The utility of positron emission tomography for the diagnosis and staging of recurrent esophageal cancer

被引:108
作者
Flamen, P
Lerut, A
van Custem, E
Cambier, JP
Maes, A
De Wever, W
Peeters, M
De Leyn, P
Van Raemdonck, D
Mortelmans, L
机构
[1] Katholieke Univ Leuven, Univ Hosp Gasthuisberg, Dept Nucl Med, B-3000 Louvain, Belgium
[2] Katholieke Univ Leuven, Univ Hosp Gasthuisberg, Dept Internal Med, B-3000 Louvain, Belgium
[3] Katholieke Univ Leuven, Univ Hosp Gasthuisberg, Dept Radiol, B-3000 Louvain, Belgium
[4] Katholieke Univ Leuven, Univ Hosp Gasthuisberg, Dept Thorac Surg, B-3000 Louvain, Belgium
关键词
D O I
10.1067/mtc.2000.110464
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Objective: To study the utility of whole-body positron emission tomography with F-18-fluoro-deoxy-D-glucose (FDG-PET) for the evaluation of recurrence after curative resection of cancer of the esophagus or gastroesophageal junction. Methods: Forty-one patients with a clinical or radiologic suspicion of recurrent disease underwent conventional diagnostic work-up, including a spiral computed tomographic scan, an endoscopic ultrasound, and a dedicated whole-body FDG-PET. PET lesions were classified as equivocal or suspicious recurrence. The conventional diagnostic work-up and PET findings were correlated with pathology or with radiologic and clinical follow-up. Equivocal lesions were classified as positive. Results: Forty recurrences were found in 33 patients. The lesions were perianastomotic (n = 9), regional (n = 12), and at distant sites (n = 19). For the diagnosis of a perianastomotic recurrence, the sensitivity, specificity, and accuracy of FDG-PET were 100%, 57%, and 74%, versus 100%, 93%, and 96% for conventional diagnostic work-up, respectively (P = not significant). False-positive PET lesions were found in patients with a progressive anastomotic stenosis requiring repetitive endoscopic dilatation. For the diagnosis of regional and distant recurrences, the sensitivity, specificity, and accuracy of PET were 94%, 82%, and 87%, versus 81% (P = not significant), 82% (P = not significant), and 81% (P =.0771) for conventional diagnostic work-up. All false-positive PET lesions (n = 4) had been report ed as equivocal. On a patient base, PET provided additional information in 11 of 41 (27%) patients. A major impact on diagnosis was found in 5 patients with equivocal or negative findings on complete diagnostic work up in whom PET provided a true-positive diagnosis. In 5 other patients the diagnosis was staged upward from localized to extended recurrent disease, and in 1 patient with an equivocal complete diagnostic work-up, PET correctly excluded malignancy. Conclusion: FDG-PET allows a highly sensitive diagnosis and accurate whole-body staging of symptomatic recurrent esophageal cancer. Further studies in asymptomatic patients are needed to assess the potential benefit on survival.
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页码:1085 / 1092
页数:8
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