Whole-body FDG positron emission tomographic imaging for staging esophageal cancer - Comparison with computed tomography
Whole-body FDG positron emission tomographic imaging for staging esophageal cancer - Comparison with computed tomography
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DOI：
10.1097/00003072-200011000-00005
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发表时间：
2000-11-01
影响因子：
10.6
通讯作者：
Townsend, DW
中科院分区：
文献类型：
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作者：
Meltzer, CC;Luketich, JD;Townsend, DW
目的：本研究作者的目的是严格评估全身正电子发射断层扫描（PET）成像与氟-18氟脱氧葡萄糖（FDG）在食管癌分期中的作用，并进一步将该方法与传统的计算机断层扫描（CT）成像进行比较。材料和方法：作者是独立的，对47例在微创手术前进行食管癌初始分期的患者的FDG PET图像进行盲法回顾性评价分期付款随机选择了20项来自非食道胸癌患者的PET研究纳入PET读数中。在47例病例中的37例子集中，将PET结果与在相同的6周间隔内获得的CT研究的独立读数进行比较。使用高灵敏度解释（即，将不确定的发现指定为阳性）和低灵敏度解释（即，结果：PET诊断局部淋巴结转移的敏感性（高敏感度模式为41%，低敏感度模式为35%）低于CT（63%~ 87%），72%的患者通过手术评估确定。然而，值得注意的是，PET确定的淋巴结部位的特异性（约90%）高于CT（14%至43%）。在检测组织学证实的远处转移（n = 10）中，当以高灵敏度模式应用时，PET表现得相当好，在总组和具有相关CT数据的患者子集中，灵敏度率约为70%，特异性率超过90%。在低灵敏度模式中，CT仅识别了7个转移部位中的2个，而高灵敏度模式导致不可接受的高假阳性读数率（阳性预测值，29%）。PET正确地确定了一个额外的转移部位，没有检测到CT.Conclusions：PET识别局部病变的敏感性相对较低，排除了其替代传统的CT分期。然而，PET成像的主要优点是其对肿瘤检测的上级特异性和对远处转移部位的诊断价值的提高，这些特征可能会极大地影响患者的管理决策。总之，PET成像在食管癌的初始分期中是有用的，并提供了通过CT成像获得的额外和补充信息。
Purpose: The aim of the authors in this study was to critically evaluate the role of whole-body positron emission tomographic (PET) imaging with fluorine-18 fluorodeoxyglucose (FDG) in staging esophageal cancer, and further to compare this method with conventional imaging with computed tomography (CT).Materials and Methods: The authors performed independent, blinded retrospective evaluations of FDG PET images obtained in 47 patients referred for the initial staging of esophageal cancer before minimally invasive surgical staging. Twenty PET studies from patients with nonesophageal thoracic cancers were randomly selected for inclusion in the PET readings. In a subset of 37 of 47 cases, the PET findings were compared with independent readings of CT studies acquired within the same 6-week interval, The utility of the imaging findings was evaluated using a high-sensitivity interpretation (i.e., assigning equivocal findings as positive) and a low-sensitivity interpretation (i.e., assigning equivocal findings as negative).Results: PET was less sensitive (41% in high-sensitivity mode, 35% in low-sensitivity mode) than CT (63% to 87%) for diagnosing tumor involvement in locoregional lymph nodes, which was identified by surgical assessment in 72% of patients. Notable, however, was the greater specificity of PET-determined nodal sites (10 approximately 90%) compared with CT (14% to 43%). In detecting histologically proved distant metastases (n = 10), PET performed considerably better when applied in the high-sensitivity mode, with a sensitivity rate of approximately 70% and a specificity rate of more than 90% in the total group and in the subset of patients with correlative CT data, In the low-sensitivity mode, CT identified only two of seven metastatic sites, whereas the high-sensitivity mode resulted in an unacceptably high rate of false-positive readings (positive predictive value, 29%). PET correctly identified one additional site of metastasis that was not detected by CT.Conclusions: The relatively low sensitivity of PET for identifying locoregional lesions precludes its replacement of conventional CT staging. However, the primary advantage of PET imaging is its superior specificity for tumor detection and improved diagnostic value for distant metastatic sites, features that may substantially affect patient management decisions. In conclusion, PET imaging is useful in the initial staging of esophageal cancer and provides additional and complementary information to that obtained by CT imaging.