CT及18F-FDGPET/CT诊断食管癌术前淋巴结转移及N分期对比研究

目的 研究CT及18F-氟脱氧葡萄糖(FDG) PET/CT术前诊断食管癌淋巴结转移及确定N分期的价值.资料与方法 连续随机选择经食管镜或胃镜证实、拟行手术治疗、能够耐受手术的47例食管癌患者,术前1周内行CT及18F-FDG PET/CT检查,以术后病理为“金标准”,比较CT及18F-FDG PET/CT诊断食管癌淋巴结转移及N分期的敏感性、特异性、准确性、阳性预测值及阴性预测值.结果 31例存在淋巴结转移,共切除并分离淋巴结387枚(209组),其中65枚(46组)发现转移.CT诊断淋巴结转移的敏感性、特异性、准确性、阳性预测值、阴性预测值分别为53.8％、92.8％、86.3％、60.3％和90.9％;18F-FDG PET/CT分别为89.2％、93.8％、93.0％、74.4％和97.7％.PET/CT诊断淋巴结转移的敏感性、准确性及阴性预测值均显著高于CT,差异有统计学意义(P＜0.05),特异性及阳性预测值差异无统计学意义(P＞0.05).CT及18F-FDG PET/CT确定淋巴结分期的准确率分别为74.5％和91.5％,差异有统计学意义(P＜0.05).伴淋巴结转移的食管癌原发灶最大标准摄取值(SUVmax)为( 14.899±3.770),而无淋巴结转移者为(9.427±2.854).结论 18F-FDGPET/CT术前诊断食管癌淋巴结转移及确定N分期优于CT;食管癌原发灶SUVmax在一定程度上可以反映淋巴结转移情况.

CTVersus 18F-FDGPET/CT for Pre-surgical Detection of Lymph Node Metastasis and N Staging in Esophageal Carcinoma:a Comparative Study

Purpose To compare the diagnostic values of CT and 18 F-FDG PET/CT in the detection of lymph node metastasis and N staging for esophageal carcinoma.Materials and Methods Forty-seven patients with esophageal carcinoma proved by esophagoscope or gastroscope were enrolled in this study.The CT and 18 F-FDG PET/CT examination were performed one week before surgery.The diagnostic values of CT and 18 F-FDG PET/CT in the detection of lymph node metastasis and N staging were compared.The pathological results served as gold standard.Results The pathological examination confirmed metastasis in thirty-one out of forty-seven patients and sixty-five out of three hundred and eighty-seven excised lymph nodes.For CT analysis,the sensitivity,specificity,accuracy,positive predictive value and negative predictive value was 53.8%,92.8%,86.3%,60.3% and 90.9%,respectively.PET/CT resulted in a sensitivity of 89.2%,a specificity of 93.8%,a diagnostic accuracy of 93.0%,a positive predictive value of 74.4% and a negative predictive value of 97.7%.The accuracy of CT and 18 F-FDG PET/CT in defining N staging was 74.5% and 91.5% respectively.PET/CT was better in diagnostic sensitivity,accuracy,negative predictive value and defining N staging than CT(P < 0.05),but the differences of the specificity and positive predictive value between PET/CT and CT showed no difference.The SUV max of primary lesion accompanied with lymph node metastasis and without lymph node metastasis were (14.899±3.770) and (9.427±2.854) respectively.Conclusion The diagnostic values of 18 F-FDG PET/CT in the detection of lymph node metastasis and N staging for esophageal carcinoma outweigh CT.To some extent,The SUV max of primary lesion can reflect the lymph node metastasis.