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FDG-PET/CT for lymph node staging prior to radical cystectomy

Pihl, Vilhelm ; Markus, Maria LU ; Abrahamsson, Johan LU ; Bläckberg, Mats LU ; Hagberg, Oskar LU ; Kollberg, Petter ; Simoulis, Athanasios LU orcid ; Trägårdh, Elin LU and Liedberg, Fredrik LU (2023) In European journal of hybrid imaging 7(1).
Abstract

Background: 18F-Fluorodeoxyglucose positron emission combined with computed tomography (FDG-PET/CT) has been proposed to improve preoperative staging in patients with bladder cancer subjected to radical cystectomy (RC). Objective: Our aim was to assess the accuracy of FDG-PET/CT for lymph node staging ascertained at the multidisciplinary tumour board compared to lymph node status in the surgical lymphadenectomy specimen obtained at RC, and to explore potential factors associated with false-positive FDG-PET/CT results. Design, setting and participants: Consecutive patients with bladder cancer undergoing RC with extended lymph node dissection between 2011 and 2019 without preoperative chemotherapy in a tertial referral... (More)

Background: 18F-Fluorodeoxyglucose positron emission combined with computed tomography (FDG-PET/CT) has been proposed to improve preoperative staging in patients with bladder cancer subjected to radical cystectomy (RC). Objective: Our aim was to assess the accuracy of FDG-PET/CT for lymph node staging ascertained at the multidisciplinary tumour board compared to lymph node status in the surgical lymphadenectomy specimen obtained at RC, and to explore potential factors associated with false-positive FDG-PET/CT results. Design, setting and participants: Consecutive patients with bladder cancer undergoing RC with extended lymph node dissection between 2011 and 2019 without preoperative chemotherapy in a tertial referral cystectomy unit were included in the study. Outcome measurements and statistical analyses: Sensitivity, specificity, positive and negative predictive values and likelihood ratios were calculated. Potential factors investigated for association with false-positive FDG-PET/CT were; bacteriuria within four weeks prior to FDG-PET/CT, Bacillus Calmette–Guerin (BCG) treatment within 12 months prior to FDG-PET/CT and transurethral resection of bladder tumour (TURB) within four weeks prior to FDG-PET/CT. Results: Among 157 patients included for analysis, 44 (28%) were clinically node positive according to FDG-PET/CT. The sensitivity and specificity for detection of lymph node metastasis were 50% and 84%, respectively, and the corresponding positive predictive and negative predictive values were 61% and 76%. Positive and negative likelihood ratios were 3.0 and 0.6, respectively. No association was found between bacteriuria, previous BCG treatment or TURB within 28 days and false-positive FDG-PET/CT results. Conclusions: Preoperative FDG-PET/CT prior to RC had a clinically meaningful high specificity (84%) but lower sensitivity (50%) for detection of lymph node metastases compared to lymph node status in an extended pelvic lymphadenectomy template. We could not identify any factors associated with false-positive FDG-PET/CT outcomes.

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author
; ; ; ; ; ; ; and
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Bladder cancer, FDG-PET/CT, Lymph node metastasis, Radical cystectomy, Sensitivity, Specificity, Staging
in
European journal of hybrid imaging
volume
7
issue
1
article number
13
publisher
Springer
external identifiers
  • scopus:85165553526
  • pmid:37482566
ISSN
2510-3636
DOI
10.1186/s41824-023-00170-9
language
English
LU publication?
yes
id
42df5906-d793-438c-9810-1088ffed9ec0
date added to LUP
2023-08-30 13:53:24
date last changed
2024-10-05 19:17:40
@article{42df5906-d793-438c-9810-1088ffed9ec0,
  abstract     = {{<p>Background: <sup>18</sup>F-Fluorodeoxyglucose positron emission combined with computed tomography (FDG-PET/CT) has been proposed to improve preoperative staging in patients with bladder cancer subjected to radical cystectomy (RC). Objective: Our aim was to assess the accuracy of FDG-PET/CT for lymph node staging ascertained at the multidisciplinary tumour board compared to lymph node status in the surgical lymphadenectomy specimen obtained at RC, and to explore potential factors associated with false-positive FDG-PET/CT results. Design, setting and participants: Consecutive patients with bladder cancer undergoing RC with extended lymph node dissection between 2011 and 2019 without preoperative chemotherapy in a tertial referral cystectomy unit were included in the study. Outcome measurements and statistical analyses: Sensitivity, specificity, positive and negative predictive values and likelihood ratios were calculated. Potential factors investigated for association with false-positive FDG-PET/CT were; bacteriuria within four weeks prior to FDG-PET/CT, Bacillus Calmette–Guerin (BCG) treatment within 12 months prior to FDG-PET/CT and transurethral resection of bladder tumour (TURB) within four weeks prior to FDG-PET/CT. Results: Among 157 patients included for analysis, 44 (28%) were clinically node positive according to FDG-PET/CT. The sensitivity and specificity for detection of lymph node metastasis were 50% and 84%, respectively, and the corresponding positive predictive and negative predictive values were 61% and 76%. Positive and negative likelihood ratios were 3.0 and 0.6, respectively. No association was found between bacteriuria, previous BCG treatment or TURB within 28 days and false-positive FDG-PET/CT results. Conclusions: Preoperative FDG-PET/CT prior to RC had a clinically meaningful high specificity (84%) but lower sensitivity (50%) for detection of lymph node metastases compared to lymph node status in an extended pelvic lymphadenectomy template. We could not identify any factors associated with false-positive FDG-PET/CT outcomes.</p>}},
  author       = {{Pihl, Vilhelm and Markus, Maria and Abrahamsson, Johan and Bläckberg, Mats and Hagberg, Oskar and Kollberg, Petter and Simoulis, Athanasios and Trägårdh, Elin and Liedberg, Fredrik}},
  issn         = {{2510-3636}},
  keywords     = {{Bladder cancer; FDG-PET/CT; Lymph node metastasis; Radical cystectomy; Sensitivity; Specificity; Staging}},
  language     = {{eng}},
  number       = {{1}},
  publisher    = {{Springer}},
  series       = {{European journal of hybrid imaging}},
  title        = {{FDG-PET/CT for lymph node staging prior to radical cystectomy}},
  url          = {{http://dx.doi.org/10.1186/s41824-023-00170-9}},
  doi          = {{10.1186/s41824-023-00170-9}},
  volume       = {{7}},
  year         = {{2023}},
}