PET/CT在胸段食管癌诊断与淋巴分期中的应用价值

The applicable value of PET/CT in diagnosing and lymphatic staging for thoracic esophageal cancer

目的:探讨18F-脱氧葡萄糖(FDG)正电子发射型计算机断层(PET/CT)在胸段食管癌诊断与淋巴分期中的应用价值。方法:回顾性分析了经PET/CT显像的34例患者资料。患者在显像后2～3周内行手术治疗,手术时对颈、胸、上腹部三野淋巴结清扫,所有淋巴结送病理学检查。病理学证实34例患者均为鳞状细胞癌。胸上段食管癌4例,中段食管癌16例,下段食管癌14例。结果:34例患者食管肿瘤长度为1～8.3cm(4.5±1.6cm)。PET/CT均显示FDG代谢增高,SUV最高值范围4.3～23.2(10.84±5.32),平均SUV值3～16.7(8.92±4.09)。作为对照,分析36例PET/CT健康查体人员,发现有2例食管平滑肌瘤显示假阳性。PET/CT诊断食管癌的准确度、灵敏度、特异度、阳性预测值和阴性预测值分别为:97.1%、100%、94.4%、94.4%和100%。34例患者中有20例发生不同程度的淋巴结转移,PET/CT显示转移淋巴结高FDG代谢,SUV最高值为2.7～13.9(7.28±2.75),SUV平均值为2.3～10.7(5.63±2.49);其中有6例患者转移到腹腔内,6例腹腔淋巴结转移患者中有5例为下段食管癌,1例为中段食管癌。4例转移至颈部淋巴结,为中上段食管癌转移。手术清除淋巴结163枚,其中病理示转移淋巴结52枚,PET/CT显像结果与病理结果比较,有7枚小淋巴结未能显示,排除了3枚直径大于1cm的可疑转移淋巴结,有13个良性淋巴结显示假阳性,对淋巴结诊断的准确度、灵敏度、特异度、阳性预测值和阴性预测值分别为:87.7%、86.2%、88.2%、77.6%和85.2%。结论:PET/CT对食管癌原发灶的诊断有很高的价值,对淋巴结分期有较高的灵敏度与特异性。

Objective：To evaluate the applicable value of ^18F-FDG PET/CT in diagnosing and lymptratic staging for thoracic esophageal cancer. Methods：The data of 34 patients were retrospetively analysed. All patients underwent PET/CT 2 - 3 weeks before operation. Cervical, thoracic and upper abdomen 3-field lymph nodes were dissected and all the nodes were .labelled separately and examined histologially for the presence of malignant cells. All of 34 patients with sqnamous cell cancer of thoracic esophagus were detenninated by histologially and thoracic upper segment in 4, middle in 16, lower in 14. Results： The length range of esophageal lesions was 1 - 8.3 em （ mean 4.5 ± 1.6 cm）. All the lesions were showed high FDG uptake. The range of maxSUV was 4.3 - 23.2（ mean 10.84 ± 5.32）. The range of aveSUV was 3 - 16.7 （mean 8.92 ± 4.09）. As control PET/CT imaging of 36 heahhcare examination people were investigated and 2 esophageal leiomyoma were showed false positive. PET/CT analysis in diagnosing esophageal cancer showed accuracy of 97.1%, sensitivity of 100%, specificity of 94.4%, positive predictive value （PPV） of 94.4% and negative predictive value （NPV） of 100%.By surgical staging and histologic examination, 20 of 34 patients were founded lymph metastases in diferent way. All of metastases lymph were showed high FDG uptake. The range of maxSUV was 2.7-13.9（mean 7.28 ± 2.75）, The range of aveSUV was 2.3 - 10.7（mean 5.63± 2.49. 6 patients had upper abdomen lymph metastases and 5 of 6 came from thoracic lower esophageal cancer and another one came from thoracic middle segment. 4 patients had cervical lymph metastases, the lymph came from thoracic upper and middle segment esophageal cancer. 163 lymph nodes were dissected and 52 of diem were founded malignant cells. PET/CT showed definite FDG uptake in 45 of 52.3 diameter large than 3 em lymph nodes PET/CT showed low FI）G uptake were benign ones, but 13 benign nodes were showed false positive. PET/CT analysis in lymph staging showed accuracy of 87.7%, sensitivity of 86.2%, specificity of 88.2%, positive predictive value （PPV） of 77.6 % and negative predictive value （NPV） of 85.2 %. Conclusion：It has great value of PET-CT in judging esophageal cancer and it has high sensitivity and specificity in lymphatic staging esophageal cancer.