Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Osaka, Japan.
Department of Radiology, Graduate School of Medicine, Osaka University, Osaka, Japan.
BJS Open. 2022 Jul 7;6(4). doi: 10.1093/bjsopen/zrac090.
Endoscopic and transanal local resection without lymph node dissection are treatment options for patients with a low risk of lymph node metastasis; however, some patients might have undiagnosed lymph node metastases before surgery. This retrospective study aimed to evaluate the efficacy of preoperative PET/CT for diagnosing regional lymph node metastasis.
Patients who underwent curative resection with lymph node dissection for colorectal cancer at Osaka University between January 2012 and December 2015 were included. The cut-off values appropriate for diagnosing lymph node metastasis were calculated by way of a receiver operating characteristic (ROC) curves from maximum standard unit value (SUVmax) of main tumour, and lymph node short axis, and SUVmax of lymph node. The cut-off values of primary tumour SUVmax: 7, short-axis diameter of the lymph node at 7 mm, and lymph node SUVmax at 1.5 were set.
A total of 541 patients were included. Regional lymph node metastases were confirmed in resected specimens from 187 patients (35 per cent). With a primary tumour SUVmax of 7 used as a cut-off value, the sensitivity and specificity of regional lymph node metastasis were 70.1 per cent and 45.5 per cent respectively. With a cut-off short-axis diameter of the regional lymph node of 7 mm, the sensitivity and specificity of regional lymph node metastasis were 75.2 per cent and 82.6 per cent respectively, and with a cut-off regional lymph node SUVmax of 1.5, the sensitivity and specificity of regional lymph node metastasis were 78.6 per cent and 96.8 per cent respectively. When the diagnostic criteria were defined by a lymph node short-axis diameter of 7 mm or SUVmax of 1.5, the sensitivity and specificity were 87.4 per cent and 81.8 per cent respectively.
Preoperative PET/CT is a useful modality for evaluating regional lymph node metastasis in patients with colorectal cancer.
对于淋巴结转移风险低的患者，内镜下和经肛门局部切除术而不进行淋巴结清扫是一种治疗选择；然而，有些患者在手术前可能存在未诊断的淋巴结转移。本回顾性研究旨在评估术前 PET/CT 诊断区域淋巴结转移的效果。
纳入 2012 年 1 月至 2015 年 12 月期间在大阪大学接受根治性切除术伴淋巴结清扫术治疗的结直肠癌患者。通过受试者工作特征（ROC）曲线计算最大标准单位值（SUVmax）、主肿瘤淋巴结短轴、淋巴结 SUVmax 诊断淋巴结转移的合适截断值。原发性肿瘤 SUVmax 的截断值为 7、淋巴结短轴直径为 7mm、淋巴结 SUVmax 为 1.5。
共纳入 541 例患者。在切除标本中证实 187 例（35%）存在区域淋巴结转移。当以原发性肿瘤 SUVmax 为 7 作为截断值时，区域淋巴结转移的灵敏度和特异性分别为 70.1%和 45.5%。当以区域淋巴结短轴直径 7mm 作为截断值时，区域淋巴结转移的灵敏度和特异性分别为 75.2%和 82.6%，当以区域淋巴结 SUVmax 为 1.5 作为截断值时，区域淋巴结转移的灵敏度和特异性分别为 78.6%和 96.8%。当诊断标准定义为淋巴结短轴直径 7mm 或 SUVmax 为 1.5 时，灵敏度和特异性分别为 87.4%和 81.8%。
术前 PET/CT 是评估结直肠癌患者区域淋巴结转移的一种有用方法。
