Evaluation of lymph node status in patients with urothelial carcinoma—still in search of the perfect imaging modality: a systematic review

Abstract

While accurate lymph node status evaluation in urothelial carcinoma patients is essential for the correct disease staging and, hence, establishing the most beneficial treatment strategy, the diagnostic performance of routine imaging in regards to this issue is not satisfactory. For the purpose of this article, we systematically reviewed the contemporary literature on the sensitivity and specificity of particular imaging modalities which have been studied for detecting lymph node metastases in patients diagnosed with urothelial carcinoma. The evidence reviewed shows that computed tomography (CT), although recognized as the imaging modality of choice, is associated with marked limitations, resulting in its low sensitivity for lymph node involvement detection in urothelial carcinoma patients, with no study reporting a value higher than 46% using standard cut-off values. Markedly higher sensitivity rates may be achieved with magnetic resonance imaging (MRI), especially when using ultrasmall superparamagnetic iron oxide as the contrast agent, however, no uniform protocol has been systematically studied up to date. The vast majority of recent evidence concerns positron emission tomography (PET), which is being reported to improve the diagnostic performance of CT alone, as has been demonstrated in multiple articles, which investigated the accuracy of PET/CT at primary or post-treatment staging of urothelial carcinoma patients. However, there has been substantial heterogeneity in terms of methodology and results between those studies, making it premature to draw any definitive conclusions. The results of this review lead to a conclusion, that while CT, despite being not fully satisfactory, still remains the gold-standard method of imaging for staging purposes in urothelial carcinoma, other imaging modalities are under investigation, with promising results.

A deep learning model for lymph node metastasis prediction based on digital histopathological images of primary endometrial cancer

“…At present, the use of cutting-edge DL technology to predict the preoperative LNM status of tumors, including gastric cancer (26,27), breast cancer (28), colorectal cancer (29), lung cancer (30), urothelial cancer (31) and EC (7,32), usually relies on the readily-available MRI/ CT and ultrasound imaging. Clinical experience has illustrated that the existing LNM risk stratification criteria, including the Mayo criteria and NCCN guidelines, will expose 75% of EC patients to unnecessary lymphadenectomy (33) and about 10% of low-risk and 15% of early-stage ECs will progress to LNM (34).…”

A clinical case of a big urethral recurrence after cystectomy in a patient with invasive bladder cancer

“…Несмотря на то что наиболее эффективным методом выявления локорегионарного рецидива/прогрессирования у пациентов с иРМП считается 18 FDG-PET/КТ [5], для диагностики регионарного метастазирования допускается использование как компьютерной, так и магнитно-резонансной томографии. МРТ, в частности, позволяет диагностировать регионарное лимфогенное метастазирование в 76% случаев [14]. Наше наблюдение также подтверждает высокую эффективность использования МРТ для диагностики УР после ЦЭ.…”

The Added-value of Staging ¹⁸F-FDG PET/CT in the Prediction of Overall Survival in the Patients with Bladder Cancer

“…Initially, its use was limited in patients with BC due to the high urinary excretion activity of the ureters and bladder ( 7 ). Nevertheless, several studies have shown that PET/CT has a higher sensitivity in the determination of LN and distant metastases than CT and MRI, and it has caused a therapy management alteration in 19-68% of BC patients ( 8 , 9 , 10 ). Therefore, 18 F-FDG PET/CT is increasingly being used in clinical practice, and its exact role continues to be evaluated ( 6 ).…”