| Objective:The regional lymph node metastasis is significant for treatment choice of patients with esophageal squamous cell carcinoma.So it is necessary to evaluate the regional lymph node metastasis of esophageal cancer before operation.Although18F-Fluoro-2-Deoxyglucose positron emission tomography/computed tomography(18F-FDG PET/CT)is of great value in preoperative evaluation of esophageal cancer,in the previous literature,there is no unified criteria to determine regional lymph node,and the diagnostic efficiency is limited.The purpose of this study is to explore a new criteria that can improve the diagnostic value of 18F-FDG PET/CT in regional lymph node metastasis and lead to better clinical decision.Materials and methods:A total of 111 patients with esophageal squamous cell carcinoma treated in our hospital from June 2016 to December 2018 was analyzed retrospectively.All patients underwent preoperative PET/CT examination,resection of esophageal cancer and regional lymph node dissection.The PET/CT images were interpreted by two experienced diagnosticians of our PET / CT center.All lymph nodes were defined according to two different criteria respectively(including the traditional diagnostic criteria and the new diagnostic criteria),so as to achieve diagnostic efficiency of two criteria and extract advantages of new diagnostic criteria.Results: A total of 4847 lymph nodes were dissected,of which 147 were confirmed as metastases by postoperative pathology.A total of 656 lymph nodes making sense were screened by 18F-FDG PET/CT imaging,of which were divided to 5 subregions.Determination of all 656 lymph nodes by PET/CT were compared with the pathological results.The overall accuracy,sensitivity,specificity,false positive rate,false negative rate,positive predictive value and negative predictive value of the new standard vs traditional standard are as follows: 90.70% vs 74.85%,71.43% vs 72.11%,96.27% vs 75.64%,15.32%vs53.91%,7.89%vs9.62%,84.68% vs 46.09%,92.11% vs90.38%;The diagnostic accuracy of the new standard and the traditional standard for five zones(para-esophageal sulcus,neck,upper mediastinum,middle-lower mediastinum,ventral)are as follows: 74.60% vs 61.90%,86.44% vs 81.36%,90.26%vs 70.78%,96.19% vs 75.09%,87.91% vs 85.71%.The diagnostic efficiency of the new criteria was significantly better than that of the traditional one for all and 5subregions,meanwhile the difference was statistically significant(p value <0.05).Conclusion: Optimizing the diagnostic criteria is important to improve the performance of PET / CT in regional lymphatic diagnosis for patients with esophageal cancer.The new diagnostic criteria performs better because it sufficiently combines the anatomical and functional imageology. |
