Histopathologic validation of lymph node staging with FDG-PET scan in cancer of the esophagus and gastroesophageal junction - A prospective study based on primary surgery with extensive lymphadenectomy

被引:192
作者
Lerut, T
Flamen, P
Ectors, N
Van Cutsem, E
Peeters, M
Hiele, M
De Wever, W
Coosemans, W
Decker, G
De Leyn, P
Deneffe, G
Van Raemdonck, D
Mortelmans, L
机构
[1] Catholic Univ Louvain, Univ Hosp Gasthuisberg, Dept Thorac Surg, B-3000 Louvain, Belgium
[2] Univ Hosp Gasthuisberg, Dept Nucl Med, B-3000 Louvain, Belgium
[3] Univ Hosp Gasthuisberg, Dept Pathol, B-3000 Louvain, Belgium
[4] Univ Hosp Gasthuisberg, Dept Internal Med, B-3000 Louvain, Belgium
[5] Univ Hosp Gasthuisberg, Dept Radiol, B-3000 Louvain, Belgium
关键词
D O I
10.1097/00000658-200012000-00003
中图分类号
R61 [外科手术学];
学科分类号
摘要
Objective To assess the Value of positron emission tomography with (18)fluorodeoxyglucose (FDG-PET) for preoperative lymph node staging of patients with primary cancer of the esophagus and gastroesophageal junction. Summary Background Data FDG-PET appears to be a promising tool in the preoperative staging of cancer of the esophagus and gastroesophageal junction. Recent reports indicate a higher sensitivity and specificity for detection of stage IV disease and a higher specificity for diagnosis of lymph node involvement compared with the standard use of computed tomography and endoscopic ultrasound. Methods Forty-two patients entered the prospective study. All underwent attenuation-corrected FDG-PET imaging of the neck, thorax, and upper abdomen, a spiral computed tomography scan, and an endoscopic ultrasound. The gold standard consisted exclusively of the histology of sampled nodes obtained by extensive two-field or three-field lymphadenectomies (n = 39) or from guided biopsies of suspicious distant nodes indicated by imaging (n = 3). Results The FDG-PET scan had lower accuracy for the diagnosis of locoregional nodes (N1-2) than combined computed tomography and endoscopic ultrasound (48% vs. 69%) because of a significant lack of sensitivity (22% vs. 83%). The accuracy for distant nodal metastasis (M+Ly), however, was significantly higher for FDG-PET than the combined use of computed tomography and endoscopic ultrasound (86% vs. 62%). Sensitivity was not significantly different, but specificity was greater (90% vs. 69%). The FDG-PET scan correctly up-staged five patients (12%) from N1-2 stage to M+Ly stage. One patient was falsely downstaged by FDG-PET scanning. Conclusions FDG-PET scanning improves the clinical staging of lymph node involvement based on the increased detection of distant nodal metastases and on the superior specificity compared with conventional imaging modalities.
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页码:743 / 751
页数:9
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