18氟脱氧葡萄糖正电子扫描和计算机断层扫描应用于胃癌术前分期的研究

Value of 18F - FDG PET/CT in the preoperative staging of gastric carcinoma

目的研究18氟脱氧葡萄糖正电子扫描（18F—FDGPET）和计算机断层扫描（CT）融合显像（18F—FDGPET／CT）在胃癌术前分期中的作用。方法2006年1月至2009年12月间经内镜活检与病理学检查确诊、并使用18F—FDGPET／CT作术前评估的胃癌患者67例。对比分析18F—FDGPET／CT的术前分期和手术病理学检查结果，探讨18F—FDGPET／CT在胃癌术前分期中的敏感度、特异性和准确度。结果癌细胞转移到淋巴结50例，肝2例，网膜3例，肠系膜2例，肠壁2例，腹膜4例，肺1例，骨1例，子宫、附件2例。18F—FDGPET／CT对胃癌术前分期的敏感度、特异性和准确度分别是87％，96％和88％。18F—FDGPET／CT对不同TNM分期胃癌的敏感度、特异性和准确度并不相同，分别是I期50％，100％，50％；II期89％，87％，89％和Ⅲ期86％，97％，86％。但Ⅳ期胃癌的敏感度、特异性和准确度均为100％。结论18F—FDGPET／CT不仅能检测肿瘤原发灶和周围淋巴结，且能全面了解病变全身的累及范围，对制定合理的治疗方案有重要的参考价值。特别是对不能根治的胃癌具有极高的诊断率，可避免不必要的手术探查。

Objective To assess the value of the fluorine - 18 fluorodeoxyglucose positron emission tomography/computed tomography（ 18F - FDG PET/CT）in the preoperative staging of gastric carcinoma. Methods From January 2006 to December 2009,67 patients（45 males and 22 females; mean age：58.6 y）were definitely diagnosed as having gastric carcinoma by endoscopic biopsy and histological examination. All the patients underwent 18F - FDG PET/CT scanning for preoperative staging. The results of preoperative staging by 18 F - FDG PET/CT were compared with those of the histological and surgical findings. The sensitivity, specificity, and accuracy of 18 F - FDG PET in preoperative staging for gastric carcinoma were assessed. Results Cancer cells metastasized to lymph nodes in 50 cases, liver in 2 cases, retina in 3 cases, mesenterium in 2 cases,intestinal wall in 2 cases,peritoneum in 4 cases,lung in 1 case, bone in 1 case,and uterine and annex in 2 cases. The sensitivity, specificity and accuracy of 18F - FDG PET/CT for preoperative staging were 87% ,96% and 88% , respectively. However, the sensitivity, specificity and accuracy of 18F - FDG PET/CT varied by different TNM stages. They were 50%, 100% and 50% at I stage,89% ,87% and 89% at II stage,and 86% ,97% and 86% at III stage,respectively. The sen- sitivity,specifieity and accuracy of 18F - FDG PET/CT at IV stage of gastric carcinoma were high up to100%. Conclusion 18F - FDG PET/CT can detect not only the primary tumor and surrounding lymph nodes, but also the remote metastasis. Use of 18F - FDG PET/CT is very important for designing the appropriate therapeutic strategy and avoiding any unnecessary laparotomy procedures in unresectable gastric cancer.