Greven K M, Williams D W, Keyes J W, McGuirt W F, Harkness B A, Watson N E, Raben M, Frazier L C, Geisinger K R, Cappellari J O
Bowman Gray School of Medicine, Department of Radiology (Radiation Oncology), Winston-Salem, NC.
Int J Radiat Oncol Biol Phys. 1994 Jul 1;29(4):841-5. doi: 10.1016/0360-3016(94)90574-6.
Distinguishing persistent or recurrent tumor from postradiation edema, or soft tissue/cartilage necrosis in patients treated for carcinoma of the larynx can be difficult. Because recurrent tumor is often submucosal, multiple deep biopsies may be necessary before a diagnosis can be established. Positron emission tomography with 18F-2fluoro-2deoxyglucose (FDG) was studied for its ability to aid in this problem.
Positron emission tomography (18FDG) scans were performed on 11 patients who were suspected of having persistent or recurrent tumor after radiation treatment for carcinoma of the larynx. Patients underwent thorough history and physical examinations, scans with computerized tomography, and pathologic evaluation when indicated. Standard uptake values were used to quantitate the FDG uptake in the larynx.
The time between completion of radiation treatment and positron emission tomography examination ranged from 2 to 26 months with a median of 6 months. Ten patients underwent computed tomography (CT) of the larynx, which revealed edema of the larynx (six patients), glottic mass (four patients), and cervical nodes (one patient). Positron emission tomography scans revealed increased FDG uptake in the larynx in five patients and laryngectomy confirmed the presence of carcinoma in these patients. Five patients had positron emission tomography results consistent with normal tissue changes in the larynx, and one patient had increased FDG uptake in neck nodes. This patient underwent laryngectomy, and no cancer was found in the primary site, but nodes were pathologically positive. One patient had slightly elevated FDG uptake and negative biopsy results. The remaining patients have been followed for 11 to 14 months since their positron emission studies and their examinations have remained stable. In patients without tumor, average standard uptake values of the larynx ranged from 2.4 to 4.7, and in patients with tumor, the range was 4.9 to 10.7.
Positron emission tomography with labeled FDG appears to be useful in distinguishing benign from malignant changes in the larynx after radiation treatment. This noninvasive technique may be preferable to biopsy, which could traumatize radiation-damaged tissues and precipitate necrosis.
区分喉癌患者放疗后出现的持续性或复发性肿瘤与放射性水肿、软组织/软骨坏死可能具有挑战性。由于复发性肿瘤常位于黏膜下，在确诊前可能需要多次深部活检。对18F - 氟代脱氧葡萄糖（FDG）正电子发射断层扫描（PET）辅助解决这一问题的能力进行了研究。
对11例疑似喉癌放疗后存在持续性或复发性肿瘤的患者进行了正电子发射断层扫描（18FDG）。患者接受了全面的病史和体格检查、计算机断层扫描，并在必要时进行了病理评估。采用标准摄取值来定量喉部的FDG摄取情况。
放疗结束至正电子发射断层扫描检查的时间为2至26个月，中位数为6个月。10例患者接受了喉部计算机断层扫描（CT），显示喉部水肿（6例）、声门肿物（4例）和颈部淋巴结肿大（1例）。正电子发射断层扫描显示5例患者喉部FDG摄取增加，喉切除术证实这些患者存在癌。5例患者的正电子发射断层扫描结果与喉部正常组织变化一致，1例患者颈部淋巴结FDG摄取增加。该患者接受了喉切除术，原发部位未发现癌症，但淋巴结病理检查呈阳性。1例患者FDG摄取略有升高，活检结果为阴性。其余患者自正电子发射研究后已随访11至14个月，检查结果保持稳定。无肿瘤患者喉部的平均标准摄取值为2.4至4.7，有肿瘤患者的范围为4.9至10.7。
标记FDG的正电子发射断层扫描似乎有助于区分放疗后喉部的良性与恶性变化。这种非侵入性技术可能比活检更可取，活检可能会损伤受辐射损伤的组织并导致坏死。
