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PET–CT for staging patients with muscle invasive bladder cancer: is it more than just a fancy tool?

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Abstract

Purpose

We aim to evaluate the diagnostic accuracy of PET–CT/MRI in the local and distant staging of patients with muscle invasive bladder cancer (MIBC).

Methods

Medline, Pubmed and EMBASE were searched for studies evaluating the diagnostic performance of PET–CT/MRI in the primary staging of MIBC patients. The pooled sensitivity, specificity, positive and negative likelihood ratio (PLR and NLR, respectively) and diagnostic odds ratio (DOR = PLR/NLR) are reported.

Results

We retrieved 35 articles. For local staging, a pooled sensitivity and specificity of 88% (95% CI: 81–92%) and 68% (95% CI: 50–82%), respectively, were found. The PLR and NLR are 2.88 (95% CI: 1.71–4.73) and 0.19 (95% CI: 0.12–0.30) resulting in a DOR of 16.60 (95% CI: 5.98–37.50). For regional lymph node staging, the pooled sensitivity and specificity are 57% (95% CI: 5–63%) and 89% (95% CI: 83–3%). The PLR is 5.33 (95% CI: 3.44–8.09) and NLR is 0.48 (95% CI: 0.42–0.55). The corresponding DOR is 11.10 (95% CI: 6.62–17.60). For distant metastases, a pooled sensitivity and specificity of 89% (95% CI: 61–98%) and 95% (95% CI: 80–99%), respectively, were found. The PLR is 23.70 (95% CI: 4.19–72.10) and the NLR is 0.13 (95% CI: 0.02–0.36) with a DOR of 236.00 (95% CI: 38.00–871.00).

Conclusion

PET–CT/MRI appears to have higher diagnostic accuracy than CT or MRI for local and distant staging of MIBC but it cannot (yet) be recommended in clinical practice because the quality of the evidence is insufficient and the effects on treatment decisions and patient’s outcome remain unclear.

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Acknowledgments

Ellen De Schepper for statistical support.

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Authors and Affiliations

  1. Department of Radiation-Oncology, Ghent University Hospital, C. Heymanslaan 10, 9000, Ghent, Belgium

    Valérie Fonteyne & P. Ost

  2. Department of Radiology and Nuclear Medicine, Ghent University Hospital, Ghent, Belgium

    K. De Man, P. De Visschere & G. Villeirs

  3. Department of Urology, Ghent University Hospital, Ghent, Belgium

    K. Decaestecker

  4. Department of Radiation-Oncology, Iridium Cancer Network, Antwerp, Belgium

    P. Dirix

  5. Department of Radiation-Oncology, University Hospitals Leuven, Leuven, Belgium

    G. De Meerleer & C. Berghen

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  1. Valérie Fonteyne
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Correspondence to Valérie Fonteyne.

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V. Fonteyne is a post-doctorate clinical specialist funded by the Belgian foundation against cancer.

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Fonteyne, V., De Man, K., Decaestecker, K. et al. PET–CT for staging patients with muscle invasive bladder cancer: is it more than just a fancy tool?. Clin Transl Imaging 9, 83–94 (2021). https://doi.org/10.1007/s40336-020-00397-7

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  • DOI: https://doi.org/10.1007/s40336-020-00397-7

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