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. 2023 May 9;12(10):3367.
doi: 10.3390/jcm12103367.

The Implementation of FDG PET/CT for Staging Bladder Cancer: Changes in the Detection and Characteristics of Occult Nodal Metastases at Upfront Radical Cystectomy?

Sarah M H Einerhand  1 , Lotte G Zuur  1 , Maurits J Wondergem  2 , Thierry N Boellaard  3 , Kurdo Barwari  1 , Pim J van Leeuwen  1 , Bas W G van Rhijn  1   4 , Laura S Mertens  1
Affiliations

The Implementation of FDG PET/CT for Staging Bladder Cancer: Changes in the Detection and Characteristics of Occult Nodal Metastases at Upfront Radical Cystectomy?

Sarah M H Einerhand et al. J Clin Med. .

Abstract

Occult lymph node (LN)-metastases are frequently found after upfront radical cystectomy (uRC) for bladder cancer (BC). We evaluated whether the implementation of 18F-fluoro-2-deoxy-D-glucose positron emission tomography/computed tomography (FDG PET/CT) influenced nodal staging at uRC. All consecutive BC patients who underwent uRC with bilateral pelvic lymph node dissection (PLND) were identified and divided into two cohorts: cohort A consisted of patients staged with FDG PET/CT and contrast-enhanced CT (CE-CT) (2016-2021); cohort B consisted of patients staged with CE-CT only (2006-2011). The diagnostic performance of FDG PET/CT was assessed and compared with that of CE-CT. Thereafter, we calculated the occult LN metastases proportions for both cohorts. In total, 523 patients were identified (cohort A n = 237, and cohort B n = 286). Sensitivity, specificity, PPV and NPV of FDG PET/CT for detecting LN metastases were 23%, 92%, 42%, and 83%, respectively, versus 15%, 93%, 33%, 81%, respectively, for CE-CT. Occult LN metastases were found in 17% of cohort A (95% confidence interval (CI) 12.2-22.8) and 22% of cohort B (95% CI 16.9-27.1). The median size of LN metastases was 4 mm in cohort A versus 13 mm in cohort B. After introduction of FDG PET/CT, fewer and smaller occult LN metastases were present after uRC. Nevertheless, up to one-fifth of occult (micro-)metastases were still missed.

Keywords: CT; FDG PET/CT; bladder cancer; imaging; lymph node; metastasis; neoadjuvant chemotherapy; radical cystectomy; staging; urothelial carcinoma.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Selection of patients for cohort A and cohort B. Abbreviations: RC = radical cystectomy; CE-CT = contrast enhanced computed tomography; FDG PET/CT = 18F-fluoro-2-deoxy-D-glucose-positron emission tomography with computed tomography; PLND = pelvic lymph node dissection; Rtx = radiotherapy; NAC = neoadjuvant chemotherapy; cN+ = clinically node positive; LN = lymph node; NMIBC = non-muscle invasive bladder cancer; MIBC = muscle invasive bladder cancer; Occult LN metastases = pathologically node-positive patients who were clinically node-negative. * The period from 2012 to 2015 was a transition period, during which FDG PET/CT was not used routinely. Because of this heterogeneity in use, we did not analyse this period and chose a full FDG PET/CT cohort (cohort A) vs. a full non-FDG PET/CT cohort (cohort B).
See this image and copyright information in PMC

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