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Carcinoma of the Esophagus - part 7

Mặc dù tầm quan trọng của dàn nút, mặt cắt ngang kỹ thuật không xâm lấn có những hạn chế nổi tiếng. Có nhiều nghiên cứu đánh giá tính chính xác của PET cho di căn nút địa phương, và kết quả là rất khác nhau. | FDG-PET and PET CT in Esophageal Cancer 89 Despite the importance of nodal staging the noninvasive cross-sectional techniques have well-known limitations. There are many studies assessing the accuracy of PET for local nodal metastases and the results are very variable. The earlier studies produced good results. Flanagan et al. reported that PET was more sensitive and specific than CT 72 and 82 for PET versus 28 and 73 for CT 7 and Kole et al. reported a sensitivity of 92 for local nodal detection 25 . The later studies produced different results with some of the reported variability arising from the study methodology with mixed populations of adenocarcinoma and SCC and whether the correlation was with a two or three-field lymphadenectomy or transhiatal resection which will identify fewer nodes and may understage the disease. Kim et al. studied 50 patients with SCC all of whom underwent two or three-field lymphadenectomy and found PET more sensitive 52 than CT 15 with a similar specificity 8 . Yoon et al. studied 81 patients with SCC and full surgical correlation 10 . PET was more sensitive than CT for individual nodal groups 30 versus 11 and also for nodal staging 64 versus 31 but its specificity was less 68 versus 86 with false positive results in hilar lymph nodes in patients with chronic lung disease or previous tuberculosis and these authors concluded that neither test was sufficiently sensitive for the detection of local nodal disease. Kneist et al. were the only group to find CT more sensitive than PET but less specific 75 and 71 versus 42 and 94 respectively 26 these authors thought FDG-PET provided no management advantage and should be reserved for patients with inconclusive CT findings. Most institutions use the combination of CT and EUS for the assessment of the primary tumor and nodal disease and the results of the comparison of PET with the combination of CT and EUS are conflicting. Choi et al. preformed a study in 48 patients with SCC and compared the