Comparison of 18F-FLT and 18F-FDG PET/CT for lymph node staging in thoracic esophageal carcinoma / 中华核医学杂志

Objective To compare the diagnostic value 18F-fluorothymidine (FLT) and 18F-fluorodeoxyglucose (FDG) PET/CT in detecting lymph node metastases of untreated thoracic esophageal carcinoma. Methods Twenty-two patients with thoracic esophageal squamous cell carcinoma underwent both 18F-FLT and 18F-FDG PET/CT before surgery. The imaging results of the two modalities in detecting regional lymph node metastases were compared prospectively with the pathologic findings. The X2-test was used with SPS S 13.0. Results All patients underwent esophagectomy and lymphadenectomy. The metastatic lymph nodes were found in 16 patients, from which 47 of 424 excised nodes were positive by pathologic examination. False positive results were 14 while false negative 8 on 18F-FDG PET/CT. In contrast, false positive results were only 3 but false negative were 12 on 18 F-FLT PET/CT. The sensitivity, specificity, accuracy,negative predictive value, and positive predictive value were 74.47% ( 35/47 ), 99.20% ( 374/377 ),96.46% (409/424), 96.89% ( 374/386 ) and 92.11% ( 35/38 ) respectively for 18 F-FLT PET/CT, whereas the corresponding values were 82.98% (39/47), 96.29% (363/377), 94.81% (402/424), 97.84%(363/371 ) and 73.58% (39/53) respectively for 18 F-FDG PET/CT (X2 = 0.572, 6.018, 1.017, 0.348,3.852, P＞0. 05, ＜0.05, ＞0.05, ＞0.05 and ＞0.05). Conclusions Compared with 18F-FDG PET/CT, 18F-FLT PET/CT may be less sensitive but more specific for the detection of lymph node metastases of thoracic esophageal carcinoma.

Study of gastric function after esophagectomy and cardiectomy with vagus nerve preserved and reconstruction of gastric funds in patients with esophageal and cardiac cancer / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To study the gastric function after esophagectomy and cardiectomy with vagus nerve preserved and reconstruction of gastric funds (VPRG)in patients with esophageal cancer (EC) and cardiac cancer (CC).</p><p><b>METHODS</b>Sixty-eight patients with early or middle staged EC or CC received esophagectomy and cardiectomy with vagus nerve preserved and reconstruction of gastric funds (VPRG),while other 68 patients esophagectomy and cardiectomy with vagus nerve severed and no reconstruction of gastric funds (VSNG) as control. The symptoms,the pressure of the residual esophagus and thoracic stomach, 24-hour pH monitoring, mean basic gastric acid output, gastric emptying time of the intrathoracic stomach,fasting serum gastrin level, fibreoptic endoscopic results were compared before and after operation between the two groups.</p><p><b>RESULTS</b>The patients with VPRG had less symptoms after operation than those with VSNG such as anorexia, belch, reflux, heartburn, nausea, diarrhea, postcibal satiety (P< 0.01). In VPRG group,compared with the results before operation,there were no significant differences in 24-hour pH monitoring,the mean basic gastric acid output, the fasting serum gastrin level,the gastric emptying time of intrathoracic stomach one month and one year after operation (both P > 0.05). The pressure of the residual esophagus above the anastomosis in VPRG group was significantly higher than that in VSNG group (both P< 0.05). Fibreoptic endoscopic examination revealed higher incidences of postoperative atrophic gastritis and reflux esophagitis in VPRG group one month and one year after operation than those in VSNG group (P< 0.01).</p><p><b>CONCLUSION</b>Preservation of the vagus nerve and reconstruction of gastric funds after esophagectomy and cardiectomy for esophageal and cardiac cancer can prevent digestive disorder and improve the life quality of the patients.</p>

Bronchial and pulmonary arterial sleeve resection and reconstruction in the treatment of central NSCLC / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To evaluate the indications and surgical procedure of bronchial and pulmonary artery sleeve resection for patients with centrally located non-small cell lung cancer, and how to prevent complications.</p><p><b>METHODS</b>From July 1989 to Aug 2000, 32 cases of central NSCLC were treated with bronchial and pulmonary arterial sleeve resection and reconstruction. The results were retrospectively analyzed.</p><p><b>RESULTS</b>The complication rate was 25.0% (8/32), the mortality rate in 30-day postoperation was 6.3% (2/32), the overall 1-, 3- and 5-year survival rate was 82.8% (24/29), 50.0% (11/22) and 33.3% (4/12), respectively.</p><p><b>CONCLUSION</b>Bronchial and pulmonary arterial sleeve resection and reconstruction in the treatment of patients with central NSCLC can not only maximize preservation of functional pulmonary parenchyma and improve patients, quality of life, but also provide an opportunity for those patients with poor pulmonary function to receive surgical resection of the tumor.</p>

A comparative study on radiology and pathology target volume in non-small-cell lung cancer / 中华肿瘤杂志

<p><b>OBJECTIVE</b>Defining the margin of clinical target volume (CTV) is very important for three-dimensional conformal radiotherapy (3DCRT) and intensity-modulated radiation therapy (IMRT). In this study, according to the comparison between gross tumor volume (GTV) silhouetted by radiology and pathology in non-small-cell lung cancer (NSCLC), we tried to define the correlation of GTV by radiology and pathology, and assess the degree of correlation to local microscopic extension (ME) among different pathologic types of NSCLC, so as to define the margin of CTV precisely.</p><p><b>METHODS</b>From February 2001 to February 2002, forty-three NSCLC patients after surgical resection were studied. All patients had had CT scans of the chest before surgery and routine pathology examination after surgery. The tumor size at X (lateral direction), Y (ventrodorsal direction) and Z (craniocaudal direction) axes were measured on CT. Also by pathology examination, the tumor size at X, Y, Z axes and the degree of ME at X, Y, Z axes were measured, respectively.</p><p><b>RESULTS</b>Without taking into account the value of ME, there was almost total agreement on the GTV by radiology and pathology in three dimensions. The mean value of ME was 2.18 mm for adenocarcinoma (ADC) and 1.33 mm for squamous cell carcinoma (SCC) (P = 0.001). But, taking into account 95% of the ME, a margin of 7 mm and 5 mm must be allowed for ADC and SCC, respectively.</p><p><b>CONCLUSION</b>There exists a correlation of GTV by radiology and pathology. In the target volume defining for 3DCRT and IMRT, we could use the GTV by radiology instead of the GTV by pathology, with the ME being different for ADC and SCC. To cover 95% of the ME, the margin from GTV to CTV must be extended to 7 mm and 5 mm for ADC and SCC, respectively.</p>

Clinical value of ~(18)FDG PET-CT in the detection of Ivmoh node metastasis from advanced esophageal carcinoma / 中华放射肿瘤学杂志

Objective To evaluate the clinical value of 18floro-deoxyglucose positron emission tomography-CY(~(18)FDG PET-CT)in the diagnosis of lymph node metastasis from advanced esophageal carcinoma. Methods A prospective study is perfonued here to assess whether ~(18)FDG PET-CT can improve the diagnostic accuracy in lymph node metastasis for patients with advanced esophageal carcinoma.Thirty patients had undergone esophagectomy with extensive lymph node dissection.PET-CT findings were compared with that d CT with pathological finding as the final say.Results All patients were operated successfully without peri-operative complications.The pathological examination conformed metastasis in 22 patients and 49 out of 243 excised lymph nodes.In CT analysis,the sensitivity was 40.8%,specificity was 96.9%,with a diagnostic accuracy of 85.6%, The positive and negative predictive value was 76.9%,86.4% respectively;PET-CT resulted in a sensitivity of 93.9%,specificity of 91.2%,accuracy of 91.8%.The positive predictive value was 73.0% and negative predictive value was 98.3%,The difference of sensitivity(P＜0.001),accuracy(P＜0.05)and negative predictive value between the two radiological modalities was statistically significant(P＜0.001).Conclusions With a high sensitivity and accuracy in the diagnosis of lymph node metastasis,PET-CT appears necessary in preoperative examination for advanced esophageal carcinoma in the hope that surgical treatment be guided by the results of PET-CT,especially for the elder patients with poor pulmonary function or heart or brain complications. Moreover,it could be used as the basis of the conformal radiation therapy planning for inoperable patients.