正子斷層造影在有與無症狀大腸直腸癌患者檢查之比較

PET Findings in Symptomatic and Asymptomatic Colorectal Cancer Patients

鄭如華(Ru-Hwa Cheng) ； 周燕輝(Yenn-Hwei Chou) ； 殷國維(Kuo-Wei Yin) ； 黃美美(Mei-Mei Huang) ； 施勇綸(Yung-Luen Shih) ； 葉加祿(Chia-Lu Yeh) ； 李進成(Chin-Cheng Lee) ； 陳遠光(Yen-Kung Chen)

《核子醫學雜誌》 19卷1期 (2006/03) Pp. 29-36

https://doi.org/10.6332/ANMS.1901.005

摘要

背景：癌症治癒率的提高及患者存活期之延長關鍵在於早期發現早期治療。本研究的目的在探討正子斷層造影於無症狀大腸直腸癌篩檢之應用與角色。
方法：針對4,453名無特殊症狀之健康檢查受檢者（男性2,372名、女性2,081名；平均年齡為54.3±9.0歲）以正子斷層造影進行全身癌症篩檢。對照組則為14名有腸胃道症狀並先由組織病理診斷確診為大腸直腸癌之患者，之後以正子斷層造影進行全身掃描以偵測是否轉移。局部具高葡萄糖代謝率而吸收強度超過肝臟所測得的FDG強度之病灶視為是正子斷層造影陽性並判讀為腫瘤。
結果：在4,453名正子斷層造影之無症狀癌症篩檢受檢者中，共發現31例異常報告，其中包含11例大腸直腸癌。這11名有4例組織病理診斷分期為Dukes' A，6例為Dukes' B，1例為Dukes' C。在對照組中之14名個案，其中有7例之組織病理分期為Dukes' B，5例為Dukes' C，2例為Dukes' D。在經過至少二年三個月以上的追蹤，無症狀之31名受檢者，其存活率為100%；但在14名有症狀之對照組中，則共有三名患者過世。
結論：正子斷層造影在大腸直腸癌的診斷上具高敏感度及特異性，有可能檢測出直徑大於0.7cm以上的腺瘤（咸認為是癌前病變），能使癌症早期發現的個案增加。此一非侵襲性之全身掃描工具亦可同時檢測轉移之病灶，提供的資訊更足以改變治療策略。如果價格能更平民化，正子斷層造影於大腸直腸癌篩檢之應用，相信可有更舉足輕重的地位。

關鍵字

氟－18-去氧葡萄糖 ； 正子斷層造影 ； 大腸直腸癌

並列摘要

Background: Early detection and early treatment is the most important basis to raise the cure rate of cancer and prolong cancer patients' survival span. The purpose of this article is to investigate the performance of PET scan for colorectal cancer screening in asymptomatic individuals.
Methods: A total number of 4,453 examinees (2,372 male, 2,081 female; mean age ± SD, 54.3±9 years) underwent PET scan for physical check-up cancer screening. In the control group, 14 patients who had gastrointestinal symptoms with biopsy-proved colorectal cancer were recruited and underwent PET scan for the detection of metastasis.
Results: Thirty one abnormal results, including 11 cases of colorectal cancer, were found among 4,453 asymptomatic examinees. Of 11 cases diagnosed with cancer, four had Dukes' A lesions, six had Dukes' B lesions, and one had a Dukes' C lesion. In the control group, of 14 patients with biopsy-proved colorectal cancer followed by PET scan, seven had Dukes' B lesions, five had Dukes' C lesion, and two had Dukes' D lesions. After follow-up for more than two years and three months, the survival rate was 100% in those 31 asymptomatic patients. In the 14 symptomatic cases, however, 3 patients died.
Conclusions: This study suggests that PET scan shows high sensitivity and specificity in the detection of colorectal cancer. It is possible to detect small adenoma when its diameter is greater than 0.7cm by PET scan and enables the chance of early detection of cancer. Besides, as a non-invasive whole body screening tool, PET provides information of both primary and metastatic lesions, which have profound impacts on therapeutic strategy. When the cost goes down, hopefully, the role of PET scan in the screening of asymptomatic colorectal cancer is believed to become more significant in the near future.

並列關鍵字

FDG ； PET ； colorectal cancer