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J.Jpn. Surg. Soc.. 109(1): 3-9, 2008

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Department of Surgery, Kinki University School of Medicine, Osaka, Japan

Takushi Yasuda, Haruhiko Imamoto, Hitoshi Shiozaki

There has been remarkable progress in diagnostic modalities in recent years. The development of endoscopic instruments and introduction of fluoro deoxy glucose-positron emission tomography (FDG-PET) and sentinel node (SN) diagnosis markedly improved diagnostic quality. The requirement for individualized treatment is increasing with the progress in less-invasive treatment, and therefore it is necessary to select the optimal treatment individually on the basis of accurate tumor staging.
In diagnosis of the T category, zoom endoscopy and autofluorescence imaging/narrow band imaging technology improved the diagnostic accuracy of T1 stage. T2 or higher tumors are diagnosed with endoscopic ultrasonography (EUS) and multidetector computed tomography (CT). In diagnosis of the N category, FDG-PET was expected to be useful. However, it often gave false-negative lymph node (LN) results, and was revealed to have low sensitivity in contrast to high specificity. It is important to detect swollen LNs using CT and then to assess qualitatively the presence or absence of metastasis with EUS and FDG-PET. SN diagnosis using radioisotopes as tracers was introduced as preliminary research for subsequent less-invasive surgery. In diagnosis of the M category, FDG-PET is currently the most important to obtain additional information missed on CT, because FDG-PET can assess the whole body.
For response evaluation to neoadjuvant treatment, FDG-PET is extremely useful. It can predict histologic response and postoperative survival accurately and allow diagnosis of distant metastases in the entire body simultaneously. All information needed for a decision on surgical indications can be acquired noninvasively, and therefore FDG-PET may be the key modality in multimodality treatment.

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