2021/02/08 15:43:15 林星妤 回首頁

病例2_正確診斷大腸癌復

一位66歲的女病患,一年前因大腸癌接受了切除手術以及術後的化學治療,不過近幾個月來發現腫瘤指數(癌胚胎抗原; CEA)有輕微逐漸上升的情形,由原來的3.07,在四個月內升至5.09,懷疑有大腸癌的復發。由腹部電腦斷層檢查(CT)沒有發現局部復發或其它明顯的異常,於是我們為她安排了正子攝影(PET/CT)的檢查,結果在肝臟的左葉發現了一個代謝增高的微小病灶(圖一),在疑似肝轉移的診斷之下接受手術治療,手術後病理檢查證實這一個病灶為大腸癌的肝轉移。

大腸直腸癌術後的復發,大多發生在前面的四年之內。近年來許多的研究報告都指出,在大腸直腸癌的復發方面,PET比起傳統的影像檢查有更高的價值(註一)。一項結合11份研究的綜合分析(meta-analysis)指出,PET在偵測復發的敏感性為97%,特異性為76%(註二)。最近結合61份研究大腸癌肝轉移的報告發現PET的敏感性為95%,明顯高於CT65%MRI76%(註三)

因此,在適當的時機使用PET來作癌症復發的評估,例如本病例的情況,的確可以早期正確診斷疾病,也可以避免不必要的檢查與其造成的病情延誤。

 擷取5.JPG

圖一、肝臟左葉內出現一微小高代謝性病灶,疑為大腸癌復發之肝轉移,手術切除後的病理檢查證實是一大腸癌的轉移。

 

註一:

1.          Bipat S, van Leeuwen MS, Comans EF, et al: Colorectal liver metastases: CT, MR imaging, and PET for diagnosis–meta-analysis. Radiology 237:123-131, 2005

2.          Kinkel K, Lu Y, Both M, et al: Detection of hepatic metastases from cancers of the gastrointestinal tract by using noninvasive imaging methods (US, CT, MR imaging, PET): A meta-analysis. Radiology 224:748-756, 2002

3.          Staib L, Schirrmeister H, Reske SN, et al: Is (18)F-fluorodeoxyglucose positron emission tomography in recurrent colorectal cancer a contribution to surgical decision making? Am J Surg 180:1-5, 2000.

4.          Valk PE, Abella-Columna E, Haseman MK, et al: Whole-body PET imaging with [18F]fluorodeoxyglucose in management of recurrent colorectal cancer. Arch Surg 1999;134:503-511; discussion 511-503.

5.          Whiteford MH, Whiteford HM, Yee LF, et al: Usefulness of FDG-PET scan in the assessment of suspected metastatic or recurrent adenocarcinoma of the colon and rectum. Dis Colon Rectum 43:759-767, 2000; discussion 767-770

6.          Lai DT, Fulham M, Stephen MS, et al: The role of whole-body positron emission tomography with [18F]fluorodeoxyglucose in identifying operable colorectal cancer metastases to the liver. Arch Surg 131:703-707, 1996.

7.          Vitola JV, Delbeke D, Sandler MP, et al: Positron emission tomography to stage suspected metastatic colorectal carcinoma to the liver. Am J Surg 171:21-26, 1996.

8.          Delbeke D, Vitola JV, Sandler MP, et al: Staging recurrent metastatic colorectal carcinoma with PET. J Nucl Med 38:1196-1201, 1997

9.          Hustinx R, Paulus P, Jacquet N, et al: Clinical evaluation of wholebody 18F-fluorodeoxyglucose positron emission tomography in the detection of liver metastases. Ann Oncol 9:397-401, 1998.

10.      Kalff V, Hicks RJ, Ware RE, et al: The clinical impact of (18)F-FDG PET in patients with suspected or confirmed recurrence of colorectal cancer: A prospective study. J Nucl Med 43:492-499, 2002.

 註二:

1.          Huebner RH, Park KC, Shepherd JE, et al: A meta-analysis of the literature for whole-body FDG PET detection of recurrent colorectal cancer. J Nucl Med 41:1177-1189, 2000.

 註三:

1.          Bipat S, van Leeuwen MS, Comans EF, et al: Colorectal liver metastases: CT, MR imaging, and PET for diagnosis–meta-analysis. Radiology 237:123-131, 2005.