Potential impact of 18F-FDG PET/CT on patients selection for neoadjuvant chemotherapy before radical cystectomy |
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| Institution: | 1. Department of Urology, Hôpital Foch, Suresnes, France;2. UFR des Sciences de la Santé, Université Versailles-Saint-Quentin-en-Yvelines, France;3. Department of Nuclear Medicine, Hôpital Foch, Suresnes, France;4. Department of Pathology, Hôpital Foch, Suresnes, France;1. Department of Molecular Medicine and Surgery, Karolinska Institutet and Center for Digestive Disease, Karolinska University Hospital, Solna, P9:03, 17176 Stockholm, Sweden;2. Karolinska Institutet (KI), Department of Oncology-Pathology (OnkPat) K7, Z4:01, Karolinska University Hospital, 17176 Stockholm, Sweden;3. Department of Radiology, Oncology and Radiation Science, Uppsala University, Akademiska sjukhuset, 75185 Uppsala, Sweden;1. Department of Urology, Weill Cornell Medical College, New York-Presbyterian Hospital, New York, NY, USA;2. Department of Urology, University Hospital Basel, Basel, Switzerland;3. Department of Urology, Cochin Hospital, APHP, Paris Descartes University, Paris, France;4. Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany;5. Department of Urology, AP-HP, Hopital Pitié-Salpétrière, Service d''Urologie, Paris, France;6. UPMC Univ. Paris 06, GRC5, ONCOTYPE-Uro, Institut Universitaire de Cancérologie, Paris, France;7. Division of Urologic Surgery and Center for Surgery and Public Health, Brigham and Women''s Hospital/Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA;8. Department of Urology, Medical University of Vienna, Vienna, Austria;9. Department of Surgical, Oncological and Gastroenterologic Sciences, Urology Clinic, University of Padua, Italy;10. Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA;11. Department of Urology, Hospital Universitario Puerta de Hierro-Majadahonda, Universidad Autónoma de Madrid, Madrid, Spain;12. Department of Urology, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan;13. Department of Urology, Landesklinikum Korneuburg, Korneuburg, Austria;14. Department of Urology, University of Montreal, Montreal, QC, Canada;15. Department of Urology, Vita-Salute University, Milan, Italy;1. Department of Gastric Surgery, Liaoning Cancer Hospital & Institute, Shenyang, People''s Republic of China;2. Department of Radiology, Liaoning Cancer Hospital & Institute, Shenyang, People''s Republic of China;3. Center of Tumor Diagnosis and Therapy, The Second Workers Hospital of Liaohe Oil Field, Panjin, People''s Republic of China;1. Royal Victoria Hospital, Belfast BT12 6BA, Northern Ireland, United Kingdom;2. Altnagelvin Area Hospital, Derry BT47 6SB, Northern Ireland, United Kingdom;3. Liverpool Hepatobiliary Centre, University Hospital Aintree, Liverpool L9 7AL, United Kingdom;1. Department of Mathematics, Faculty of Science, Universiti Putra Malaysia, Malaysia;2. Department of Mathematics and Computer Science, Umaru Musa Yar’adua University, Katsina, Nigeria |
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| Abstract: | BackgroundThe detection of lymph node metastases in bladder cancer has a major impact on treatment decisions and patients prognosis. Due to limited value of conventional imaging, the place of molecular and functional imaging needs to be precised, particularly in the neoadjuvant setting.MethodsFrom June 2011 to June 2013, 102 patients with clinically localized BCa were simultaneously staged with 18F-FDG PET/CT before RC. This study assessed the diagnostic accuracy of 18F-FDG PET/CT for the detection of metastases in normal-sized lymph nodes using extended pelvic lymph node dissection and histopathology as the reference standard.ResultsA total of 1211 LNs were examined histopathologically. Sixty-seven (5.5%) metastatic nodes were found in 26/102 patients (25.5%). Lymph node density was 22%. On patient-based analysis, sensitivity, specificity, predictive positive value (PPV), negative positive value (NPV) and accuracy for 18F-FDG PET/CT were calculated as 50%, 96.2%, 80%, 86.2% and 85.3% respectively. On a field-based analysis, sensitivity, specificity, PPV, NPV and accuracy for 18F-FDG PET/CT were calculated as 50.0%, 99.0%, 71.9%, 97.4%, and 96.5% respectively. The majority of missed metastases were micrometastasis <5 mm in long axis diameter.Conclusions18F-FDG PET/CT improves diagnostic efficacy for lymph node staging in patients staged N0 with conventional cross-sectional imaging. 18F-FDG PET/CT could be used as a surrogate marker for detection of metastases in non-enlarged pelvic lymph nodes and enhances management strategy guiding patients selection for neoadjuvant chemotherapy. |
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| Keywords: | Neoadjuvant chemotherapy Muscle-invasive bladder cancer |
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