Preoperative chemo-radiation-induced ulceration in patients with esophageal cancer: A confounding factor in tumor response assessment in integrated computed tomographic-positron emission tomographic imaging
Preoperative chemo-radiation-induced ulceration in patients with esophageal cancer: A confounding factor in tumor response assessment in integrated computed tomographic-positron emission tomographic imaging
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DOI：
10.1097/01243894-200606000-00016
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发表时间：
2006-06-01
影响因子：
20.4
通讯作者：
Swisher, Stephen G.
中科院分区：
文献类型：
--
作者：
Erasmus, Jeremy J.;Munden, Reginald F.;Swisher, Stephen G.
假设：正电子发射断层扫描可用于预测食道癌手术前放化疗(CRT)后的疗效。我们评价了综合CT-PET在食道癌CRT术后患者中的应用。方法：3位临床和病理分期盲目的评价者回顾了术前CRT后食道癌患者的CT-PET扫描结果。[F-18]-氟-2-脱氧-D-葡萄糖摄取通过肉眼分析和标化摄取值(SUV；=4)半定量测定残留恶性肿瘤的摄取量。通过目测分析，CT-PET在检测残留恶性肿瘤方面的敏感性为47%，特异性为58%。半定量分析显示，19例患者在原发灶区域有SUV-4，并被解释为有残留恶性肿瘤(敏感性43%，特异性50%)。在这19例中，有6例对CRT有完全病理反应。由于内窥镜检查发现的治疗诱导的溃疡，这些假阳性结果限制了单独使用CT-PET来检测残留恶性肿瘤。同样，在检测残留恶性肿瘤方面，内窥镜/活检的敏感性(25%)和特异性(73%)都很差。然而，CT-PET在检测残留恶性肿瘤方面的准确性在结合内窥镜检查结果时得到了提高。在胃镜检查无溃疡的情况下，8例化疗后SUV和GT；=4的患者中有8例在手术中仍有肿瘤残留。结论：CRT诱导的溃疡导致CT-PET假阳性，妨碍了对残留食道肿瘤的准确检测。然而，CT-PET结合内窥镜检查有助于确定CRT后肿瘤残留的高风险患者。
Hypothesis: Positron emission tomography can be useful in predicting response of esophageal cancer after preoperative chemo-radiation therapy (CRT). We evaluated the use of integrated computed tomography (CT)-PET among patients with esophageal cancer being considered for resection after CRT.Methods: Three reviewers blinded to clinical and pathologic staging retrospectively reviewed the CT-PET scans of patients with esophageal cancer after preoperative CRT who underwent esophagectomy. [F-18]-fluoro-2-deoxy-D-glucose uptake for residual malignancy was determined by visual analysis and semi-quantitatively when standardized uptake value (SUV) was >= 4.Results: Forty-two patients underwent esophageal resection. Using visual analysis, CT-PET had a sensitivity of 47% and specificity of 58% in detecting residual malignancy. Using semi-quantitative analysis, 19 patients had a SUV 4 in the region of the primary esophageal tumor and were interpreted as having residual malignancy (sensitivity 43%, specificity 50%). Of these 19, six had complete pathologic response to CRT. These false-positive results, due to therapy-induced ulceration detected at endoscopy, limit the use of CT-PET alone in detecting residual malignancy. Similarly, sensitivity (25%) and specificity (73%) of endoscopy/biopsy in detecting residual malignancy were poor. However, the accuracy of CT-PET in detecting residual malignancy was improved when combined with endoscopic findings. In the absence of ulceration at endoscopy, 8 of 8 patients with SUV >= 4 after chemo-radiation had residual malignancy at surgery.Conclusions: CRT-induced ulceration results in false-positive results on CT-PET and precludes accurate detection of residual esophageal tumor. However, CT-PET in combination with endoscopy is useful in identifying patients with a high risk of residual tumor post-CRT.