Department of Thoracic Surgery, Fudan University Shanghai Cancer Center, Shanghai, China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China.
Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China; Department of Nuclear Medicine, Fudan University Shanghai Cancer Center, Shanghai, China.
J Thorac Cardiovasc Surg. 2020 Aug;160(2):544-550. doi: 10.1016/j.jtcvs.2019.11.046. Epub 2019 Dec 11.
Accurate nodal staging is crucial for esophageal cancer. A prospective study was performed to assess the value of [18F] fluorodeoxyglucose (FDG) positron emission tomography (PET)/computed tomography (CT) for diagnosing cervical lymph node metastasis (LNM) of esophageal squamous cell carcinoma.
From June 2018 to November 2018, 110 patients with resectable esophageal cancer were prospectively enrolled. Esophagectomy with 3-field lymphadenectomy was performed after FDG-PET/CT scanning. The primary end point was cervical LNM determined via postoperative histologic examination. The sensitivity (SE), specificity (SP), positive predictive value (PPV), negative predictive value (NPV), and accuracy (AC) of FDG-PET/CT for the assessment of LNM were determined using histologic results as reference standards.
Positive lymph nodes as determined via FDG-PET/CT were detected in 61 patients (55.5%), of whom 13 (11.8%) had positive cervical lymph nodes. After surgery, 59 patients (53.6%) exhibited pathologic LNM, of whom 20 (18.2%) had cervical LNM. SE, SP, PPV, NPV, and AC were 65.6%, 61.2%, 67.8%, 58.8%, and 63.6%, respectively, with regards to diagnosing overall LNM, and were 45.0%, 95.6%, 69.2%, 88.7%, and 86.4%, respectively, for diagnosing cervical LNM. Of the 110 patients, 90 underwent both FDG-PET/CT scanning and ultrasonography in the neck, and there were no significant differences in SE, SP, PPV, NPV, or AC with respect to cervical LNM diagnosis between FDG-PET/CT and ultrasonography.
For cervical LNM of esophageal squamous cell carcinoma, FDG-PET/CT scanning exhibited high specificity but low sensitivity, suggesting that it is of limited value for this purpose.
准确的淋巴结分期对食管癌至关重要。本研究旨在评估氟代脱氧葡萄糖（FDG）正电子发射断层扫描（PET）/计算机断层扫描（CT）对诊断食管鳞状细胞癌颈淋巴结转移（LNM）的价值。
2018 年 6 月至 2018 年 11 月，前瞻性纳入 110 例可切除食管癌患者。所有患者均行 FDG-PET/CT 扫描后行三野淋巴结清扫术。主要终点为术后组织学检查确定的颈淋巴结转移。以组织学结果为参考标准，评估 FDG-PET/CT 对 LNM 评估的敏感性（SE）、特异性（SP）、阳性预测值（PPV）、阴性预测值（NPV）和准确性（AC）。
FDG-PET/CT 检测出阳性淋巴结 61 例（55.5%），其中 13 例（11.8%）为颈淋巴结转移。术后病理 LNM 59 例（53.6%），其中颈淋巴结转移 20 例（18.2%）。诊断总 LNM 的 SE、SP、PPV、NPV 和 AC 分别为 65.6%、61.2%、67.8%、58.8%和 63.6%，诊断颈淋巴结转移的 SE、SP、PPV、NPV 和 AC 分别为 45.0%、95.6%、69.2%、88.7%和 86.4%。110 例患者中，90 例行颈 FDG-PET/CT 扫描和颈部超声检查，FDG-PET/CT 和超声对颈淋巴结转移的诊断 SE、SP、PPV、NPV 和 AC 差异均无统计学意义。
对于食管鳞状细胞癌颈淋巴结转移，FDG-PET/CT 扫描具有较高的特异性，但敏感性较低，提示其对诊断颈淋巴结转移的价值有限。
