^(18)F-FDG PET显像在食管癌诊断中的临床意义

Importance of ^(18)F-FDG PET in early diagnosis of esophageal cancer

目的:探讨正电子发射型电子计算机断层(positronemissioncomputedtomography,PET)显像在食管癌早期诊断以及临床分期中的临床应用价值。方法:23例食管癌患者,进行全身18F脱氧葡萄糖(18Ffluorodeoxyglucose,18FFDG)PET显像,并与外科手术或内镜活检病理结果和CT检查结果对照。结果:46例患者中PET显像食管部位均有异常放射性浓聚灶,经病理确诊,46处食管浓聚灶均为食管癌原发病灶。其中28例为单发病灶,2例为食管多发灶,其余16例除食管原发病灶外,还有其他部位32个病灶,经临床和病理证实为远处转移病灶。与46例PET显像前CT结果相比较,PET共检出食管部位恶性病灶46例,检出率为100.0%,而CT仅检出34例,检出率为73.9%。46例中确诊有其他部位转移者18例,PET检出18例,检出率为100.0%,而PET显像前CT仅检出6例,检出率为33.3%。27例手术治疗者PET分期与临床病理分期一致,而常规检查对食管癌临床分期高估5例,低估12例,PET显像改变了这17例患者的临床治疗方案。结论:18FFDGPET显像对食管癌的诊断、淋巴结和远处转移的分期、治疗方案的制定有重要的临床应用价值。

OBJECTIVE:To evaluate the role of 18 F-FDG PET for early diagnose and clinical stage of esophageal cancer.METHODS:Forty-six patients with esophageal cancer underwent the whole body PET scan, with the injection of 18 F-FDG. The results were then compared with the associated post surgical (or endoscopic) histology and aforehand CT images. RESULTS: The primary lesion of esophageal cancer (confirmed by histology) represented an abnormal intense focus of 18 F-FDG uptake in esophagus in the PET images for all these 46 patients. Twenty-eight patients of the total had single focus within regional esophagus, 18 patients had multiple focuses within regional esophagus and the rest (16 patients) had a local focus with a distant expansion (add up to 32 focuses). The 18 F-FDG PET detected malignant esophageal lesions for the total 46 patients with the overall sensitivity of 100%, compared with aforehand CT that only revealed 34 cases with the overall sensitivity of 73.9%. For metastatic cases (total 16 cases), the sensitivity of PET in this study reached 100% (i.e. positive in 16 cases), whereas the sensitivity of CT was only 56.3% (i.e. positive in 9 cases). The staging of esophageal cancer by PET was consistent with that according to histology for all the 27 cases treated with surgery in this study. Compared with conventional clinical checks that overestimated the stage in 5 cases and underestimated in 12 cases. Clearly, the 18 F-FDG PET changed the treatment plans for these 17 patients with esophageal cancer. CONCLUSIONS:The 18 F-FDG PET can be used as an important tool for early diagnosing, clinical staging and treatment planning of the patients with esophageal cancer.