Usefulness of combined PET/CT to assess regional lymph node involvement in gastric cancer
Usefulness of combined PET/CT to assess regional lymph node involvement in gastric cancer
复制标题
DOI：
10.1700/1491.16415
复制
发表时间：
2014-03-01
期刊：
影响因子：
1.9
通讯作者：
Song, Hunho
中科院分区：
文献类型：
--
作者：
Park, Kwonoh;Jang, Geundoo;Song, Hunho
目标和背景。本研究的目的是评价正电子发射断层扫描/计算机断层扫描（PET/CT）对胃癌术前分期的价值，并比较PET/CT与对比增强计算机断层扫描（CECT）的诊断性能。我们回顾性分析了2007年4月至2011年7月期间接受术前PET/CT和CECT以及随后根治性手术切除的74例胃癌患者。回顾性分析了原发性胃肿瘤和淋巴结转移的术前PET/CT和CECT图像。所有患者的原发肿瘤和淋巴结转移的最终诊断均基于组织病理学标本。65%的患者（n = 48）存在晚期胃癌，其余患者为早期胃癌（n = 26）。16例患者（22%）显示印戒细胞组织学。对于原发肿瘤的检测，PET/CT的敏感性显著高于CECT（分别为67%和55%; P = 0.049）。PET/CT和CECT对区域淋巴结转移的敏感性、特异性和准确性分别为34%和51%（P = 0.065）、88%和79%（P = 0.687）、58%和64%（P = 0.332）。PET/CT和CECT均未发现早期胃癌患者的区域淋巴结转移。印戒细胞组织学显示非FDG亲合性淋巴结转移趋势（比值比= 0.15，95%置信区间0.17-1.37，P = 0.093）。PET/CT的准确性较低，对于早期胃癌和印戒细胞癌的总体胃癌分期来说，它不是一个有用的工具。PET/CT对区域淋巴结转移的诊断敏感性不如CECT。
Aims and background. The aim of this study was to evaluate the value of positron emission tomography/computed tomography (PET/CT) for preoperative staging of gastric cancer and to compare the diagnostic performance of PET/CT with that of contrast-enhanced computed tomography (CECT).Methods. We retrospectively reviewed 74 gastric cancer patients who underwent preoperative PET/CT and CECT, and subsequent curative surgical resection between April 2007 and July 2011. Preoperative PET/CT and CECT images for primary tumors of the stomach and lymph node metastases were reviewed retrospectively. The final diagnoses of primary tumors and LN metastases were based on histopathological specimens in all patients.Results. Advanced gastric cancer was present in 65% of patients (n = 48), and the remaining patients had early gastric cancer (n = 26). Sixteen patients (22%) showed signet-ring-cell histology. For the detection of the primary tumor, the sensitivity of PET/CT was significantly higher than that of CECT (67% vs 55%, respectively; P = 0.049). For the evaluation of regional lymph node metastasis, the sensitivity, specificity, and accuracy of PET/CT and CECT were 34% and 51% (P = 0.065), 88% and 79% (P = 0.687), and 58% and 64% (P = 0.332), respectively. Neither PET/CT nor CECT detected regional lymph node metastases in early gastric cancer patients. Signet-ring-cell histology showed trends of non-FDG-avid lymph node metastases (odds ratio = 0.15, 95% confidence interval 0.17-1.37, P = 0.093)Conclusions. The accuracy of PET/CT is low and it is not a useful tool in the staging of gastric cancer overall in early gastric cancer and in signet-ring-cell carcinoma. Furthermore, the sensitivity of PET/CT could be inferior to that of CECT in the diagnosis of regional lymph node metastasis.