First Department of Surgery, Dokkyo Medical University, Mibu, Tochigi, Japan.
Cancer Med. 2018 Aug;7(8):3604-3610. doi: 10.1002/cam4.1628. Epub 2018 Jun 28.
F-Fluorodeoxyglucose positron emission tomography (FDG-PET) is a useful imaging modality that reflects the tumor activity. However, FDG-PET is mainly used for advanced cancer, not superficial cancer. In this study, we investigated the relationship between the superficial tumor depth of esophageal cancer and the FDG uptake to determine the indications for endoscopic resection (ER). From 2009 to 2017, 444 patients with esophageal cancer underwent esophagectomy or endoscopic submucosal dissection (ESD), and 195 patients were pathologically diagnosed with superficial cancer. Among them, 146 patients were examined by FDG-PET before esophagectomy or ESD. In these 146 patients, the relationship between the pathological tumor depth and FDG uptake was analyzed. The mean maximum standardized uptake value in pT1a-EP/LPM tumors was 1.362 ± 0.890, that in pT1a-MM/pT1b-SM1 tumors was 2.453 ± 1.872, and that in pT1b-SM2/SM3 tumors was 4.265 ± 3.233 (P < .0001). Among 51 pT1a-EP/LPM tumors, 10 (19.6%) showed positive detection of FDG. For pT1a-MM/pT1b-SM1 and pT1b-SM2/SM3 tumors, the detection rate was 52.9% (18/34) and 82.0% (50/61), respectively. The detection rate of pT1a-EP/LPM was significantly lower than in the other two groups (P < .0001). Among 10 FDG-PET-positive lesions, only 1 had no apparent reason for PET positivity; however, 9 of 10 had a suitable reason for detectability by PET and inadequacy for ER. Negative detection of superficial esophageal squamous cell carcinoma by FDG-PET is useful to determine the indication for ER when the tumor depth cannot be diagnosed even after performing magnifying endoscopy with narrow band imaging and endoscopic ultrasonography. When FDG uptake is recognized, a therapeutic modality other than ER should be considered.
氟代脱氧葡萄糖正电子发射断层扫描（FDG-PET）是一种有用的成像方式，可反映肿瘤活性。然而，FDG-PET 主要用于晚期癌症，而不是早期癌症。在这项研究中，我们调查了食管癌的浅表肿瘤深度与 FDG 摄取之间的关系，以确定内镜切除（ER）的适应证。2009 年至 2017 年间，444 例食管癌患者接受了食管切除术或内镜黏膜下剥离术（ESD），其中 195 例病理诊断为早期癌症。其中，146 例患者在食管切除术或 ESD 前接受了 FDG-PET 检查。在这 146 例患者中，分析了病理肿瘤深度与 FDG 摄取之间的关系。pT1a-EP/LPM 肿瘤的最大标准化摄取值的平均值为 1.362±0.890，pT1a-MM/pT1b-SM1 肿瘤为 2.453±1.872，pT1b-SM2/SM3 肿瘤为 4.265±3.233（P<0.0001）。在 51 例 pT1a-EP/LPM 肿瘤中，10 例（19.6%）显示 FDG 阳性检测。对于 pT1a-MM/pT1b-SM1 和 pT1b-SM2/SM3 肿瘤，检测率分别为 52.9%（18/34）和 82.0%（50/61）。pT1a-EP/LPM 的检测率明显低于其他两组（P<0.0001）。在 10 例 FDG-PET 阳性病变中，只有 1 例无明显的 FDG 阳性原因；然而，10 例中有 9 例有 PET 检测的适当原因，不适合 ER。即使在使用窄带成像放大内镜和内镜超声检查后仍无法诊断肿瘤深度时，早期食管鳞状细胞癌的 FDG-PET 阴性检测有助于确定 ER 的适应证。当发现 FDG 摄取时，应考虑 ER 以外的治疗方式。
