¹⁸F‐fluorodeoxyglucose positron emission tomography–computed tomography for preoperative lymph node staging in patients undergoing radical cystectomy for bladder cancer: A prospective study

Abstract

Abbreviations & AcronymsObjectives: The objective of our study was to analyze the diagnostic performance of 18 F-fluorodeoxyglucose positron emission tomography-computed tomography for lymph node staging in patients with bladder cancer before radical cystectomy and to compare it with that of computed tomography. Methods: A total of 52 patients operated on between 2005 and 2010 were prospectively included in this prospective, mono-institutional, open, non-randomized pilot study. Patients who had received neoadjuvant chemotherapy or radiotherapy were excluded. 18 F-fluorodeoxyglucose positron emission tomography-computed tomography in addition to computed tomography was carried out for lymph node staging of bladder cancer before radical cystectomy. Lymph node dissection during radical cystectomy was carried out. Findings from 18 F-fluorodeoxyglucose positron emission tomography-computed tomography and computed tomography were compared with the results of definitive histological examination of the lymph node dissection. The diagnostic performance of the two imaging modalities was assessed and compared. Results: The mean number of lymph nodes removed during lymph node dissection was 16.5 Ϯ 10.9. Lymph node metastasis was confirmed on histological examination in 22 cases (42.3%). This had been suspected in five cases (9.6%) on computed tomography and in 12 cases (23.1%) on 18 F-fluorodeoxyglucose positron emission tomographycomputed tomography. Sensitivity, specificity, positive predictive value, negative predictive value, relative risk and accuracy were 9.1%, 90%, 40%, 57.4%, 0.91 and 55.7%, respectively, for computed tomography, and 36.4%, 86.7%, 66.7%, 65%, 2.72, 65.4%, respectively, for 18 F-fluorodeoxyglucose positron emission tomography-computed tomography. Conclusions:18 F-fluorodeoxyglucose positron emission tomography-computed tomography is more reliable than computed tomography for preoperative lymph node staging in patients with invasive bladder carcinoma undergoing radical cystectomy.

Editorial Comment to 18F‐fluorodeoxyglucose positron emission tomography‐computed tomography for preoperative lymph node staging in patients undergoing radical cystectomy for bladder cancer: A prospective study

“…Despite the limited sample size, the study by Hitier‐Berthault et al . confirms the superiority of 18 F‐FDG PET‐CT over standard CT for the detection of lymph node metastasis . 18 F‐FDG PET‐CT had more than double the sensitivity (36.4%) than CT alone (9.1%) for the detection of lymph node metastases in the pelvis, even though it was less specific than CT (90% vs 86.7%).…”

“…To decrease the false positive results, Hitier‐Berthault et al . suggest that 18 F‐FDG PET‐CT should be carried out at a distance to the inflammatory process as in the case of Bacillus Calmette‐Guerin (BCG) or Transurethral Resection of the Bladder (TURB) that can be responsible for the specificity variation between different studies …”

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

“…There were a total of 785 patients in the included studies, and their age ranged from 23 to 87 years. Of all 14 studies, 8 studies enrolled the patients retrospectively [15, 25, 26, 29, 31-34]; the remaining 6 studies [13, 14, 24, 27, 28, 30] enrolled the patients prospectively. All studies used PET/CT as the imaging modality in their studies.…”

Neoadjuvant Chemotherapy with Gemcitabine plus Cisplatin in Patients with Locally Advanced Bladder Cancer

“…Due to dramatic improvements in CT scanning and MRI technology in the past years, higher rates of node-positive disease (cN1) are detected on diagnosis. This rate will even rise with the increased use of 18 F-fluorodeoxyglucose positron emission tomography CT [27,28] . In the past, prospective randomized trials in the neoadjuvant setting of bladder cancer have excluded patients with node-positive disease [4,5] .…”