TY - JOUR
T1 - The Implementation of FDG PET/CT for Staging Bladder Cancer
T2 - Changes in the Detection and Characteristics of Occult Nodal Metastases at Upfront Radical Cystectomy?
AU - Einerhand, Sarah M. H.
AU - Zuur, Lotte G.
AU - Wondergem, Maurits J.
AU - Boellaard, Thierry N.
AU - Barwari, Kurdo
AU - van Leeuwen, Pim J.
AU - van Rhijn, Bas W. G.
AU - Mertens, Laura S.
N1 - Publisher Copyright: © 2023 by the authors.
PY - 2023/5/1
Y1 - 2023/5/1
N2 - Occult lymph node (LN)-metastases are frequently found after upfront radical cystectomy (uRC) for bladder cancer (BC). We evaluated whether the implementation of 18F-fluoro-2-deoxy-D-glucose positron emission tomography/computed tomography (FDG PET/CT) influenced nodal staging at uRC. All consecutive BC patients who underwent uRC with bilateral pelvic lymph node dissection (PLND) were identified and divided into two cohorts: cohort A consisted of patients staged with FDG PET/CT and contrast-enhanced CT (CE-CT) (2016–2021); cohort B consisted of patients staged with CE-CT only (2006–2011). The diagnostic performance of FDG PET/CT was assessed and compared with that of CE-CT. Thereafter, we calculated the occult LN metastases proportions for both cohorts. In total, 523 patients were identified (cohort A n = 237, and cohort B n = 286). Sensitivity, specificity, PPV and NPV of FDG PET/CT for detecting LN metastases were 23%, 92%, 42%, and 83%, respectively, versus 15%, 93%, 33%, 81%, respectively, for CE-CT. Occult LN metastases were found in 17% of cohort A (95% confidence interval (CI) 12.2–22.8) and 22% of cohort B (95% CI 16.9–27.1). The median size of LN metastases was 4 mm in cohort A versus 13 mm in cohort B. After introduction of FDG PET/CT, fewer and smaller occult LN metastases were present after uRC. Nevertheless, up to one-fifth of occult (micro-)metastases were still missed.
AB - Occult lymph node (LN)-metastases are frequently found after upfront radical cystectomy (uRC) for bladder cancer (BC). We evaluated whether the implementation of 18F-fluoro-2-deoxy-D-glucose positron emission tomography/computed tomography (FDG PET/CT) influenced nodal staging at uRC. All consecutive BC patients who underwent uRC with bilateral pelvic lymph node dissection (PLND) were identified and divided into two cohorts: cohort A consisted of patients staged with FDG PET/CT and contrast-enhanced CT (CE-CT) (2016–2021); cohort B consisted of patients staged with CE-CT only (2006–2011). The diagnostic performance of FDG PET/CT was assessed and compared with that of CE-CT. Thereafter, we calculated the occult LN metastases proportions for both cohorts. In total, 523 patients were identified (cohort A n = 237, and cohort B n = 286). Sensitivity, specificity, PPV and NPV of FDG PET/CT for detecting LN metastases were 23%, 92%, 42%, and 83%, respectively, versus 15%, 93%, 33%, 81%, respectively, for CE-CT. Occult LN metastases were found in 17% of cohort A (95% confidence interval (CI) 12.2–22.8) and 22% of cohort B (95% CI 16.9–27.1). The median size of LN metastases was 4 mm in cohort A versus 13 mm in cohort B. After introduction of FDG PET/CT, fewer and smaller occult LN metastases were present after uRC. Nevertheless, up to one-fifth of occult (micro-)metastases were still missed.
KW - CT
KW - FDG PET/CT
KW - bladder cancer
KW - imaging
KW - lymph node
KW - metastasis
KW - neoadjuvant chemotherapy
KW - radical cystectomy
KW - staging
KW - urothelial carcinoma
UR - http://www.scopus.com/inward/record.url?scp=85160549738&partnerID=8YFLogxK
U2 - https://doi.org/10.3390/jcm12103367
DO - https://doi.org/10.3390/jcm12103367
M3 - Article
C2 - 37240473
SN - 0009-9147
VL - 12
JO - Clinical Chemistry
JF - Clinical Chemistry
IS - 10
M1 - 3367
ER -