To determine the diagnostic performance of 18F-FDG PET/CT for detecting nodal metastases in patients with muscle-invasive urothelial bladder cancer prior to radical cystectomy.
Preoperative 18F-FDG PET/CT scans (n = 208) were retrospectively reviewed. Scans were routinely performed in 185 patients with muscle-invasive urothelial bladder cancer between August 2012 and February 2017, all of whom underwent radical cystectomy and pelvic lymph node dissection. Analyses were stratified by clinical node involvement and chemotherapy status. The diagnostic performance of 18F-FDG PET/CT was assessed according to sensitivity, specificity, positive predictive value, and negative predictive value.
Lymph node metastases at time of PLND were present in 21.8% of those without suspicious nodes on computed tomography (clinically node negative) and 52.6% of those with suspicious nodes on CT (clinically node positive). Median metastatic focus size was 5 mm. In clinically node negative patients, 18F-FDG PET/CT rarely detected nodal metastases (sensitivity 7-23%). In clinically node positive patients, a negative 18F-FDG PET/CT was useful in ruling out lymph node metastases (sensitivity 92-100%). This study was limited by its mixed population and focus on pelvic nodal metastases only.
18F-FDG PET/CT appears to be most useful for better characterization of enlarged nodes identified by CT. Routine preoperative 18F-FDG PET/CT has limited utility in clinically node-negative patients.
The Journal of urology. 2020 Mar 05 [Epub ahead of print]
Shawn Dason, Nathan C Wong, Timothy F Donahue, Andreas Meier, Junting Zheng, Lorenzo Mannelli, Pier Luigi Di Paolo, Lucas W Dean, Victor A McPherson, Jonathan E Rosenberg, Dean F Bajorin, Marinella Capeanu, Guido Dalbagni, H Alberto Vargas, Bernard H Bochner
Department of Urology, The Ohio State University, Columbus, Ohio., Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center,New York, New York., Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York., Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York., Genitourinary Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York.