Evaluation of Fluorodeoxyglucose Positron Emission Tomography Imaging in Metastatic Transitional Cell Carcinoma with and without Prior Chemotherapy

Abstract

Introduction: This study was designed to determine the value of fluorodeoxyglucose (FDG) positron emission tomography (PET) in the evaluation of metastatic transitional cell carcinoma (TCC). Methods: Fifty-eight FDG PET scans were performed on 46 consecutive patients with TCC. Results were correlated with radiologic, pathologic, and histologic findings in these patients and the sensitivity of PET for detecting malignancy in untreated TCC patients (n = 48) was compared to the sensitivity in patients who had undergone prior chemotherapy (n = 10). Results: Of 48 scans in patients who had no prior systemic chemotherapy, 10 had increased uptake in proven metastatic TCC lesions and 3 PET studies failed to reveal metastatic TCC (sensitivity 76.9%). In patients free of metastatic disease, 33 revealed no abnormal uptake and 1 study revealed a suspicious area in a patient free of metastases (specificity = 97.1%). However, in 10 patients imaged after receiving chemotherapy, the sensitivity fell to 50% for the detection of histologically confirmed residual/recurrent tumor by PET. Conclusions: FDG PET detects increased metabolic activity. After chemotherapy, viable cancer cells may still be present but with a diminished metabolic rate. As a result, PET imaging is often useful in the evaluation of untreated metastatic TCC metastasis but should be interpreted with caution in patients who have received prior chemotherapy.

Staging and tumor biological mechanisms of lymph node metastasis in invasive urinary bladder cancer

“…Kibel et al, and Goodfellow et al (174)(175)(176)(177), noted sensitivity rates ranging from 60 to 77% § when using protocols for PET/ CT imaging and analyses similar to those employed in our study. We also found that sensitivity decreased from 41% on a patient level to 25% on a regional LN level, which agrees with Drieskens et al, who also noted a drop in sensitivity from 60% to 50% on the regional level (35).There is no obvious explanation for this discrepancy.…”

Preoperative lymph-node staging of invasive urothelial bladder cancer with18F-fluorodeoxyglucose positron emission tomography/computed axial tomography and magnetic resonance imaging: Correlation with histopathology

“…It has been shown that PET/CT staging with 18 F-FDG is significantly more accurate than PET alone, and side-by-side PET and CT [19]. Several of the 18 F-FDG PET/CT studies in bladder cancer were performed with PET alone [10,16,[20][21][22][23]. In the present study combined 18 F-FDG PET/CT scans were performed in all of the patients.…”

Identification of a bladder cancer-specific ligand using a combinatorial chemistry approach

“…Current imaging modalities like computed tomography and magnetic resonance imaging are not sensitive and/or specific. While 18F-FDG-PET has been tested in clinic for staging purposes of bladder cancer, it has not been extensively used in clinic because the sensitivity and specificity are not satisfactory [19,20]. We have shown that by linking to NIRF dye Cy5.5, PLZ4 can be used for detection of subcutaneous tumor xenograft similar to metastatic bladder cancer (Fig.…”