ABSTRACT
<p><b>OBJECTIVE</b>To compare the combined FDG PET/CT with PET alone in the detection of lymph node metastasis (LNM) for esophageal carcinoma patient.</p><p><b>METHODS</b>From November 2003 to August 2005, 35 patients with esophageal carcinoma underwent FDG PET/CT before esophagectomy and lymph node (LN) dissection. The patients who had history of previous anticancer treatment or diabetes mellitus and inflammatory lung diseases as well as being inoperable for medical reasons were excluded. The results of LNM detection by PET/CT and PET alone were compared with pathological results.</p><p><b>RESULTS</b>Twenty-nine men and 6 women were eligible for this study, with a mean age of 57 years (range: 40 to 72 years). Of these 35 patients, 3 had lesion at the upper third thoracic esophagus, 22 at the middle third and 10 at the lower third. All patients underwent surgical resection successfully. Twenty-five patients and 65 out of 313 excised nodal groups were found to have metastases by pathological examination. The true positive and true negative LNM interpretation reached 61 and 229 LN groups on PET/CT versus 53 and 217 LN groups on PET alone. False negative LNM interpretation was found in 12 LN groups on PET alone, and 8 of them were corrected by PET/CT including one cervical LN, 4 paraesophageal LNs, one left gastric arterial LN, one left gastric cardia LN, one lesser gastric curve LN. False positive interpretations on PET alone were found in 31 LN groups, 12 of them were corrected by PET/CT which included 9 false-positive interpretations due to physical tracer uptake (2 in the cervical region and 7 in gastrointestinal tract ) and 3 lesions with heterogeneous tracer uptake in the primary tumor. The sensitivity, specificity and accuracy of LNM detection by PET alone was 81.54% (53/65), 87.50% (217/248), and 86.26% (270/313), whereas by PET/CT, which was 93.85% (61/65), 91.24% (229/248) and 92.65% (290/313), respectively. There were statistically significant differences in sensitivity and accuracy of LNM detection between PET/CT and PET alone (0.033 and 0.009).</p><p><b>CONCLUSION</b>Compared with FDG PET alone, FDG PET combined with CT can improve the sensitivity and accuracy in detection of lymph node metastasis in esophageal carcinoma.</p>
Subject(s)
Adult , Aged , Female , Humans , Male , Middle Aged , Adenocarcinoma , Diagnosis , Pathology , General Surgery , Carcinoma, Squamous Cell , Diagnosis , Pathology , General Surgery , Esophageal Neoplasms , Diagnosis , Pathology , General Surgery , Esophagectomy , Fluorodeoxyglucose F18 , Lymph Nodes , Diagnostic Imaging , General Surgery , Lymphatic Metastasis , Diagnosis , Neck Dissection , Positron-Emission Tomography , Methods , Radiopharmaceuticals , Reproducibility of Results , Sensitivity and Specificity , Tomography, X-Ray Computed , MethodsABSTRACT
Objective To assess the value of 18-fluoro-deoxy-glucose positron emission-CT(FDG PET-CT) in defining the length of primary esophageal cancer.Methods Thirty-two patients had underg- one esophagoscopy,esophagography and FDG PET-CT scans one week before esophagectomy.There was one tumor located in the upper thoracic esophagus,22 in the middle thoracic esophagus,and 9 in the lower tho- racic esophagus.The location and length of primary lesion of the tumor was determined by esophagoscopy, esophagography,and FDG PET-CT.The length of the abnormality seen on the CT portion of the PET-CT scan was determined separately and independently by two radiologists.All results were compared with the resected specimen.Results According to esophagography,CT and PET-CT,all lesion lengths were compared with that of the resected specimen.It was found that the tumor location determined by esophagoscopy was not in accordance with the resected specimen in 2 patients.The mean length of the primary tumor,being from short to long,were (3.8?1.4),(4.1?1.5),(4.4?1.6),(5.3?1.9) and (4.7?1.7) cm,as determined by esophagoscopy,esophagography,CT,actral length of the resected specimen and PET-CT.Compared with the resected specimen,there was obvious difference (P=0.000,0.007,0.025,0.001).Considering that there might be some kind of shrinkage in the resected specimen (about 83.59%,as reported by Ma et al), we rectified the length of resected specimen and compared with other findings again.It was found that insig- nificant difference existed between PET-CT and rectified length value of the resected specimen (P=0.082). Conclusions FDG PET-CT is effective in the length determination of primary esophageal cancer.It may he used to determine the length of esophagus to be resected for patients indicated for esophagectomy.It may also be used to ac- curately delineate the gross tumor volume for patients eligible for radiotherapy.
ABSTRACT
Apoptosis is necessary for the development and maturation of Leydig cells. However, increased apoptosis results the decline of testosterone production, which may increase germ cell apoptosis and the possibility of infertility. There are several aspects contributing to Leydig cell apoptosis such as ethane dimethanesulphonate (EDS), glucocorticoid, developmental stage and some hormones including FSH, LH/hCG and testosterone. A number of genes are involved in the regulation of Leydig cells apoptosis. It was reported that SCF/c-kit, Bcl-2 and Bcl-xl inhibited the apoptosis while caspase-3, Fas, Bax and clusterine stimulated it.