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. 2010 Sep 1;28(25):3973-8.
doi: 10.1200/JCO.2010.28.7052. Epub 2010 Aug 2.

Clinical value of fluorine-18 2-fluoro-2-deoxy-D-glucose positron emission tomography/computed tomography in bladder cancer

Andrea B Apolo  1 , Jamie Riches, Heiko Schöder, Oguz Akin, Alisa Trout, Matthew I Milowsky, Dean F Bajorin
Affiliations

Clinical value of fluorine-18 2-fluoro-2-deoxy-D-glucose positron emission tomography/computed tomography in bladder cancer

Andrea B Apolo et al. J Clin Oncol. .

Abstract

Purpose: Fluorine-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.

Patients and methods: Between May 2006 and February 2008, 57 patients with bladder cancer at our center underwent FDG-PET/CT after CT (n = 52) or magnetic resonance imaging (MRI; n = 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.

Results: One 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.

Conclusion: FDG-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.

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Conflict of interest statement

Authors' disclosures of potential conflicts of interest and author contributions are found at the end of this article.

Figures

Fig 1.
Fig 1.
Physician answers (n =53) to National Oncology Positron Emission Tomography (PET) Registry questionnaires concerning extent of disease and the impact of fluorine-18 2-fluoro-2-deoxy-D-glucose (FDG) PET/computed tomography (CT) on clinical management. Responses were confirmed by medical record review. (A) Responses to extent of disease on FDG-PET/CT compared with CT or magnetic resonance imaging (MRI). (B) Responses to FDG-PET/CT and avoidance of additional tests.
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