Role of fluorodeoxyglucose positron emission tomography (FDG PET)‐computed tomography (CT) in the staging of bladder cancer

Abstract

ObjectiveTo determine whether to use 18 F-fluorodeoxyglucose positron emission tomography (FDG PET) scans in the preoperative staging of bladder cancer (BC). Patients and MethodsIn all, 233 patients with muscle-invasive BC (MIBC) or high-risk non-MIBC being considered for radical cystectomy (RC) between 2005 and 2011 had FDG-PET and computed tomography (CT) of the chest, abdomen and pelvis to assess for pelvic lymph node (LN) involvement or distant metastases. Sensitivity and specificity for detecting pelvic LN involvement was determined by comparing the results of the scans to the histopathology reports in patients undergoing RC. These parameters for distant metastases were determined from biopsy results or follow-up imaging. In patients who did not undergo RC, follow-up imaging was used to evaluate the sensitivity and specificity. Patients were excluded from analysis if they either had neoadjuvant chemotherapy or had <10 LNs removed at lymphadenectomy. ResultsThe PET scan was able to detect metastatic disease outside of the pelvis with a sensitivity of 54% compared with 41% for the staging CT (N = 207). Both scans had similar specificities of 97% and 98%. There were 13 PET avid lesions not visualised on the corresponding staging CT scans. These proved to be metastatic BC (six patients), a synchronous primary colonic cancer (one), colonic adenomas (one), basal cell tumour of the parotid gland (one) and inflammatory lesions (four). The sensitivity and specificity of the CT scans for pelvic LN involvement was 45% and 98%, respectively (N = 93). Using a combination of the PET and CT scan, the sensitivity for detecting metastatic disease in LNs increased to 69% with a 3% reduction in specificity to 95%. ConclusionsPET when used in conjunction with a standard CT scan provides a small improvement in preoperative staging of BC. However, this advantage is not significant enough to justify the additional cost. Hence we recommend use of dual imaging only in highly selected patients.

Evaluation of Computed Tomography for Lymph Node Staging in Bladder Cancer Prior to Radical Cystectomy

“…Moreover, our group has recently shown the lack of benefit in adding 11C-Choline-PET to conventional CT for LN staging of BCa [8]. Other groups have shown similar data for 18F-FDG-PET/CT with no or only a modest benefit in LN staging [20,21]. Thus, staging with conventional CT imaging will remain the most widely used imaging modality in the near future.…”

Diagnostic Accuracy of F-18 FDG PET/CT for Preoperative Lymph Node Staging in Newly Diagnosed Bladder Cancer Patients: A Systematic Review and Meta-Analysis

“…There were a total of 785 patients in the included studies, and their age ranged from 23 to 87 years. Of all 14 studies, 8 studies enrolled the patients retrospectively [15, 25, 26, 29, 31-34]; the remaining 6 studies [13, 14, 24, 27, 28, 30] enrolled the patients prospectively. All studies used PET/CT as the imaging modality in their studies.…”

Contemporary role of advanced imaging for bladder cancer staging

“…PET-CT for staging of bladder cancer has also been demonstrated to provide improved sensitivity of detecting metastatic disease foci outside the pelvis: 54% vs. 41% for diagnostic CT alone, while maintaining a comparably high specificity of 97% [46]. In this study by Goodfellow et al, the added preoperative detection of metastatic disease using PET-CT over conventional anatomic CT imaging could, in the future, prove to alter the treatment course prescribed.…”