TY - JOUR
T1 - Added Clinical Value of 18F-FDG-PET/CT to Stage Patients With High-Risk Non-Muscle Invasive Bladder Cancer Before Radical Cystectomy
AU - van Ginkel, Noor
AU - van Gennep, Erik J.
AU - Oosterbaan, Liselot
AU - Greidanus, Joyce
AU - Boellaard, Thierry N.
AU - Wondergem, Maurits
AU - Vis, André N.
AU - de Reijke, Theo M.
AU - van Rhijn, Bas W. G.
AU - Mertens, Laura S.
N1 - Funding Information: Conceptualization: LSM, BWGvR, Data curation: NvG, LO, EvG, Formal analysis: LO, NvG, Funding acquisition: n/a, Investigation: NvG, LO, JG, EvG, Methodology: LSM, BWG, Project administration: NvG, LO, Resources: MW, TB, Software: MW, TB, Supervision: LSM, BWGvR, ANV, TdR, Validation: n/a, Visualization: MW, TB, NvG, Roles/Writing - original draft: NvG, LO,Writing - review & editing: LSM, EvG, JG, TB, MW, ANV, TdR, BWG. Publisher Copyright: © 2023 Elsevier Inc.
PY - 2023/6
Y1 - 2023/6
N2 - Introduction and Objectives: 18F-fluorodeoxyglucose positron-emission tomography-computed tomography (FDG-PET/CT) is increasingly used in the preoperative staging of patients with muscle-invasive bladder cancer. The clinical added value of FDG-PET/CT in high-risk non-muscle invasive bladder cancer (NMIBC) is unknown. In this study, the value of FDG-PET/CT in addition to contrast enhanced (CE)-CT was evaluated in high-risk NMIBC before radical cystectomy (RC). Materials and Methods: This is a retrospective analysis of consecutive patients with high risk and very-high risk urothelial NMIBC scheduled for RC in a tertiary referral center between 2011 and 2020. Patients underwent staging with CE-CT (chest and abdomen/pelvis) and FDG-PET/CT. We assessed the clinical disease stage before and after FDG-PET/CT and the treatment recommendation based on the stage before and after FDG-PET/CT. The accuracy of CT and FDG-PET/CT for identifying metastatic disease was defined by the receiver-operating curve using a reference-standard including histopathology/cytology (if available), imaging and follow-up. Results: A total of 92 patients were identified (median age: 71 years). In 14/92 (15%) patients, FDG-PET/CT detected metastasis (12 suspicious lymph nodes and 4 distant metastases). The disease stage changed in 11/92 (12%) patients based on additional FDG-PET/CT findings. FDG-PET/CT led to a different treatment in 9/92 (10%) patients. According to the reference standard, 25/92 (27%) patients had metastases. The sensitivity, specificity and accuracy of FDG-PET/CT was 36%, 93% and 77% respectively, versus 12%, 97% and 74% of CE-CT only. The area under the ROC curve was 0.643 for FDG-PET/CT and 0.545 for CT, P = .036. Conclusion: The addition of FDG-PET/CT to CE-CT imaging changed the treatment in 10% of patients and proved to be a valuable diagnostic tool in a selected subgroup of NMIBC patients scheduled for RC.
AB - Introduction and Objectives: 18F-fluorodeoxyglucose positron-emission tomography-computed tomography (FDG-PET/CT) is increasingly used in the preoperative staging of patients with muscle-invasive bladder cancer. The clinical added value of FDG-PET/CT in high-risk non-muscle invasive bladder cancer (NMIBC) is unknown. In this study, the value of FDG-PET/CT in addition to contrast enhanced (CE)-CT was evaluated in high-risk NMIBC before radical cystectomy (RC). Materials and Methods: This is a retrospective analysis of consecutive patients with high risk and very-high risk urothelial NMIBC scheduled for RC in a tertiary referral center between 2011 and 2020. Patients underwent staging with CE-CT (chest and abdomen/pelvis) and FDG-PET/CT. We assessed the clinical disease stage before and after FDG-PET/CT and the treatment recommendation based on the stage before and after FDG-PET/CT. The accuracy of CT and FDG-PET/CT for identifying metastatic disease was defined by the receiver-operating curve using a reference-standard including histopathology/cytology (if available), imaging and follow-up. Results: A total of 92 patients were identified (median age: 71 years). In 14/92 (15%) patients, FDG-PET/CT detected metastasis (12 suspicious lymph nodes and 4 distant metastases). The disease stage changed in 11/92 (12%) patients based on additional FDG-PET/CT findings. FDG-PET/CT led to a different treatment in 9/92 (10%) patients. According to the reference standard, 25/92 (27%) patients had metastases. The sensitivity, specificity and accuracy of FDG-PET/CT was 36%, 93% and 77% respectively, versus 12%, 97% and 74% of CE-CT only. The area under the ROC curve was 0.643 for FDG-PET/CT and 0.545 for CT, P = .036. Conclusion: The addition of FDG-PET/CT to CE-CT imaging changed the treatment in 10% of patients and proved to be a valuable diagnostic tool in a selected subgroup of NMIBC patients scheduled for RC.
KW - Accuracy
KW - Diagnosis
KW - Imaging
KW - Non-muscle invasive bladder cancer
KW - Positron-emission tomography-computed tomography
KW - Treatment change
UR - http://www.scopus.com/inward/record.url?scp=85151986257&partnerID=8YFLogxK
U2 - https://doi.org/10.1016/j.clgc.2023.02.004
DO - https://doi.org/10.1016/j.clgc.2023.02.004
M3 - Article
C2 - 36918302
SN - 1558-7673
VL - 21
SP - 342
EP - 348
JO - Clinical genitourinary cancer
JF - Clinical genitourinary cancer
IS - 3
ER -