Diagnostic Accuracy of F-18 FDG PET/CT for Preoperative Lymph Node Staging in Newly Diagnosed Bladder Cancer Patients: A Systematic Review and Meta-Analysis

Abstract

Aims: We aimed to assess the diagnostic accuracy of F-18 fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) for preoperative lymph node (LN) staging in newly diagnosed bladder cancer (BC) patients through a systematic review and meta-analysis. Patients and Methods: MEDLINE, Embase, and the Cochrane Library database, from the earliest available date of indexing through June 30, 2017, were searched for studies evaluating the diagnostic performance of F-18 FDG PET/CT for preoperative LN staging in newly diagnosed BC. We determined the sensitivities and specificities across studies, calculated positive and negative likelihood ratios (LR+ and LR–), and constructed summary receiver operating characteristic curves. Results: Across 14 studies (785 patients), the pooled sensitivity was 0.57 (95% CI: 0.49–0.64) and the pooled specificity was 0.92 (95% CI: 0.87–0.95). The LR syntheses gave an overall LR+ of 7.4 (95% CI: 4.4–12.3) and an LR– of 0.47 (95% CI: 0.39–0.56). The pooled diagnostic odds ratio was 16 (95% CI: 9–28). Conclusions: F-18 FDG PET/CT shows a low sensitivity and high specificity for the detection of metastatic LNs in patients with newly diagnosed BC.

The Role of Imaging in Bladder Cancer Diagnosis and Staging

“…In a combined meta-analysis and single-institution study of patients with bladder cancer scheduled to undergo radical cystectomy and pelvic lymph node dissection, the authors determined that the pooled sensitivity and specificity for detection of lymph node metastases were 57% and 95%, respectively [52]. These findings were also confirmed in two subsequent meta-analyses, which demonstrated a pooled sensitivity of 56-57% and a pooled specificity of 92% for the detection of lymph node metastases on FDG-PET/CT [53,54]. A small (n = 15) study evaluating the use of FDG-PET/CT for the preoperative lymph node staging of MIBC demonstrated minimal benefit of FDG-PET/CT compared with CT alone, thought to potentially be due to overlap in standardized uptake values (SUVs) between inflammatory and malignant lesions [55].…”

The Role of 18F-FDG PET/CT in Guiding Precision Medicine for Invasive Bladder Carcinoma

“…A recent meta-analysis including 14 studies and 785 patients reported that the pooled sensitivity and specificity of 18F-FDG PET/CT for initial pelvic LN staging, in a per patient analysis, were 57% [95% CI 49-64%] and 92% [95% CI 87-95%], respectively (19). One major limitation of the current literature is the heterogeneous methodologies across published studies, notably regarding study designs, inclusion criteria, administration of NAC, injection-acquisition time in PET, the use of forced diuresis, the administration of contrast media for PET/CT, and interpretation criteria for both CECT and PET/CT (20).…”

Evidence-Based PET for Abdominal and Pelvic Tumours

“…Several evidence-based articles were focused on the clinical usefulness of 18 F-FDG PET/CT in patients with bladder cancer [103][104][105][106][107][108][109]. An over-all sensitivity and specificity of 82% and 92% was reported, respectively [108].…”

“…Sensitivity and specificity were 90% and 100%, respectively, for primary staging, and 82% and 89%, respectively, for restaging [105]. For detection of node metastases, specificity was found high, whereas sensitivity was poor [103,104,106]. Additionally, detection of node involvement was assessed by other radiopharmaceuticals such as 11 C-choline or 11 C-acetate [109], showing low sensitivity and moderate specificity.…”