Lai D T, Fulham M, Stephen M S, Chu K M, Solomon M, Thompson J F, Sheldon D M, Storey D W
Department of Upper Gastrointestinal Surgery, Royal Prince Alfred Hospital, Camperdown, Australia.
Arch Surg. 1996 Jul;131(7):703-7. doi: 10.1001/archsurg.1996.01430190025007.
To compare the accuracy of whole-body position emission tomography (PET)using [18F]fluorodeoxyglucose (FDG) with conventional radiological imaging techniques in identifying operable colorectal cancer metastases to the liver.
A double-blind comparative study of FDG-PET as the criterion standard vs conventional radiological imaging methods as the criterion standard, in staging of recurrent colorectal cancer.
Institutional practice in a tertiary referral center.
Thirty-four consecutive patients with suspected colorectal cancer metastases recruited for the study between May 1993 and October 1994.
Conventional radiological methods of cancer staging included abdominal computed tomography (CT) (n = 34), chest x-rays (n = 15), and chest CT (n = 19) to evaluate extrahepatic disease. Twenty-seven patients were subsequently considered to have apparently isolated cancer metastases to the liver. Anatomical resectability was assessed by magnetic resonance imaging (n = 24) or CT angiography (n = 3) in all study patients. The FDG-PET studies (n = 34) were performed within 8 weeks of conventional radiological imaging.
Malignancy of suspected lesions detected by means of FDG-PET and conventional radiological imaging was confirmed by histopathologic examination of resected specimens and percutaneous biopsy specimens and by serial CT scans demonstrating progression of disease.
Unsuspected extrahepatic malignant disease that was missed by conventional radiological imaging was detected by FDG-PET in 11 patients (32%). The PET-detected extrahepatic malignant disease included retroperitoneal nodal metastases (n = 6), pulmonary metastases (n = 3), and locoregional cancer recurrences (n = 2). The additional information afforded by PET consequently had an influence on the clinical management in 10 patients (29%).
The FDG-PET method enabled selection of patients with apparently curable colorectal cancer metastases to the liver for hepatic resection.
比较采用[18F]氟脱氧葡萄糖（FDG）的全身正电子发射断层扫描（PET）与传统放射成像技术在识别可手术切除的结直肠癌肝转移方面的准确性。
一项双盲对照研究，以FDG-PET作为标准对照，传统放射成像方法作为标准对照，用于复发性结直肠癌的分期。
一家三级转诊中心的机构性医疗实践。
1993年5月至1994年10月期间连续招募的34例疑似结直肠癌转移患者。
癌症分期的传统放射学方法包括腹部计算机断层扫描（CT）（n = 34）、胸部X线检查（n = 15）和胸部CT（n = 19），以评估肝外疾病。随后，27例患者被认为有明显孤立的肝癌转移。所有研究患者均通过磁共振成像（n = 24）或CT血管造影（n = 3）评估解剖可切除性。FDG-PET研究（n = 34）在传统放射成像的8周内进行。
通过切除标本和经皮活检标本的组织病理学检查以及通过显示疾病进展的系列CT扫描，确认FDG-PET和传统放射成像检测到的疑似病变的恶性程度。
FDG-PET在11例患者（32%）中检测到传统放射成像遗漏的意外肝外恶性疾病。PET检测到的肝外恶性疾病包括腹膜后淋巴结转移（n = 6）、肺转移（n = 3）和局部癌症复发（n = 2）。因此，PET提供的额外信息对10例患者（29%）的临床管理产生了影响。
FDG-PET方法能够选择有明显可治愈的结直肠癌肝转移患者进行肝切除。
