The Implementation of FDG PET/CT for Staging Bladder Cancer: Changes in the Detection and Characteristics of Occult Nodal Metastases at Upfront Radical Cystectomy?

Autor:	Sarah M. H. Einerhand, Lotte G. Zuur, Maurits J. Wondergem, Thierry N. Boellaard, Kurdo Barwari, Pim J. van Leeuwen, Bas W. G. van Rhijn, Laura S. Mertens
Přispěvatelé:	Urology
Rok vydání:	2023
Předmět:	bladder cancer urothelial carcinoma imaging staging CT FDG PET/CT radical cystectomy neoadjuvant chemotherapy lymph node metastasis General Medicine
Zdroj:	Einerhand, S M H, Zuur, L G, Wondergem, M J, Boellaard, T N, Barwari, K, van Leeuwen, P J, van Rhijn, B W G & Mertens, L S 2023, ' The Implementation of FDG PET/CT for Staging Bladder Cancer : Changes in the Detection and Characteristics of Occult Nodal Metastases at Upfront Radical Cystectomy? ', Clinical Chemistry, vol. 12, no. 10, 3367 . https://doi.org/10.3390/jcm12103367 Clinical Chemistry, 12(10):3367 Journal of Clinical Medicine; Volume 12; Issue 10; Pages: 3367
ISSN:	2077-0383 0009-9147
DOI:	10.3390/jcm12103367
Popis:	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.
Databáze:	OpenAIRE
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