Current Issues in the Staging of Esophageal Cancer

Staging technology and the 1983 international staging system for esophageal cancer have changed. The 1988 system is based on depth of wall penetration and regional lymph node involvement; it abandons the previous criteria of tumor length and degree of obstruction. The clinical reasoning behind this change is reviewed. New staging technology includes chest computed tomography (CT), magnetic resonance imaging (MRI), tranesophageal ultrasound (EUS), and invasive surgical staging. Overall accuracy of CT to predict depth of penetration is 80% to 85%. CT accuracy of regional lymph node status is less than 69%, but it is 90% accurate in the detection of distant metastases. MRI is comparable. EUS is 71% to 98% accurate in predicting depth of tumor invasion. Although highly sensitive (85% to 95%), the accuracy of EUS in predicting the status of lymph nodes is adversely affected by low specificity (50% to 60%), reducing its overall accuracy of node prediction to 70% to 88%. EUS may fail to assess intra-abdominal disease in 21% to 36% of patients secondary to esophageal obstruction. Regional nodes on both sides of the diaphragm can be assessed by laparoscopy combined with thoracoscopy. Thoracoscopy and laparoscopy have a greater than 92% accuracy in staging regional nodes. Such information is indispensable for the design of treatment fields. Combinations of these new technologies may provide improved preresectional staging.     

Diagnostic performance of computer tomography,magnetic resonance imaging,and positron emission tomography or positron emission tomography/computer tomography for detection of metastatic lymph nodes in patients with cervical cancer: Meta‐analysis

We performed a meta‐analysis to compare diagnostic performances of computed tomography (CT), magnetic resonance imaging (MRI), and positron emission tomography (PET or PET/CT), for detection of metastatic lymph nodes in patients with cervical cancer. We searched MEDLINE (PubMed), EMBASE and the Cochrane Review database in December 2007. All articles were independently reviewed and selected by three evaluators. We estimated a summary receiver operating characteristic (sROC) curve. The area under the curve (AUC), Q*, and pooled weighted estimates of sensitivity and specificity for each modality by patient‐based and region‐ or node‐based data analyses and conducted pair‐wise comparisons between modalities using the two‐sample Z‐test. Forty‐one of 768 initially identified studies were included in the meta‐analysis. In a patient‐based data analysis, PET or PET/CT showed the highest pooled sensitivity (82%) and specificity (95%), while CT showed 50% and 92%; and MRI, 56% and 91%, respectively. The AUC (0.9641) and Q* (0.9106) of PET or PET/CT were significantly higher than those of MRI (AUC = 0.8270; Q* = 0.7599), both P < 0.001. In region‐ or node‐based data analysis, sensitivities of CT (52%) and PET or PET/CT (54%) were higher than that of MRI (38%), P < 0.02 and P < 0.001, respectively, while specificities of MRI (97%) and PET or PET/CT (97%) were higher than that of CT (92%), both P < 0.001. The AUC and Q* showed no significant difference among CT, MRI, and PET or PET/CT. PET or PET/CT had an overall higher diagnostic performance than did CT or MRI in detecting metastatic lymph nodes in patients with cervical cancer. (Cancer Sci 2010)     

Comparison of the accuracy of magnetic resonance imaging and positron emission tomography/computed tomography in the presurgical detection of lymph node metastases in patients with uterine cervical carcinoma: a prospective study

BACKGROUND: The objective of the current study was to determine the accuracy of magnetic resonance imaging (MRI) and positron emission tomography/computed tomography (PET/CT) for detecting lymph node metastases in patients with uterine cervical carcinoma compared with thin-section histopathologic results from systemic lymphadenectomy. METHODS: Twenty-two patients with International Federation of Obstetrics and Gynecology (FIGO) Stage IB-IVA cervical carcinoma who underwent both MRI and PET/CT before lymphadenectomy were included in this study. Lymphadenectomy involved removing all visible lymph nodes in the surgical fields. To enable region-specific comparisons, paraaortic and pelvic lymph nodes were divided into seven regions: the paraaortic area, both common iliac areas, both external iliac areas, and both internal iliac/obturator areas. Histopathologic evaluation of lymph nodes was the diagnostic standard. Chi-square analysis was used to compare the accuracy of MRI and PET/CT for the detection of metastatic lymph nodes. A P value < or = 0.05 was considered statistically significant. RESULTS: With MRI, the sensitivity, specificity, and accuracy rates for detecting metastatic lymph nodes in each lymph node group were 30.3% (10 of 33 lymph node groups), 92.6% (112 of 121 lymph node groups), and 72.7% (122 of 154 lymph node groups), respectively; with PET/CT, those rates were 57.6% (19 of 33 lymph node groups), 92.6% (112 of 121 lymph node groups), and 85.1% (131 of 154 lymph node groups), respectively. Statistical analysis showed that PET/CT was more sensitive than MRI (P = 0.026) but that there were no statistical differences noted with regard to specificity (P = 1.000) or accuracy (P = 0.180). Power analysis demonstrated that a sample size of 685 lymph node groups (98 patients) would be necessary to demonstrate that PET/CT was more accurate than MRI (alpha = 0.05; beta = 0.80). CONCLUSIONS: PET/CT was more sensitive than MRI for detecting lymph node metastases in patients with uterine cervical carcinoma.     

超声引导下的细针穿刺在头颈部肿瘤淋巴结转移中的诊断价值

头颈部肿瘤的准确分期是决定治疗方案和预后的关键,而颈部淋巴结的评估又是决定分期的关键。目前评估颈部淋巴结的方法有超声、超声引导下的细针穿刺(fine needle aspiration,FNA)、CT、MRI和PET/CT等,超声引导下的FNA具有操作简单、创伤小和禁忌证少等优点,联合细胞块及分子生物学检测可在一定程度上达到病理学诊断目的。该文对超声引导下的FNA在头颈部肿瘤颈部淋巴结转移中的诊断价值进行综述。     

Role of preoperative local and distant staging in rectal cancer

Preoperative imaging in rectal cancer is very important, as accurate staging determines optimal treatment strategy. In this review, imaging modalities for locoregional and distant staging in rectal cancer are discussed. For local staging, superficial tumors are best staged using endorectal US (EUS), as EUS is the most accurate modality for assessment of tumor ingrowth into the rectal wall layers. The more advanced tumors are best imaged using MRI, because MRI accurately predicts the distance from tumor to mesorectal fascia, and thus the circumferential resection margin (CRM), as well as possible invasion into surrounding organs. For the prediction of the nodal status none of the three imaging modalities - EUS, MRI and CT - can be reliably used for clinical decision-making. Only MRI using lymph node specific contrast (such as ultrasmall paramagnetic iron oxide-enhanced MRI) seems promising for the detection of nodal disease. For the detection of distant metastases transabdominal ultrasound and chest X-ray are used as a primary screening tool. However, for the high prevalence group (stage III) both methods are insufficiently sensitive, and CT of the chest plus abdomen is preferred.     

Detection of distant metastases in patients with oesophageal or gastric cardia cancer: a diagnostic decision analysis

Computed tomography (CT) is presently a standard procedure for the detection of distant metastases in patients with oesophageal or gastric cardia cancer. We aimed to determine the additional diagnostic value of alternative staging investigations. We included 569 oesophageal or gastric cardia cancer patients who had undergone CT neck/thorax/abdomen, ultrasound (US) abdomen, US neck, endoscopic ultrasonography (EUS), and/or chest X-ray for staging. Sensitivity and specificity were first determined at an organ level (results of investigations, i.e., CT, US abdomen, US neck, EUS, and chest X-ray, per organ), and then at a patient level (results for combinations of investigations), considering that the detection of distant metastases is a contraindication to surgery. For this, we compared three strategies for each organ: CT alone, CT plus another investigation if CT was negative for metastases (one-positive scenario), and CT plus another investigation if CT was positive, but requiring that both were positive for a final positive result (two-positive scenario). In addition, costs, life expectancy and quality adjusted life years (QALYs) were compared between different diagnostic strategies. CT showed sensitivities for detecting metastases in celiac lymph nodes, liver and lung of 69, 73, and 90%, respectively, which was higher than the sensitivities of US abdomen (44% for celiac lymph nodes and 65% for liver metastases), EUS (38% for celiac lymph nodes), and chest X-ray (68% for lung metastases). In contrast, US neck showed a higher sensitivity for the detection of malignant supraclavicular lymph nodes than CT (85 vs 28%). At a patient level, sensitivity for detecting distant metastases was 66% and specificity was 95% if only CT was performed. A higher sensitivity (86%) was achieved when US neck was added to CT (one-positive scenario), at the same specificity (95%). This strategy resulted in lower costs compared to CT only, at an almost similar (quality adjusted) life expectancy. Slightly higher specificities (97-99%) were achieved if liver and/or lung metastases found on CT, were confirmed by US abdomen or chest X-ray, respectively (two-positive scenario). These strategies had only slightly higher QALYs, but substantially higher costs. The combination of CT neck/thorax/abdomen and US neck was most cost-effective for the detection of metastases in patients with oesophageal or gastric cardia cancer, whereas the performance of CT only had a lower sensitivity for metastases detection and higher costs. The role of EUS seems limited, which may be due to the low number of M1b celiac lymph nodes detected in this series. It remains to be determined whether the application of positron emission tomography will further increase sensitivities and specificities of metastases detection without jeopardising costs and QALYs.     

不同影像学检查对胰腺癌血管浸润及淋巴结转移的前瞻性评估

目的 评价超声(US)、螺旋CT(HCT)、核磁共振成像(MRI)和内镜超声(EUS)等4种影像学检查,对胰腺癌肿瘤局部血管浸润及淋巴结转移的预测价值.方法 对68例胰腺癌患者术前分别进行US、HCT、MRI和EUS检查,记录其肿瘤局部血管浸润及淋巴结转移的手术病理结果,对影像学检查与手术病理结果的一致性和相关性进行分析.结果 (1)US对于肿瘤侵犯下腔静脉、脾动脉、脾静脉的评估与手术病理结果中度一致,HCT对肿瘤侵犯肠系膜上静脉、门静脉、脾静脉的评估结果与手术病理结果高度一致,对肠系膜上动脉、下腔静脉、脾动脉、肝总动脉、肝固有动脉、腹腔动脉干、腹主动脉的评估结果与手术病理结果中度一致.MRI对肿瘤侵犯肠系膜上动脉、肠系膜上静脉、脾动脉、脾静脉的评估结果与手术病理结果中度一致.EUS对肿瘤侵犯脾静脉的评估结果与手术病理结果高度一致,对肿瘤侵犯肠系膜上静脉的评估结果与手术病理结果中度一致.(2)对淋巴结转移的评估,EUS具有最高的敏感性(75.0%)、准确性(87.5%)和阴性预测值(91.7%).HCT和MRI的敏感性明显低于EUS,分别为37.5%和35.3%,US敏感性最低,仅为18.7%.多因素Logistic回归分析结果显示,EUS对淋巴结转移具有独立预测价值(OR=34.50,95%CI:6.54～182.09).结论 HCT评估胰腺癌肿瘤局部血管浸润与手术发现一致性最好,EUS对胰腺癌淋巴结转移具有独立预测价值.     

Clinical approach in patients with metastatic differentiated thyroid carcinoma and negative 131I whole body scintigraphy: importance of 99mTc MIBI scan combined with high resolution neck ultrasonography.

AIMS AND BACKGROUND: The aim of this study was to define the clinical impact of MIBI scan combined with neck ultrasonography on the detection of metastates in differentiated thyroid carcinoma (DTC) patients with elevated serum Tg levels but negative 131I scan (non-functioning DTC). METHODS AND STUDY DESIGN: Eighty-two patients with non-functioning DTC, 19 patients with 131I-positive metastases (functioning DTC), and 24 DTC patients who were disease free after therapy (no cancer patients) were enrolled. 131I scan was performed after administration of low diagnostic and high therapeutic tracer doses. Early and delayed images were obtained after MIBI injection. Neck-chest CT scan and/or MRI were also performed in patients with non-functioning DTC. RESULTS: In the group of non-functioning DTC patients, metastatic foci were detected in 71/82 cases: in the cervical lymph nodes in 51 cases (sensitivity 94.1% with MIBI, 90.2% with US, 35.3% with CT/MRI), mediastinal lymph nodes in 31 cases (sensitivity 100% with MIBI, 58% with CT/MRI), lungs in 8 cases (sensitivity 100% with both MIBI and CT/MRI), and bone in 2 cases (sensitivity 50% with MIBI, 100% with MDP bone scan). Among the 19 patients with functioning DTC a close relationship between MIBI and 131I findings was observed. As regards the 24 tumor-free patients, MIBI was correctly negative in all cases, while US visualized enlarged cervical lymph nodes that were suspected to be neoplastic but proved to be inflammatory lesions at cytology in three patients. CONCLUSIONS: On the basis of these data, MIBI scan combined with neck US could be proposed as a first-line diagnostic imaging modality in the follow-up of DTC patients with elevated serum Tg levels and negative 131I scan.     

18FDG-PET-CT improves specificity of preoperative lymph-node staging in patients with intestinal but not diffuse-type esophagogastric adenocarcinoma

Introduction

The accuracy of preoperative lymph-node staging in patients with adenocarcinoma of the esophagogastric junction (AEG) or gastric cancer (GC) is low. The aim of this study was to assess the accuracy of [18F]fluorodeoxyglucose positron emission tomography/computed tomography (PET-CT) for lymph-node staging in patients with AEG or GC, with or without neoadjuvant treatment.

Imaging of axillary lymph nodes

There is increasing interest in the radiological diagnosis of axillary lymph nodes in patients with breast cancer, especially in the preoperative diagnosis of metastatic nodes. Both CT (computed tomography) and MRI (magnetic resonance imaging) are cross-sectional imaging methods that produce high-quality images of the axilla. MRI also uses contrast enhancement profile, for example in imaging of breast lesions. Few studies have been published on this subject, but the latest have shown high sensitivity and specificity (CT 93.8 and 82.1%, respectively; MRI 90 and 82%, respectively), although, both CT and MRI are restricted to imaging only. US (ultrasound) is widely spread and is fast and accurate with high resolution. Sensitivity and specificity vary (68.2-92% and 90-100%, respectively). Most importantly, there is the possibility of US-guided FNAB (fine-needle aspiration biopsy) of pathological nodes, which increases the specificity. Initial results with colour Doppler are promising, but a recent study has shown that the presence of colour Doppler flow signal is highly non-specific. Other parameters such as flow pattern and distribution may prove to be of value in this method. Today, the method of choice for the daily routine is US in conjunction with FNAB.     

Role of diagnostic imaging in abdominal lymphadenopathy

Abdominal lymph node chains and route of lymph drainage of various organs (stomach, duodenum, liver, gallbladder, pancreas, small intestine, appendix, blind intestine, colon rectum) are analyzed according to their location. The role of conventional radiology and diagnostic imaging is evaluated in the study of abdominal lymphatic system with particular reference to lymphangiography and the new procedures of sonography, CT and MRI. Present methods used in inflammatory abdominal lymphadenopathy with special attention to tuberculous lymphadenitis, liver cirrhosis, neoplastic abdominal lymphadenopathy, colorectal and pancreatic cancer, are illustrated. Combined modality imaging is considered in gastric cancer based on the evolution of the classification of gastric lymph nodes. The role of sonography, endoscopic ultrasonography, spiral CT and MRI is assessed in gastric cancer N staging. A retrospective study is analyzed and perspectives for the application of a new CT protocol are proposed. PET potentialities in the study of abdominal lymph nodes are examined.     

子宫颈癌腹主动脉旁淋巴结转移的诊断及治疗

子宫颈癌在女性恶性生殖系统肿瘤中的发生率居于首位,其中腹主动脉旁淋巴结（para-aortic lymph node PALN）转移与宫颈癌的治疗、预后密切相关。宫颈癌的淋巴转移途经多为宫颈旁、宫旁转移到闭孔、髂内外,再转移到髂总、骶前,最终汇集于腹主动脉旁淋巴结及（或）转移至锁骨上或腹股沟深淋巴结的阶梯式转移,但也存在不经过盆腔淋巴结的跳跃式转移。肿瘤的临床分期、有无宫旁浸润、盆腔淋巴结转移情况以及治疗前SCC 值等被认为是影响腹主动脉旁淋巴结转移的重要因素。术前评价淋巴结是否转移大多通过影像学诊断,CT通过显示淋巴结在横断面上的最大直径以及淋巴结内部密度改变来评价淋巴结是否转移,是目前应用最广泛的诊断方法,但其敏感性及准确性均低于PET 。肿大的腹主动脉旁淋巴结可以手术切除,特别是腹膜外腹主动脉旁淋巴结切除术以及腹腔镜下腹主动脉旁淋巴结切除术,由于其创伤小、对术后放疗影响小等优点逐渐发展起来,既能诊断,同时也有重要的治疗价值。腹主动脉旁淋巴结是宫颈癌治疗后最常见的复发部位之一,但被认为更多是局部病变,对复发淋巴结区域采取积极治疗仍可明显改善生存率。但初治时即存在腹主动脉旁淋巴结转移者,患者往往同时有远处转移或会在较短时间内出现远处转移,预后差。      

Role of endoscopy in staging colorectal cancer

The treatment of colorectal cancer depends in large measure on the depth of tumor invasion and the extent of lymph node involvement. Endoscopic ultrasonography (EUS) has added a new dimension to the evaluation of tumor invasion and lymph node involvement in gastrointestinal cancer. The overall EUS accuracy for colorectal cancer T-staging is 78%, specificity is 73%, and sensitivity is 94%. In determining the nodal involvement by tumor, EUS has an accuracy of 75%, specificity of 73%, and sensitivity of 74%. Comparison with computerized tomography (CT), magnetic resonance imaging (MRI), and MRI with endorectal coil (MRIEC) shows that EUS is an effective single modality for assessing tumor penetration of the rectal wall. It does not, however, allow the assessment of distant metastatic disease. For assessing lymph node involvement, MRIEC offers the most comprehensive information.     

Combined [18F]fluorodeoxyglucose positron emission tomography and computed tomography for detecting contralateral neck metastases in patients with head and neck squamous cell carcinoma

We evaluated the clinical utility of combined [(18)F]fluorodeoxyglucose (FDG) positron emission tomography (PET) and computed tomography (CT), as well as CT and magnetic resonance imaging (MRI) in identifying nodal metastases in the contralateral neck in patients with head and neck squamous cell carcinoma (HNSCC). A total of 114 patients were preoperatively evaluated with PET/CT and CT/MRI. Histopathologic analysis from bilateral neck dissection tissues was used as the gold standard in assessing these imaging techniques. Of the 114 patients, 63 (55%) had neck metastases and 26 (23%) had contralateral neck metastases. On a per-level basis, FDG PET/CT was significantly more sensitive and accurate than CT/MRI in the ipsilateral (88% vs. 70%, P<0.01 and 93% vs. 89%, P<0.01, respectively) and contralateral (52% vs. 36%, P<0.01 and 91% vs. 90%, P=0.039, respectively) neck. PET/CT and CT/MRI were less sensitive in detecting contralateral than ipsilateral neck metastases due to the lower incidence of metastases and smaller nodes on the contralateral side. Combined PET/CT is superior to CT/MRI in detecting metastatic neck nodes in HNSCC patients. However, PET/CT may not abrogate the need for contralateral neck surgery or radiotherapy in these patients.     

颈部转移淋巴结的CT、B超扫描与临床触诊对比分析

目的评价ＣＴ、Ｂ超扫描与临床触诊诊断颈部淋巴结转移的准确性,分析ＣＴ、Ｂ超诊断颈部隐匿性淋巴结转移的价值。方法对６０例７４侧颈淋巴结清扫术的患者做术前前瞻性ＣＴ、Ｂ超检查,术后与病理对照,双盲法观察及分析影像所见,将其结果做统计学处理。结果在７４侧颈部淋巴结清扫术病理检查中５６侧有转移淋巴结,临床触诊检出其中４６侧（敏感性８２．１％,特异性８３．３％,准确性８２．４％）。ＣＴ扫描确诊其中的５３侧（敏感性９４．６％,特异性９４．４％,准确性９４．６％）;ＣＴ可以确诊７０％由临床漏诊的隐匿性转移淋巴结。Ｂ超扫描确诊其中５１侧（敏感性９１．１％,特异性９４．４％,准确性９１．９％）;可以检出５０％由临床漏诊的隐匿性转移淋巴结。结论ＣＴ、Ｂ超扫描评价颈部淋巴结的准确性明显优于临床触诊,可以检出５０％～７０％由临床漏诊的隐匿性转移淋巴结。     

Ultrasonography and ultrasonographically guided fine-needle aspiration biopsy of impalpable cervical lymph nodes in patients with non-small cell lung cancer.

BACKGROUND. Neck ultrasonography (US) and ultrasonographically guided fine-needle aspiration (UGFNA) cytologic examination were used in the staging work-up of 51 consecutive patients with non-small cell lung cancer (NSCLC) with clinically impalpable cervical lymphadenopathy. METHODS. All patients had chest radiography, fiberoptic bronchoscopic examination, computed tomography (CT) scans of the chest and abdomen, bone scan, and US of the abdomen and the neck. RESULTS. Six patients (12%) were found to have cervical lymph nodes by neck US. The cytologic examination of the lymph node aspirates obtained from UGFNA confirmed the metastasis. The clinical stage thus was changed from Stage IIIa to Stage IIIb in one patient. In the other five patients, UGFNA of cervical lymph nodes prevented more invasive diagnostic procedures. CONCLUSIONS. This preliminary study shows that neck US and UGFNA of lymph nodes may be helpful in the pretreatment evaluation of patients with NSCLC with impalpable cervical lymph nodes. However, additional study is needed to confirm this result.     

Diagnostic significance of characteristic findings on ultrasonography for the stitch abscess after surgery in patients with oral squamous cell carcinoma

To elucidate the clinical significance of imaging modalities for detection of stitch abscess after surgery in patients with oral squamous cell carcinoma (SCC). In 137 patients with oral SCC suspected of having lymph node metastases, local recurrence of tumor, or stitch abscess after surgery, the characteristic imaging findings related to lymph node metastases, local recurrence of tumor, and stitch abscess on ultrasonography (US), computed tomography (CT), magnetic resonance (MR), and (18)fluorodeoxyglucose (18FDG)-positron emission tomography (PET) images were identified and analyzed. In all six patients with stitch abscess, characteristic findings were demonstrated on US, different from those of metastatic lymph nodes and local recurrence on CT, MRI, and 18FDG-PET images. Our results suggest that ultrasonography may be a very useful tool for diagnosis of postoperative stitch abscess and may help improve the quality of life of oral SCC patients.     

Staging investigations for oesophageal cancer: a meta-analysis

The aim of the study was to compare the diagnostic performance of endoscopic ultrasonography (EUS), computed tomography (CT), and 18F-fluoro-2-deoxy-D-glucose positron emission tomography (FDG-PET) in staging of oesophageal cancer. PubMed was searched to identify English-language articles published before January 2006 and reporting on diagnostic performance of EUS, CT, and/or FDG-PET in oesophageal cancer patients. Articles were included if absolute numbers of true-positive, false-negative, false-positive, and true-negative test results were available or derivable for regional, celiac, and abdominal lymph node metastases and/or distant metastases. Sensitivities and specificities were pooled using a random effects model. Summary receiver operating characteristic analysis was performed to study potential effects of study and patient characteristics. Random effects pooled sensitivities of EUS, CT, and FDG-PET for regional lymph node metastases were 0.80 (95% confidence interval 0.75-0.84), 0.50 (0.41-0.60), and 0.57 (0.43-0.70), respectively, and specificities were 0.70 (0.65-0.75), 0.83 (0.77-0.89), and 0.85 (0.76-0.95), respectively. Diagnostic performance did not differ significantly across these tests. For detection of celiac lymph node metastases by EUS, sensitivity and specificity were 0.85 (0.72-0.99) and 0.96 (0.92-1.00), respectively. For abdominal lymph node metastases by CT, these values were 0.42 (0.29-0.54) and 0.93 (0.86-1.00), respectively. For distant metastases, sensitivity and specificity were 0.71 (0.62-0.79) and 0.93 (0.89-0.97) for FDG-PET and 0.52 (0.33-0.71) and 0.91 (0.86-0.96) for CT, respectively. Diagnostic performance of FDG-PET for distant metastases was significantly higher than that of CT, which was not significantly affected by study and patient characteristics. The results suggest that EUS, CT, and FDG-PET each play a distinctive role in the detection of metastases in oesophageal cancer patients. For the detection of regional lymph node metastases, EUS is most sensitive, whereas CT and FDG-PET are more specific tests. For the evaluation of distant metastases, FDG-PET has probably a higher sensitivity than CT. Its combined use could however be of clinical value, with FDG-PET detecting possible metastases and CT confirming or excluding their presence and precisely determining the location(s).     

不同影像学检查对胰腺癌肿瘤大小及周围组织浸润的前瞻性评估

目的 前瞻性评估超声(US)、螺旋CT(HCT)、内镜超声(EUS)和核磁共振成像(MRI)在胰腺癌肿瘤大小测量及肿瘤周围组织浸润的预测价值及其临床意义.方法 对68例手术治疗的胰腺癌患者术前进行US、HCT、EUS和MRI检查,每种方法均由2位医师对其肿瘤最大径、最小径及肿瘤周围组织浸润情况进行前瞻性评估,并与手术病理结果进行对比.结果在US、HCT、EUS和MRI等4种检查方法中,EUS是评估肿瘤大小最准确的方法,最大径和最小径的回归系数分别为1.0250(P=0.0426)和0.9873(P＜0.0001).在局部组织侵犯的评估中,EUS准确率(75.8%)和敏感性最高(80.0%),而MRI的阳性预测值(97.4%)最高.单元Logistic回归显示,在胰腺癌局部组织侵犯预测方面,任何一种检查方法与手术病理结果均无相关性(P＞0.05).结论 EUS是评估胰腺癌肿瘤大小最准确的方法,在肿瘤局部组织侵犯预测方面尚需多种方法联合应用.     

The usefulness of MRI and PET imaging for the detection of parametrial involvement and lymph node metastasis in patients with cervical cancer

OBJECTIVE: The purpose of this study is to elucidate the usefulness of magnetic resonance imaging (MRI) and positron emission tomography (PET) for the detection of parametrial involvement and lymph node metastasis in patients with cervical cancer. METHODS: Thirty-six patients with cervical cancer were retrospectively enrolled. MRI and PET scans were performed for all patients within a week before radical surgery. The criterion for malignancy on MRI was >1 cm short axis diameter of the suspected lymph node. On PET, only fluorodeoxyglucose (FDG) uptake was significantly higher than the background and, if this FDG uptake showed on at least two consecutive axial slices, then the lesion was considered as a malignancy. We compared the extent of tumor on the surgical findings with the FIGO staging, MRI and PET scans. RESULTS: The accuracy of FIGO and MRI staging was 67 and 84.4%, respectively. The accuracy for detecting pelvic lymph node metastasis was better for PET than for MRI (78 versus 67%, respectively). All FDG uptake lymph nodes were confirmed as metastatic lymph nodes by pathological evaluation; this included five lymph nodes <1 cm in diameter. CONCLUSION: MRI provides an improved evaluation of local tumor extension, but PET is more useful for the evaluation of pelvic lymph nodes than MRI; however, PET still misses microscopic disease. Further studies are necessary to evaluate the usefulness of PET/computed tomography (CT) for the accuracy of the disease extension and the cost-effectiveness of MRI, PET or PET/CT in patients with cervical cancer.