Bachor R, Kocher F, Gropengiesser F, Reske S N, Hautmann R E
Urologische Klinik, Universität Ulm.
Urologe A. 1995 Mar;34(2):138-42.
Correct preoperative staging of malignant tumors is a prerequisite for an adequate therapy. This is not always possible with the imaging techniques available. Often, only an exploratory laparotomy can give the final diagnosis. Therefore, the search is on for a non-invasive technique for staging. Positron emission tomography (PET) is a new method in nuclear medicine; it is used for the diagnosis of primary tumors, for staging, and for follow-up after therapy. With PET, biochemical pathways and physiological functions are studied, in contrast to CT and MRI, with which anatomy and morphology are examined. In our department PET was used in 26 patients with invasive bladder cancer, in 11 patients with renal cell carcinoma and in 1 patient for follow-up after testicular cancer. The primary bladder tumor was found in 85% of cases; in 4 a non-organ-confined tumor was diagnosed preoperatively. Specificity in staging of lymph nodes was 86% (18/21); in 3 patients lymph nodes were false-positive on PET. However, in 5 patients all lymph node metastases were found by PET. Renal cell carcinoma were found in 8 out of 9 patients; in 2 patients with high-grade tumors an FDG-uptake defect was found. Lymph node staging was accurate in 9 patients without metastases and in 2 with metastases. One patient had a slightly enlarged retroperitoneal lymph node in the follow-up of a non-seminomatous germ cell tumor, which was positive on PET. Histology confirmed that it was the only positive lymph node within the whole specimen after retroperitoneal lymphadenectomy. PET gives new insights in uro-oncology by examination of the metabolism. Our initial results are promising and warrant further studies.
恶性肿瘤准确的术前分期是进行适当治疗的前提。但现有的成像技术并非总能实现这一点。通常，只有通过剖腹探查术才能得出最终诊断。因此，人们一直在寻找一种非侵入性的分期技术。正电子发射断层扫描（PET）是核医学中的一种新方法；它用于原发性肿瘤的诊断、分期以及治疗后的随访。与检查解剖结构和形态的CT和MRI不同，PET研究的是生化途径和生理功能。在我们科室，PET被用于26例浸润性膀胱癌患者、11例肾细胞癌患者以及1例睾丸癌治疗后的随访患者。在85%的病例中发现了原发性膀胱肿瘤；4例患者术前被诊断为非器官局限性肿瘤。淋巴结分期的特异性为86%（18/21）；3例患者的淋巴结在PET检查中呈假阳性。然而，5例患者的所有淋巴结转移均通过PET发现。9例患者中有8例发现了肾细胞癌；2例高级别肿瘤患者发现了FDG摄取缺陷。9例无转移的患者和2例有转移的患者的淋巴结分期准确。1例非精原细胞瘤性生殖细胞肿瘤随访患者的腹膜后淋巴结略有肿大，PET检查呈阳性。组织学证实，这是腹膜后淋巴结清扫术后整个标本中唯一的阳性淋巴结。PET通过检查代谢为泌尿肿瘤学提供了新的见解。我们的初步结果很有前景，值得进一步研究。
