Pelvic Lymph Node Staging by Combined 18 F-FDG-PET/CT Imaging in Bladder Cancer Prior to Radical Cystectomy

Clin Genitourin Cancer. 2017 Jun;15(3):e387-e395. doi: 10.1016/j.clgc.2016.08.009. Epub 2016 Aug 10.

Abstract

Background: Accurate lymph node (LN) staging in bladder cancer before radical cystectomy is essential as LN metastases have an independent prognostic value. Most studies used a cutoff of > 10 mm in detecting pelvic LN spread. The aim of this study was to evaluate the diagnostic accuracy of contrast-enhanced computed tomography (CT) and 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography (PET) alone, or combined for preoperative pelvic LN staging.

Patients and methods: We retrospectively analyzed the data of 70 bladder cancer patients that were staged with 18F-FDG-PET/CT before radical cystectomy between 2012 and 2015. 18F-FDG-PET images were analyzed visually and semi-quantitatively by calculating the maximum standardized uptake value. CT scans were reviewed using different cutoffs of pelvic LNs, with the best cutoff at 8 mm (area under the curve = 0.684).

Results: Metastatic LNs were confirmed in 53 (2.8%) of 1906 resected LNs in 11 (15.7%) patients. Sensitivity, specificity, and accuracy were 54.5%, 89.8%, and 84.3% for 18F-FDG-PET alone; 45.5%, 91.5%, and 84.3% for CT (LNs > 8 mm) alone; and 27.3%, 96.6%, and 85.7% for CT (LNs > 10 mm) alone, respectively. Combined 18F-FDG-PET/CT resulted in a nonsignificant increase of diagnostic accuracy using a cutoff > 8 mm for LN evaluation (63.6%, 86.4%, and 82.9%, respectively). A significant improvement of sensitivity to 63.6% was achieved only when LNs > 10 mm were considered suspicious (P = .046), but this reduced specificity to 88.1% (P = .025).

Conclusions: Combined 18F-FDG-PET/CT does not seem to be justified in preoperative staging if the threshold of pelvic LNs is set > 8 mm.

Keywords: CT; Cystectomy; Lymph node metastases; PET; Preoperative staging.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Cystectomy
  • Female
  • Fluorodeoxyglucose F18 / metabolism*
  • Humans
  • Lymph Nodes / diagnostic imaging
  • Lymph Nodes / pathology*
  • Lymphatic Metastasis
  • Male
  • Middle Aged
  • Neoplasm Staging
  • Pelvis
  • Positron Emission Tomography Computed Tomography / methods*
  • Prognosis
  • Radiopharmaceuticals / metabolism*
  • Retrospective Studies
  • Sensitivity and Specificity
  • Urinary Bladder Neoplasms / diagnostic imaging
  • Urinary Bladder Neoplasms / pathology*
  • Urinary Bladder Neoplasms / surgery

Substances

  • Radiopharmaceuticals
  • Fluorodeoxyglucose F18