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Integrated analysis of 18F-FDG PET/CT improves preoperative lymph node staging for patients with invasive bladder cancer

  • Nuclear Medicine
  • Published:
European Radiology Aims and scope Submit manuscript

Abstract

Objectives

Preoperative 18F-fluoro-2-deoxy-d-glucose (18F-FDG) positron emission tomography/computed tomography (PET/CT) is controversial to assess lymph node (LN) staging in patients with invasive bladder cancer. We proposed to use the maximum standardized uptake value (SUVmax) associated with axial-based LN size to improve the detection of regional LN metastasis.

Methods

From May 2015 to May 2017, we prospectively included patients with urothelial bladder cancer who underwent radical cystectomy with extended pelvic LN dissection. All patients underwent preoperative 18F-FDG PET/CT staging before surgery. The gold standard comparator was the pathological examination of resected LNs. The data were reported on a regional per area- and patient-based model according to SUVmax values and axial-based LN size criteria.

Results

In total, 1012 LNs were identified in 61 patients with clinically localized invasive bladder cancer who underwent radical cystectomy and extended pelvic LN dissection. Loco-regional involvement of 24 LN areas was confirmed in 17 patients. In per area analysis, diagnostic accuracy of PET/CT and CT alone were respectively 84% and 78% (p = 0.039). On patient-based analysis, combined PET/CT correctly classified pelvic LN status in 5/61 (+ 8%) additional patients using optimal thresholds compared to CT alone, with accuracies of 82% and 74%, respectively (p = 0.13).

Conclusion

Combining SUVmax and axial-based LN size criteria using 18F-FDG PET/CT improved the diagnostic accuracy for preoperative LN staging in patients with invasive bladder cancer, in per area analysis.

Key Points

• Combining metabolical and morphological features using18F-FDG PET/CT improves the detection of malignant lymph node in patients with bladder cancer.

• 18 F-FDG PET/CT may help for initial staging of patients with muscle invasive bladder cancer.

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Abbreviations

ePLND:

Extended pelvic lymph node dissection

IQR:

Interquartile range

LN:

Lymph node

MIBC:

Muscle-invasive bladder cancer

NAC:

Neoadjuvant chemotherapy

NMIBC:

Non-muscle-invasive bladder cancer

PPV:

Positive predictive value

NPV:

Negative predictive value

RC:

Radical cystectomy

SUVmax :

Maximal standardized uptake value

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The authors state that this work has not received any funding.

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Authors and Affiliations

  1. Department of Nuclear Medicine, Hôpital Foch, Université Versailles-Saint-Quentin-en-Yvelines, Université Paris-Saclay, 40, Rue Worth, 92150, Suresnes, France

    Antoine Girard, Astrid Girma, Elise Le Stanc & Jean-François Grellier

  2. Department of Nuclear Medicine, Centre Eugène Marquis, Université Rennes 1, Rennes, France

    Antoine Girard

  3. Department of Urology, Hôpital Foch, Université Versailles-Saint-Quentin-en-Yvelines, Université Paris-Saclay, Suresnes, France

    Mathieu Rouanne, Yann Neuzillet & Thierry Lebret

  4. Department of Pathology, Hôpital Foch, Université Versailles-Saint-Quentin-en-Yvelines, Université Paris-Saclay, Suresnes, France

    Sarah Taconet, Camélia Radulescu & Aurélie Beaufrere

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  1. Antoine Girard
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  2. Mathieu Rouanne
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  3. Sarah Taconet
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Correspondence to Antoine Girard.

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The scientific guarantor of this publication is Antoine Girard.

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The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.

Statistics and biometry

No complex statistical methods were necessary for this paper.

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Written informed consent was obtained from all subjects (patients) in this study.

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Institutional Review Board approval was obtained.

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• diagnostic study

• performed at one institution

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Antoine Girard and Mathieu Rouanne are first co-authors.

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Girard, A., Rouanne, M., Taconet, S. et al. Integrated analysis of 18F-FDG PET/CT improves preoperative lymph node staging for patients with invasive bladder cancer. Eur Radiol 29, 4286–4293 (2019). https://doi.org/10.1007/s00330-018-5959-0

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