FDG PET/CT与PET对食管癌淋巴结转移的诊断价值比较

目的比较脱氧葡萄糖(FDG)PET/CT和PET对食管癌淋巴结转移的诊断价值。方法随机选择拟行手术治疗的食管癌患者35例,行PET/CT检查。全部患者均行食管癌切除和淋巴结清扫术,以术后病理检查为金标准,比较PET/CT与PET对食管癌淋巴结转移的诊断价值。结果术后病理结果显示,25例患者存在淋巴结转移。共切取淋巴结313组,其中65组为转移淋巴结。PET确定转移真阳性淋巴结53组,真阴性淋巴结217组。PET/CT确定转移真阳性淋巴结61组,真阴性淋巴结229组。PET诊断转移假阴性淋巴结12组,其中8组被PET/CT校正,包括1组颈深淋巴结,4组食管旁淋巴结,1组胃左动脉干淋巴结,1组左贲门旁淋巴结,1组胃小弯淋巴结;PET诊断转移假阳性淋巴结31组,其中12组被PET/CT校正,3组缘于食管癌原发灶不均匀摄取,2组缘于颈部组织生理性摄取,7组缘于胃肠道生理性摄取或良性病变。PET的敏感性、特异性和准确性分别为81.54%、87.50%和86.26%,PET/CT的敏感性、特异性和准确性分别为93.85%、91.24%和92.65%,PET/CT诊断食管癌淋巴结转移的敏感性和准确性均高于PET(P<0.05)。结论与PET相比,FDG PET/CT诊断食管癌淋巴结转移具有更高的敏感性和准确性,可提供更多有价值的诊断信息。

FDG PET/CT versus PET alone for pre-surgical detection of lymph node metastasis in esophageal carcinoma

Objective To compare the combined FDG PET/CT with PET alone in the detection of lymph node metastasis ( LNM) for esophageal carcinoma patient. Methods From November 2003 to August 2005, 35 patients with esophageal carcinoma underwent FDG PET/CT before esophagectomy and lymph node (LN) dissection. The patients who had history of previous anticancer treatment or diabetes mellitus and inflammatory lung diseases as well as being inoperable for medical reasons were excluded. The results of LNM detection by PET /CT and PET alone were compared with pathological results. Results Twenty-nine men and 6 women were eligible for this study, with a mean age of 57 years (range: 40 to 72 years). Of these 35 patients, 3 had lesion at the upper third thoracic esophagus, 22 at the middle third and 10 at the lower third. All patients underwent surgical resection successfully. Twenty-five patients and 65 out of 313 excised nodal groups were found to have metastases by pathological examination. The true positive and true negative LNM interpretation reached 61 and 229 LN groups on PET/CT versus 53 and 217 LN groups on PET alone. False negative LNM interpretation was found in 12 LN groups on PET alone, and 8 of them were corrected by PET/CT including one cervical LN, 4 paraesophageal LNs, one left gastric arterial LN, one left gastric cardia LN, one lesser gastric curve LN. False positive interpretations on PET alone were found in 31 LN groups, 12 of them were corrected by PET/CT which included 9 false-positive interpretations due to physical tracer uptake (2 in the cervical region and 7 in gastrointestinal tract ) and 3 lesions with heterogeneous tracer uptake in the primary tumor. The sensitivity, specificity and accuracy of LNM detection by PET alone was 81. 54% (53/65), 87. 50% (217/248) , and 86. 26% (270/313), whereas by PET/ CT, which was 93. 85% (61/65), 91. 24% (229/248) and 92. 65% (290/313), respectively. There were statistically significant differences in sensitivity and accuracy of LNM detection between PET/CT and PET alone (0.033 and 0.009). Conclusion Compared with FDG PET alone, FDG PET combined with CT can improve the sensitivity and accuracy in detection of lymph node metastasis in esophageal carcinoma.