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目的评价~(18)FDG PET-CT对进展期食管癌淋巴结转移的诊断价值及临床意义。方法随机选择拟行手术治疗的进展期食管癌患者30例,术前1周内行~(18)FDG PET-CT检查及CT增强扫描。根据术后病理结果,对比CT与PET-CT诊断食管癌淋巴结转移的敏感性、特异性、阴性预测值、阳性预测值与准确性的差异。结果术后病理原发灶均为鳞状细胞癌,22例存在淋巴结转移。共切取淋巴结243个,病理确定的转移淋巴结49个,平均直径1．4cm(0．3～2．8cm)。CT确定的转移淋巴结26个,平均直径1．7 cm(1．1～2．8cm)；敏感性和特异性分别为40．8%和96．9%,阳性预测值76．9%,阴性预测值86．6%,准确性85．6%。~(18)FDG PET-CT确定淋巴结转移63个,平均直径1．5cm(0．8～2．8cm)；敏感性和特异性分别为93．9%和91．2%,阳性预测值73．0%,阴性预测值98．3%,准确性91．9%。~(18)FDG PET-CT的敏感性、阴性预测值、准确性均高于CT(P＜0．001、0．001、0．05)。结论~(18)FDG PET-CT是检测进展期食管癌淋巴结转移的有用工具,可指导手术剖胸径路的选择、优化适形放疗计划,临床应用价值优于CT。
Objective To evaluate the diagnostic value and clinical significance of ~ (18) FDG PET-CT in lymph node metastasis of advanced esophageal cancer. Methods Thirty patients with advanced esophageal cancer who underwent surgery were randomly selected. All patients underwent ~ (18) FDG PET-CT and CT scan within one week before operation. According to postoperative pathological results, the sensitivity, specificity, negative predictive value, positive predictive value and accuracy of CT and PET-CT in diagnosing esophageal cancer lymph node metastasis were compared. Results Primary pathological lesions were squamous cell carcinoma, lymph node metastasis in 22 cases. A total of 243 lymph nodes were dissected and 49 pathologically confirmed lymph nodes were dissected. The average diameter was 1.4 cm (0.3-2.8 cm). Twenty-six metastatic lymph nodes were detected by CT with a mean diameter of 1.7 cm (1.1-2.8 cm). The sensitivity and specificity were 40.8% and 96.9%, respectively. The positive predictive value was 76.9% The predicted value of 86.6%, the accuracy of 85.6%. There were 63 lymph node metastases with ~ (18) FDG PET-CT, with an average diameter of 1.5cm (0.8 ~ 2.8cm). The sensitivity and specificity were 93.9% and 91.2% respectively. The positive predictive value was 73 .0%, the negative predictive value of 98.3%, the accuracy of 91.9%. The sensitivity, negative predictive value and accuracy of ~ (18) FDG PET-CT were all higher than those of CT (P <0.001,0.001,0.05). Conclusions ~ (18) FDG PET-CT is a useful tool to detect lymph node metastasis in advanced esophageal cancer. It can guide the choice of surgical approach for thoracotomy and optimize the plan of conformal radiotherapy. The clinical value of FDG PET-CT is better than that of CT.