾病的证据。查阅病历以确定PET扫描是否有助于避免非治疗性手术或使最初被认为不可切除的患者能够接受手术切除。
共有100例患者，其中63例为意外发现的GBC。38例患者未进行手术，35例接受了切除手术，27例患者进行了探查但发现有不可切除的疾病。39例患者的PET检查显示有转移性疾病（敏感性56%，特异性94%）。5例患者确实从PET检查中获益：3例患者PET检查发现了CT上未显示的疾病，2例CT检查结果可疑的患者PET检查为阴性并成功进行了切除手术。另有12例患者的PET检查证实了CT检查结果不明确的情况。3例患者因其他部位PET检查呈阳性而进行了额外的侵入性检查。PET在CT检查发现可疑淋巴结疾病的患者中的应用价值更高[比值比（OR）为7.1，而无淋巴结疾病的患者为OR 7.1，P = 0.0004]，在未进行过胆囊切除术的患者中应用价值也更高（OR为3.1，而胆囊切除术后患者为OR 3.1，P = 0.04）。
在传统的断层成像中添加PET对术前管理有一定影响，特别是在未进行过胆囊切除术的患者中，以及用于确认CT检查发现的可疑淋巴结疾病。
