Improvement in preoperative staging of gastric adenocarcinoma with positron emission tomography
Improvement in preoperative staging of gastric adenocarcinoma with positron emission tomography
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作者：
Chen, J;Cheong, JH;Noh, SH
背景。正电子发射断层扫描（PET）与18-氟脱氧葡萄糖（FDG）已被用于检测和分期各种恶性肿瘤。本研究探讨了PET在胃腺癌术前分期中的价值。68例胃腺癌患者（男49例，女19例）术前行FDG-PET扫描，纳入本研究。患者在转诊后1周内行螺旋CT检查。所有患者的最终诊断是由组织学和外科检查结果作出的。在PET定量分析中，采用标准化摄取值（SUV）测量肿瘤区域FDG摄取。对于胃腺癌的原发肿瘤，68例患者中有64例（敏感性94%）PET显示摄取增加，平均SUV为7.0（范围0.9-27.7）。FDG摄取与临床病理特征的比较显示，FDG摄取与宏观类型、肿瘤大小、淋巴结转移、组织学类型和TNM分期有显著相关性。PET扫描在诊断局部和远处淋巴结转移以及腹膜状态方面与CT具有相似的准确性。然而，在评估局部淋巴结状态时，PET比CT具有更高的特异性（92%对62%，P = 0.000）。此外，PET在68例患者中的10例（15%）患者中有额外的诊断价值，其中4例（6%）患者和6例（9%）患者。PET联合CT对术前分期的准确性高于单独使用任何一种方式（分别为66%对51%，66%对47%；P = 0.002）。FDG-PET提高胃腺癌术前TNM分期。基于其优越的特异性，FDG-PET可以通过确认CT识别的淋巴结状态来帮助患者选择治疗性切除。(c) 2005年美国癌症协会。
BACKGROUND. Positron emission tomography (PET) with 18- fluorodeoxyglucose (FDG) has been used to both detect and stage a variety of malignancies. The current study examined the value of PET for preoperative staging of gastric adenocarcinoma.METHODS. Sixty-eight patients (49 males and 19 females) with gastric adenocarcinoma, who were referred for preoperative FDG-PET scans, were enrolled in this study. The patients underwent spiral-computed tomography (CT) within 1 week of referral. The final diagnosis in all patients was made by histologic and surgical findings. For quantitative PET analysis, the regional tumor FDG uptake was measured by the standardized uptake value (SUV).RESULTS. For the primary tumor of a gastric adenocarcinoma, PET demonstrated an increased uptake in 64 of 68 patients (sensitivity, 94%), with a mean SUV of 7.0 (range, 0.9-27.7). A comparison of FDG uptake and clinicopathologic features showed significant association between FDG uptake and macroscopic type, tumor size, lymph node metastasis, histologic type, and TNM stage. The PET scan had a similar accuracy with that of CT for diagnosing local and distant lymph node metastases as well as peritoneal status. In assessing local lymph node status, however, PET had a higher specificity than CT (92% vs. 62%, P = 0.000). Moreover, PET had additional diagnostic value in 10 (15%) of 68 patients by upstaging 4 (6%) and downstaging 6 (9%) patients. PET combined with CT was more accurate for preoperative staging than either modality alone (66% vs. 51%, 66% vs. 47%, respectively; P = 0.002).CONCLUSIONS. FDG-PET improves the preoperative TNM staging of gastric adenocarcinoma. Based on its superior specificity, FDG-PET can facilitate the selection of patients for a curative resection by confirming a nodal status identified by CT. (c) 2005 American Cancer Society.