Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
Department of Nuclear Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
Cancer Med. 2018 Aug;7(8):3561-3570. doi: 10.1002/cam4.1617. Epub 2018 Jun 22.
This study aimed to evaluate the frequency of nodal metastases and to disclose the diagnostic performance of endoscopic ultrasonography (EUS) and PET/CT in T and N staging in surgically resected early-stage esophageal squamous cell carcinomas (eSCCs). Institutional review board approved this retrospective study with waiver of informed consent for reviewing medical record. We included 435 patients with an early T-stage (Tis or T1a [≤T1a], T1b and T2) eSCC. The rates of metastatic lymphadenopathy were calculated. Then, the performance of EUS and PET/CT in subdividing T and N stages was assessed. 131 ≤ T1a, 234 T1b, and 70 T2 eSCCs were identified. In discriminating ≤T1a from other cancers, the sensitivity, specificity, and accuracy of EUS were 60.3% (79/131), 80.3% (244/304), and 74.3% (323/435) respectively. With ROC curve analysis, cut-off value of SUVmax 3.05 at PET provided sensitivity 74.8% (98/131), specificity 70.1% (213/304), and accuracy 71.5% (311/435) for differentiating ≤T1a eSCCs from others. Ten (7.6%) of 131 ≤ T1a cancers had nodal metastasis. In discriminating N0 from node-positive disease, sensitivity, specificity, and accuracy of EUS were 89.6% (267/298), 41.6% (57/137), and 74.5% (324/435), respectively, whereas those of PET/CT were 88.9% (265/298), 38.7% (53/137), and 73.1% (318/435) respectively. In >70% of patients with ≤T1a eSCCs, the tumor stage can be discriminated from higher stage cancers by using EUS or PET/CT. Substantial percentage (7.6%) of ≤T1a eSCC patients have nodal metastases, which are missed in more than half of the patients in clinical staging.
这项研究旨在评估淋巴结转移的频率，并揭示内镜超声检查（EUS）和 PET/CT 在外科切除的早期食管鳞状细胞癌（eSCC）中的 T 和 N 分期中的诊断性能。机构审查委员会批准了这项回顾性研究，对病历进行审查时放弃了知情同意。我们纳入了 435 名早期 T 期（Tis 或 T1a[≤T1a]、T1b 和 T2）eSCC 患者。计算了转移性淋巴结病的发生率。然后，评估了 EUS 和 PET/CT 在细分 T 和 N 分期中的性能。131 例≤T1a、234 例 T1b 和 70 例 T2 eSCC 被确定。在将≤T1a 与其他癌症区分开来时，EUS 的敏感性、特异性和准确性分别为 60.3%（79/131）、80.3%（244/304）和 74.3%（323/435）。通过 ROC 曲线分析，在 PET 中，SUVmax 为 3.05 的截断值为 74.8%（98/131），特异性为 70.1%（213/304），准确性为 71.5%（311/435），用于区分≤T1a eSCCs 与其他癌症。在 131 例≤T1a 癌症中，有 10 例（7.6%）发生淋巴结转移。在将 N0 与阳性淋巴结疾病区分开来时，EUS 的敏感性、特异性和准确性分别为 89.6%（267/298）、41.6%（57/137）和 74.5%（324/435），而 PET/CT 的敏感性、特异性和准确性分别为 88.9%（265/298）、38.7%（53/137）和 73.1%（318/435）。在大多数≤T1a eSCC 患者中，肿瘤分期可以通过 EUS 或 PET/CT 与更高分期的癌症区分开来。在临床分期中，超过一半的患者会遗漏 7.6%的≤T1a eSCC 患者的淋巴结转移。
