^(18)F-FDG SPET/CT诊断胸段食管癌淋巴结转移的准确性研究

A Study on the Accuracy of ^(18)F-FDG SPET/CT in Diagnosing Metastatistic Lymph Nodes in Esophageal Carcinoma

目的通过18F-FDG SPET/CT扫描诊断食管癌淋巴结转移与术后病理金标准比较,评价18F-FDG SPET/CT诊断的准确性,为临床应用提供理论依据。方法选择2007年1月～2010年6月首程治疗行颈、胸、腹三野淋巴结清扫的胸段食管癌根治术40例患者,术前1周内行18F-FDG SPET/CT检查,将18F-FDG SPET/CT诊断食管淋巴结转移与术后病理诊断进行对比研究。结果全组共清除淋巴结1216枚,平均每例清除淋巴结30.4枚(15～55枚),淋巴结转移率67.5%。SPET/CT诊断食管癌总淋巴结转移的敏感性、特异性及准确性分别为44.4%、84.6%和57.5%。但进一步分析SPET/CT诊断对颈部、上纵隔、下纵隔及腹部区域淋巴结转移的准确性较低,分别为35.0%、50.0%、32.5%和27.5%。其中转移淋巴结短径<0.8cm、0.8～1.2cm和>1.2cm的准确性分别为0.0%、43.8%和84.6%。结论 18F-FDG SPET/CT对食管癌淋巴结转移诊断有较高的特异性,但敏感性及准确性较低;对转移淋巴结短径>1.2cm有较高的准确性。

Objective To evaluate the accuracy of 18F-FDG SPET /CT in diagnosing metastatistic lymph nodes and to provide theoretic base for clinical practices by detecting metastatistic lymph nodes with 18F-FDG SPET/CT compared with the postoperative pathological golden criteria in esophageal carcinoma（EPC）.Methods From January 2007 to June 2010,40 patients with esophageal carcinoma in thoracic segments who received initial treatment with 3-field lymphadenectomy were enrolled.All cases received 18F-FDG SPET/CT one week before the operation.Metastatistic lymph nodes diagnosed with 18F-FDG SPET /CT were compared with postoperative pathological specimens.Results Total 1216 lymph nodes were removed.For each case,30.4 lymph nodes（15~55） were averagely dissected.The lymph node metastasis rate was 67.5%.18F-FDG SPET/CT analysis in metastatistic lymph nodes showed sensitivity of 44.4%,specificity of 84.6% and accuracy of 57.5%.The accuracy of lymph node metastasis on neck,superior mediastinum,inferior mediastinum and abdominal regional with 18F-FDG SPET/CT were 35.0%,50.0%,32.5% and 27.5%,respectively.The accuracy were 0.0%,43.8% and 84.6% of the shorter diameters 0.8 cm,0.8~1.2cm and 1.2cm,respectively.Conclusion 18F-FDG SPET/CT in the detection of metastatistic lynph nodes had high specificity,but low sensitivity and accuracy in EPC;and it had higher accuracy in the detection of the lymph nodes with the shorter diameter1.2cm.