Clinical Value of Fluorine-18 2-Fluoro-2-Deoxy-D-Glucose Positron Emission Tomography/Computed Tomography in Bladder Cancer

Abstract

A B S T R A C T PurposeFluorine-18 2-fluoro-2-deoxy-D-glucose (FDG) positron emission tomography (PET)/computed tomography (CT) has been approved for imaging in many malignancies but not for bladder cancer. This study investigated the value of FDG-PET/CT imaging in the management of patients with advanced bladder cancer. Between May 2006 and February 2008, 57 patients with bladder cancer at our center underwent FDG-PET/CT after CT (n ϭ 52) or magnetic resonance imaging (MRI; n ϭ 5). The accuracy of FDG-PET/CT was assessed using both organ-based and patient-based analyses. FDG-PET/CT findings were validated by either biopsy or serial CT/MRI. Clinician questionnaires performed before and after FDG-PET/CT assessed whether those scan results affected management. Patients and Methods ResultsOne hundred thirty-five individual lesions were evaluable in 47 patients for the organ-based analysis. Overall sensitivity and specificity were 87% (95% CI, 76% to 94%) and 88% (95% CI, 78% to 95%), respectively. In the patient-based analysis, malignant disease was correctly diagnosed in 25 of 31 patients, resulting in a sensitivity of 81% (95% CI, 63% to 93%). FDG-PET/CT was negative in 15 of 16 patients without malignant lesions for a specificity of 94% (95% CI, 71% to 100%). Pre-and post-PET surveys revealed that FDG-PET/CT detected more malignant disease than conventional CT/MRI in 40% of patients. Post-PET surveys showed that clinicians changed their planned management in 68% of patients based on the FDG-PET/ CT results. ConclusionFDG-PET/CT has excellent sensitivity and specificity in the detection of metastatic bladder cancer and provides additional diagnostic information that enhances clinical management more than CT/MRI alone. FDG-PET/CT scans may provide better accuracy in clinical information for directing therapy.

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

“…The diagnostic performances of 18 F-FDG PET-CT for lymph node staging and/or detection of distant metastases in bladder cancer are better than those of standard CT. [23][24][25] There is no statistical testing to compare sensibility and specificity difference between 18 F-FDG PET-CT and CT, but all results were in favor of 18 F-FDG PET-CT. A recent meta-analysis showed high specificity (89%) and sensitivity (82%) of 18 F-FDG PET-CT for staging or restaging (metastatic lesions) of bladder cancer. 26 However, few published series have assessed the value of 18 F-FDG PET-CT for the precise diagnosis of lymph node invasion.…”

Prognostic Value of ¹¹C-Choline PET/CT and CT for Predicting Survival of Bladder Cancer Patients Treated with Radical Cystectomy

“…Over the last few years PET/CT with the tracers 18 F-FDG, 11 C-choline or 11 C-acetate has evolved as a new staging modality combining cross-sectional anatomical and functional imaging [13,14,15,16,17,18,19,20,21,22,23,24,25,26]. Several studies described increased accuracy and high specificity rates especially in the detection of lymph nodes or distant metastases to bone and visceral organs with 18 F-FDG-based [13,16,17,19,20], 11 C-choline-based [14,24,37] or 11 C-acetate-based [24] PET/CT, which had an impact on further clinical management in a significant number of patients.…”

“…Recently, positron emission tomography (PET) as functional imaging with tracers like 18 F-FDG, 11 C-choline or 11 C-acetate in combination with CT has been introduced [13,14,15,16,17,18,19,20,21,22,23,24,25,26]. However, these studies present conflicting data as to whether these new imaging modalities are able to improve clinical staging in comparison to results of the ‘gold standard' histopathology.…”

Current Concepts in the Management of Muscle Invasive Bladder Cancer

“…With a pooled sensitivity of 82% and pooled specificity of 89% based on a meta-analysis of six studies, PET/CT provides better insight compared to CT/MRI. PET/CT detected more malignant disease in 40% of the patients compared to CT and MRI, and clinicians changed the plan of management in 68% of the patients based on results from PET/CT [37].…”