The increasing indications of FDG-PET/CT in the staging and management of Invasive Bladder Cancer

Omorphos, Nicolas Pavlos; Ghose, Aruni; Hayes, John; Kandala, Abhinav; Sharma, Anand; Vasdev, Nikhil

doi:10.1016/j.urolonc.2022.05.017

Cited by 10 publications

(16 citation statements)

References 55 publications

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“…Based on those different scenarios, the composite outcome altered treatment based on FDG-PET/CT ndings prior to RC has been reported in one out of ve patients [19]. Still, there are discrepancies in how different guidelines interpret the current evidence, resulting in different recommendations regarding the use of preoperative FDG-PET/CT [5].…”

Section: Discussionmentioning

confidence: 99%

“…When based on computed tomography (CT) or magnetic resonance imaging (MRI) such assessment is mainly limited to measure LN size and LN morphology, with the risk of missing small metastases in lymph nodes with normal size and shape [2]. 18 F-ourodeoxyglucose positron emission combined with CT (FDG-PET/CT) has been suggested to improve the accuracy in preoperative staging of LN status compared to CT [3][4][5][6][7][8][9][10]. Nonetheless, three smaller trials including 70 patients or less could not verify improved nodal staging by FDG-PET/CT [11][12][13][14].…”

Section: Introductionmentioning

confidence: 99%

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FDG-PET/CT for lymph node staging in bladder cancer treated with radical cystectomy

Pihl

Markus

Abrahamsson

et al. 2023

Preprint

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Background 18F-Flourodeoxyglucose positron emission combined with computed tomography (FDG-PET/CT) has been proposed to improve preoperative staging in patients with bladder cancer subjected to radical cystectomy (RC). Objective Our aim was to assess the accuracy of FDG-PET/CT for lymph node staging compared to lymph node status in the surgical lymphadenectomy specimen obtained at RC, and to explore potential factors associated with false positive FDG-PET/CT results. Design, setting and participants Consecutive patients with bladder cancer undergoing RC with extended lymph node dissection between 2011 and 2019 without preoperative chemotherapy in a tertial referral cystectomy unit were included in the study. Outcome measurements and statistical analyses Sensitivity, specificity, positive and negative predictive values, and likelihood ratios were calculated. Potential factors investigated for association with false positive FDG-PET/CT were; bacteriuria within four weeks prior to FDG-PET/CT, Bacillus Calmette-Guerin (BCG) treatment within 12 months prior to FDG-PET/CT and transurethral resection of bladder tumor (TURB) within four weeks prior to FDG-PET/CT. Results Among 159 patients included for analysis, 46 (29%) were clinically node positive according to FDG-PET/CT. The sensitivity and specificity for detection of lymph node metastasis were 50% and 82%, respectively, and the corresponding positive predictive and negative predictive values were 59% and 76%. Positive and negative likelihood ratios were 2.8 and 0.6, respectively. No association were found between bacteriuria, previous BCG treatment or TURB within 28 days and false positive FDG-PET/CT results. Conclusions Preoperative FDG-PET/CT prior to RC had a clinically meaningful high specificity (82%) but lower sensitivity (50%) for detection of lymph node metastases compared to lymph node status in an extended pelvic lymphadenectomy template. We could not identify any factors associated with false positive FDG-PET/CT outcomes.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

FDG-PET/CT for lymph node staging in bladder cancer treated with radical cystectomy

Pihl

Markus

Abrahamsson

et al. 2023

Preprint

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“…The acquisition of traditional medical CT examination images, on the other hand, requires a great deal of time and space since more information is contained in them about the human tissues [ 9 ]. It is therefore not only more difficult but also more expensive to segment CT images using CT image segmentation technology [ 10 ]. In medical CT images, it is easy to cause mis-segmentation, especially when body tissues have abnormalities, such as severely damaged tissues [ 11 ].…”

Section: Introductionmentioning

confidence: 99%

Analysis of Bladder Cancer Staging Prediction Using Deep Residual Neural Network, Radiomics, and RNA-Seq from High-Definition CT Images

Zhou,

Zheng,

Sun

et al. 2024

Genetics Research

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Bladder cancer has recently seen an alarming increase in global diagnoses, ascending as a predominant cause of cancer-related mortalities. Given this pressing scenario, there is a burgeoning need to identify effective biomarkers for both the diagnosis and therapeutic guidance of bladder cancer. This study focuses on evaluating the potential of high-definition computed tomography (CT) imagery coupled with RNA-sequencing analysis to accurately predict bladder tumor stages, utilizing deep residual networks. Data for this study, including CT images and RNA-Seq datasets for 82 high-grade bladder cancer patients, were sourced from the TCIA and TCGA databases. We employed Cox and lasso regression analyses to determine radiomics and gene signatures, leading to the identification of a three-factor radiomics signature and a four-gene signature in our bladder cancer cohort. ROC curve analyses underscored the strong predictive capacities of both these signatures. Furthermore, we formulated a nomogram integrating clinical features, radiomics, and gene signatures. This nomogram’s AUC scores stood at 0.870, 0.873, and 0.971 for 1-year, 3-year, and 5-year predictions, respectively. Our model, leveraging radiomics and gene signatures, presents significant promise for enhancing diagnostic precision in bladder cancer prognosis, advocating for its clinical adoption.

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“…staging). However, despite current preoperative imaging, about half of the BCa patients are understaged at the time of radical cystectomy [2]. This is especially due to the lack of sensitivity for nodal metastases with computed tomography (CT) and MRI [2].…”

Section: Introductionmentioning

confidence: 99%

“…Despite being useful in the detection of the invasion into the perivesical fat (T3b) and adjacent organs, CT has limitations in differentiating between stages. The accuracy of CT increases with more advanced up to 92% in tumours with extravesical extension [2]. However, taken together due to the lack of molecular discrimination, it generally underperforms with sensitivities of 55-92% for lymph node staging.…”

Section: Introductionmentioning

confidence: 99%

PET in bladder cancer imaging

Muin¹,

Laukhtina

Hacker³

et al. 2023

Current Opinion in Urology

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Purpose of reviewThe aim of this study was to summarize the available evidence on different PET imaging modalities for the staging of patients diagnosed with bladder cancer (BCa). We further discuss the use of PET/computed tomography (CT) and PET/MRI with different radiopharmaceuticals to characterize tumour biology for treatment guidance. Recent findingsAvailable evidence supports the benefits of PET/CT in BCa staging due to its higher accuracy in the detection of nodal metastases compared with CT alone. The use of PET/MRI is of major future interest due to the higher soft tissue contrast of MRI, which might enable the early detection of the tumour in the bladder. For the time being, the sensitivity of PET/MRI is still too low, when it comes to the diagnosis of early-stage BCa. This is mainly due to the renal excretion of the commonly used [ 18 F]FDG PET tracer, wherefore small lesions in the wall of the bladder can be missed. Novel studies using PET radiopharmaceuticals to target immune checkpoints or other immune cell targets (immunoPET) demonstrated high uptake in tumour lesions with high PD-L1 expression. The use of immunoPET could therefore help identify BCa patients who exhibit PD-L1 positive tumours for systemic immune-therapy. SummaryPET/CT and PET/MRI seem to be promising imaging tools in BCa staging, especially for the detection of lymph node and distant metastases, as they are more accurate than conventional CT. Future clinical trials with novel radiopharmaceuticals and machine-learning driven PET-technologies bear the potential to help in the early detection, staging, monitoring and precision-medicine approach. Specifically, immunoPET is of high future interest, as it could help develop the concept of precision-medicine in the age of immunotherapy.

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The increasing indications of FDG-PET/CT in the staging and management of Invasive Bladder Cancer

Cited by 10 publications

References 55 publications

FDG-PET/CT for lymph node staging in bladder cancer treated with radical cystectomy

FDG-PET/CT for lymph node staging in bladder cancer treated with radical cystectomy

Analysis of Bladder Cancer Staging Prediction Using Deep Residual Neural Network, Radiomics, and RNA-Seq from High-Definition CT Images

PET in bladder cancer imaging

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