見習各科外科學4.22制作preoperative pet11

1、A prospective study based on primary surgery and histopathologic validation Improvement in Preoperative Staging of Gastric Adenocarcinoma with Positron Emission TomographyJ Chen, J H Cheong, J Kim, WJ Hyung, SH Choi, SH NohDepartment of Surgery, Yonsei University College of MedicineBACKGROUNDCarcino

2、mas of the stomach are still considered to have a poor prognosis because most patients have advanced disease when they are diagnosed Pretreatment assessment and staging of the disease extent is essential for managing gastric cancerUntil now, preoperative staging relies on the standard noninvasive im

3、aging modality of abdomen and pelvis computed tomography (CT)Positron emission tomography (PET) scanning has potential as a new imaging tool Yonsei University College of MedicinePURPOSETo assess the value of positron emission tomography with18- fluorodeoxyglucose (FDG-PET) for the preoperative Tumor

4、-Node-Metastasis (TNM) stagingof patients with gastric adenocarcinomaYonsei University College of MedicinePATIENTS & METHODSPeriod: August 2000 June 2003Patients: 68 patients with an esophagogastroduodenoscopy (EGD) biopsy-proven gastric adenocarcinoma Preoperative Staging: CTFDG-PET Tumor Marker (C

5、EA, CA 19-9)Standard staging procedures including history and physical examination, laboratory testsYonsei University College of MedicineRESULTSClinicopathologic Features Parameter Number (n=68)%Age (mean. years) 54.8 GenderMale4972Female1928Macroscopic typeEGC812AGC6088Tumor size (median. cm)6.8 De

6、pth of invasionT1812 T223 T35074 T411Unknown710 Extent LN metastasisN013 19Peri-LN4769Extra-LN812Histologic typeDifferentiated1319Undifferentiated5581Stage I1015 II46 III2942 IV2537Hematogenous metastasis23Peritoneal dissemination1015CurabilityCurative5885Palliative1015YUMCRESULTS PET Findings of th

7、e Primary Lesion according to theDepth of Tumor Invasion & Histological TypePresent Absent Sensitivity (%) P value*EGC535/8 (63)0.004AGC59159/60 (98)Differ11211/13 (85)0.162Undiffer53253/55 (96)*: Results were compared by a Fishers exact test Yonsei University College of MedicineRESULTSPreopreative

8、Assessment of Lymph Node & Peritoneum MetastasisPET (%) CT (%) P valueSensitivityPeri-LN31/55(56%)43/55(78%) 0.002Extra-LN7/8(88%)6/8(75%) 1.000Peritoneum3/10(30%)8/10(80%) 0.063SpecificityPeri-LN12/13(92%)8/13(62%) 0.000Extra-LN51/53(96%)48/53(91%) 0.219Peritoneum57/58(98%)53/58(91%) 0.125AccuracyP

9、eri-LN43/68(63%)51/68(75%) 0.115Extra-LN58/61(95%)54/61(89%) 0.180Peritoneum60/68(88%)61/68(89%) 1.000Yonsei University College of MedicineRESULTS PETTumor maker TP FN TP % P valueCEA (+)1201000.000CEA ()182245CA19-9 (+)123800.000CA19-9 ()151944Associations between the PET Findings and Serum Tumor M

10、arker Levels in Patients with a Perigastric Lymph Node Metastasis CEA (+) 5ng/ml, CA19-9 (+) 37ul/ml Yonsei University College of MedicineRESULTSOverall Accuracy of Preoperative Staging in the Patients with Gastric Adenocarcinoma Correct False n % n % P valuePET32473653 0.002CT36533247PET+CT46682232

11、Yonsei University College of MedicineSUMMARY FDG-PET is highly sensitive in detecting Primary lesion in gastric cancer Extragastric lymph node metastasis FDG-PET appears limited in the detection of Perigastric lymphadenopathy Peritoneal dissemination FDG-PET has superior specificity compared with CT Yonsei University College of MedicineCONCLUSIONSFDG-PET improves the preoperative TNM staging of a gastric adenocarcinoma Based on the Sup