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Longoni M, Scilipoti P, Re C, Rosiello G, Nocera L, Pellegrino F, Basile G, de Angelis M, Quarta L, Burgio G, Necchi A, Cigliola A, Chiti A, Picchio M, Salonia A, Briganti A, Montorsi F, Moschini M. Use of 18F-fluoro-2-deoxy-d-glucose (18F-FDG) PET/CT for lymph node assessment before radical cystectomy in bladder cancer patients. BJU Int 2024. [PMID: 38621771 DOI: 10.1111/bju.16363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/17/2024]
Abstract
OBJECTIVE To assess the diagnostic performance of 18F-fluoro-2-deoxy-d-glucose (18F-FDG) positron emission tomograpy (PET)/computed tomography (CT) in nodal staging before radical cystectomy (RC) and pelvic lymph node dissection (PLND) for bladder cancer (BCa). MATERIALS AND METHODS This analysis was based on a cohort of 199 BCa patients undergoing RC and bilateral PLND between 2015 and 2022. Neoadjuvant chemotherapy (NAC) or immunotherapy (NAI) was administered after oncological evaluation. All patients received preoperative 18F-FDG PET/CT to assess extravesical disease. Point estimates for true negative, false negative, false positive, true positive, sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of conventional imaging and PET/CT were calculated. Subgroup analysis in patients receiving neoadjuvant treatment was performed. RESULTS At preoperative evaluation, 30 patients (15.1%) had 48 suspicious nodal spots on 18F-FDG PET/CT. At RC and bilateral PLND, a total of 4871 lymph nodes (LNs) were removed with 237 node metastases corresponding to 126 different regions. Pathological node metastases were found in 17/30 (57%) vs 39/169 patients (23%) with suspicious vs negative preoperative 18F-FDG PET/CT, respectively (sensitivity = 0.30, specificity = 0.91, PPV = 0.57, NPV = 0.77, accuracy = 0.74). On per-region analysis including 1367 nodal regions, LN involvement was found in 19/48 (39%) vs 105/1319 (8%) suspicious vs negative regions at PET/CT, respectively (sensitivity = 0.15, specificity = 0.98, PPV = 0.40, NPV = 0.92, ACC = 0.90). Similar results were observed for patients receiving NAC (n = 44, 32.1%) and NAI (n = 93, 67.9% [per-patient: sensitivity = 0.36, specificity = 0.91, PPV = 0.59, NPV = 0.80, accuracy = 0.77; per-region: sensitivity = 0.12, specificity = 0.98, PPV = 0.32, NPV = 0.93, ACC = 0.91]). Study limitations include its retrospective design and limited patient numbers. CONCLUSIONS In eight out of 10 patients with negative preoperative 18F-FDG PET/CT, pN0 disease was confirmed at final pathology. No differences were found based on NAC vs NAI treatment. These findings suggest that 18F-FDG PET/CT could play a role in the preoperative evaluation of nodal metastases in BCa patients, although its cost-effectiveness is uncertain.
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Affiliation(s)
- Mattia Longoni
- Department of Urology and Division of Experimental Oncology, URI, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Pietro Scilipoti
- Department of Urology and Division of Experimental Oncology, URI, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Chiara Re
- Department of Urology and Division of Experimental Oncology, URI, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Giuseppe Rosiello
- Department of Urology and Division of Experimental Oncology, URI, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Luigi Nocera
- Department of Urology and Division of Experimental Oncology, URI, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Francesco Pellegrino
- Department of Urology and Division of Experimental Oncology, URI, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Giuseppe Basile
- Department of Urology and Division of Experimental Oncology, URI, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Mario de Angelis
- Department of Urology and Division of Experimental Oncology, URI, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Leonardo Quarta
- Department of Urology and Division of Experimental Oncology, URI, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Giusy Burgio
- Department of Urology and Division of Experimental Oncology, URI, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Andrea Necchi
- Department of Genitourinary Medical Oncology, IRCCS San Raffaele Hospital and Scientific Institute, Milan, Italy
| | - Antonio Cigliola
- Department of Genitourinary Medical Oncology, IRCCS San Raffaele Hospital and Scientific Institute, Milan, Italy
| | - Arturo Chiti
- Department of Nuclear Medicine, IRCCS San Raffaele Hospital and Scientific Institute, Milan, Italy
| | - Maria Picchio
- Department of Nuclear Medicine, IRCCS San Raffaele Hospital and Scientific Institute, Milan, Italy
| | - Andrea Salonia
- Department of Urology and Division of Experimental Oncology, URI, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Alberto Briganti
- Department of Urology and Division of Experimental Oncology, URI, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Francesco Montorsi
- Department of Urology and Division of Experimental Oncology, URI, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Marco Moschini
- Department of Urology and Division of Experimental Oncology, URI, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
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Koshkin VS, Kumar V, Kline B, Escobar D, Aslam M, Cooperberg MR, Aggarwal RR, de Kouchkovsky I, Chou J, Meng MV, Friedlander T, Porten S, Hope TA. Initial Experience with 68Ga-FAP-2286 PET Imaging in Patients with Urothelial Cancer. J Nucl Med 2024; 65:199-205. [PMID: 38212070 DOI: 10.2967/jnumed.123.266390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 11/07/2023] [Indexed: 01/13/2024] Open
Abstract
Improved imaging modalities are needed to accurately stage patients with muscle-invasive bladder cancer (MIBC) and metastatic urothelial carcinoma. Imaging with small-molecule ligands or inhibitors of fibroblast activation protein (FAP) is a promising modality that has demonstrated initial efficacy across a broad range of tumors. We present our experience with the novel FAP-peptide binder 68Ga-FAP-2286 in patients with MIBC. Methods: Patients with histopathologically confirmed bladder cancer who had either localized disease at diagnosis (localized cohort, n = 13) or known metastatic disease (metastatic cohort, n = 8) were imaged with 68Ga-FAP-2286 PET as part of a clinical trial (NCT04621435). The SUVmax of 68Ga-FAP-2286 PET-positive lesions and lesion size were documented. In patients who had available 18F-FDG PET performed within 45 d of 68Ga-FAP-2286 PET (n = 5), uptake on the 2 scans was compared. When there was a discrepancy between imaging modalities on retrospective review, biopsy of suggestive lesions was performed as the standard of care. Results: In the metastatic and localized cohorts, 36 and 18 68Ga-FAP-2286-avid lesions, respectively, were identified across multiple anatomic locations, including lymph nodes, visceral metastases, and bones. Fourteen of 36 lesions in the metastatic cohort and 14 of 18 lesions in the localized cohort were lymph nodes measuring less than 1 cm. Among lesions measuring less than 0.5 cm, 0.5-1 cm, and more than 1 cm, average SUVmax was 5.2 ± 2.6, 9.6 ± 3.7, and 13.0 ± 4.3, respectively, in the metastatic cohort and 10.5 ± 5.1, 10.8 ± 5.7, and 9.9 ± 5.4, respectively, in the localized cohort. Five patients had 18F-FDG PET available for comparison. The average SUVmax for lesions avid on 68Ga-FAP-2286 PET and 18F-FDG PET was 9.9 ± 3.4 versus 4.2 ± 1.9, respectively (n = 16 lesions). For 3 patients in the localized cohort, 68Ga-FAP-2286 PET informed clinical management, including identification of both false-positive findings on 18F-FDG PET and false-negative findings on conventional CT. Conclusion: 68Ga-FAP-2286 imaging is highly sensitive in patients with urothelial cancer and is effective in identifying metastatic lesions across a variety of anatomic sites, including subcentimeter lymph nodes that would not have raised suspicion on conventional scans. This novel imaging modality may inform clinical decision-making in patients with MIBC both by refining local nodal staging and by defining metastatic disease that would otherwise be undetectable on conventional imaging.
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Affiliation(s)
- Vadim S Koshkin
- Division of Hematology/Oncology, Department of Medicine, University of California San Francisco, San Francisco, California;
- Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, California; and
| | - Vipul Kumar
- Division of Hematology/Oncology, Department of Medicine, University of California San Francisco, San Francisco, California
| | - Brad Kline
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California
| | - Domenique Escobar
- Department of Urology, University of California San Francisco, San Francisco, California
| | - Maya Aslam
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California
| | - Matthew R Cooperberg
- Department of Urology, University of California San Francisco, San Francisco, California
| | - Rahul R Aggarwal
- Division of Hematology/Oncology, Department of Medicine, University of California San Francisco, San Francisco, California
- Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, California; and
| | - Ivan de Kouchkovsky
- Division of Hematology/Oncology, Department of Medicine, University of California San Francisco, San Francisco, California
- Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, California; and
| | - Jonathan Chou
- Division of Hematology/Oncology, Department of Medicine, University of California San Francisco, San Francisco, California
- Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, California; and
| | - Maxwell V Meng
- Department of Urology, University of California San Francisco, San Francisco, California
| | - Terence Friedlander
- Division of Hematology/Oncology, Department of Medicine, University of California San Francisco, San Francisco, California
- Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, California; and
| | - Sima Porten
- Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, California; and
- Department of Urology, University of California San Francisco, San Francisco, California
| | - Thomas A Hope
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California
- Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, California; and
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Urso L, Bauckneht M, Albano D, Chondrogiannis S, Grassetto G, Lanfranchi F, Dondi F, Fornarini G, Lazzeri M, Evangelista L. The evolution of PET imaging in renal, bladder, upper urinary tract urothelial, testicular and penile carcinoma - Today's impact, tomorrow's potential. Expert Rev Med Devices 2024; 21:55-72. [PMID: 38072680 DOI: 10.1080/17434440.2023.2293919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2023] [Accepted: 12/07/2023] [Indexed: 02/05/2024]
Abstract
INTRODUCTION The advancement of hybrid PET/CT or PET/MRI imaging for non-prostate genitourinary cancers has not experienced the rapid progress of prostate cancer. Nevertheless, these neoplasms are aggressive and reliable imaging plays a pivotal role in enhancing patients' quality of life and prognosis. AREAS COVERED the main evidence regarding [18F]FDG and non-[18F]FDG PET/CT or PET/MRI in non-prostate uro-oncological malignancies are summarized and discussed. Moreover, potential future directions concerning PET imaging in these neoplasms are debated, with the aim to stimulate future research projects covering these fields. EXPERT OPINION In Renal Cell Carcinoma (RCC), [18F]FDG PET/CT demonstrates varying efficacy in staging, restaging, and prognostic stratification, but PSMA PET/CT is emerging as a potential game-changer, particularly in advanced, high-grade aggressive clear cell RCC. [18F]FDG PET/CT may see an increased use in N and M-staging of bladder cancer, as well as for detecting recurrence and response to neoadjuvant chemotherapy. Preliminary data regarding [68Ga]-FAPI also looks promising in this context. [18F]FDG PET/MRI could be useful for the T-staging of bladder cancer, while upper tract urothelial carcinoma still lacks of molecular imaging literature reports. In testicular and penile cancer [18F]FDG PET/CT has demonstrated its usefulness in several clinical settings, although experiences with non-[18F]FDG radiotracers are lacking.
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Affiliation(s)
- Luca Urso
- Department of Nuclear Medicine - PET/CT Center, S. Maria Della Misericordia Hospital, Rovigo, Italy
| | - Matteo Bauckneht
- Nuclear Medicine Unit, IRCCS Ospedale Policlinico, San Martino, Genova, Italy
- Department of Health Sciences (DISSAL), University of Genoa, Genova, Italy
| | - Domenico Albano
- Nuclear Medicine Department, ASST Spedali Civili of Brescia, University of Brescia, Brescia, Italy
| | - Sotirios Chondrogiannis
- Department of Nuclear Medicine - PET/CT Center, S. Maria Della Misericordia Hospital, Rovigo, Italy
| | - Gaia Grassetto
- Department of Nuclear Medicine - PET/CT Center, S. Maria Della Misericordia Hospital, Rovigo, Italy
| | - Francesco Lanfranchi
- Nuclear Medicine Unit, IRCCS Ospedale Policlinico, San Martino, Genova, Italy
- Department of Health Sciences (DISSAL), University of Genoa, Genova, Italy
| | - Francesco Dondi
- Nuclear Medicine Department, ASST Spedali Civili of Brescia, University of Brescia, Brescia, Italy
| | - Giuseppe Fornarini
- Medical Oncology Unit 1, IRCCS Ospedale Policlinico, San Martino, Genova, Italy
| | - Massimo Lazzeri
- Department of Urology, IRCCS Humanitas Clinical and Research Hospital, Rozzano, Italy
| | - Laura Evangelista
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy
- Nuclear Medicine Unit, IRCCS Humanitas Research Hospital, Rozzano, Italy
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Öztürk H, Karapolat İ. Evaluation of response to gemcitabine plus cisplatin-based chemotherapy using positron emission computed tomography for metastatic bladder cancer. World J Clin Cases 2023; 11:8447-8457. [PMID: 38188218 PMCID: PMC10768499 DOI: 10.12998/wjcc.v11.i36.8447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Revised: 11/10/2023] [Accepted: 12/06/2023] [Indexed: 12/22/2023] Open
Abstract
BACKGROUND The purpose of the present study was to examine retrospectively the contribution of 18Fluorodeoxyglucose positron emission tomography computed tomography (18FDG-PET/CT) to the evaluation of response to first-line gemcitabine plus cisplatin-based chemotherapy in patients with metastatic bladder cancer. AIM To evaluate the response to Gemcitabine plus Cisplatin -based chemotherapy using 18FDG-PET/CT imaging in patients with metastatic bladder cancer. METHODS Between July 2007 and April 2019, 79 patients underwent 18FDG-PET/CT imaging with the diagnosis of Metastatic Bladder Carcinoma (M-BCa). A total of 42 patients (38 male, 4 female) were included in the study, and all had been administered Gemcitabine plus Cisplatin-based chemotherapy. After completion of the therapy, the patients underwent a repeat 18FDG-PET/CT scan and the results were compared with the PET/CT findings before chemotherapy according to European Organisation for the Research and treatment of cancer criteria. Mean age was 66.1 years and standard deviation was 10.7 years (range: 41-84 years). RESULTS Of the patients, seven (16.6%) were in complete remission, 17 (40.5%) were in partial remission, six (14.3%) had a stable disease, and 12 (28.6%) had a progressive disease. The overall response rate was 57.1 percent. CONCLUSION 18FDG-PET/CT can be considered as a successful imaging tool in evaluating response to first-line chemotherapy for metastatic bladder cancer. Anatomical and functional data obtained from PET/CT scans may be useful in the planning of secondline and thirdline chemotherapy.
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Affiliation(s)
- Hakan Öztürk
- Department of Urology, Izmir University of Economics, Karsiyaka Izmir 35330, Turkey
| | - İnanç Karapolat
- Department of Nuclear Medicine, School of Medicine, İzmir Tınaztepe University, Izmir 35000, Turkey
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Pihl V, Markus M, Abrahamsson J, Bläckberg M, Hagberg O, Kollberg P, Simoulis A, Trägårdh E, Liedberg F. FDG-PET/CT for lymph node staging prior to radical cystectomy. Eur J Hybrid Imaging 2023; 7:13. [PMID: 37482566 PMCID: PMC10363520 DOI: 10.1186/s41824-023-00170-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Accepted: 06/21/2023] [Indexed: 07/25/2023] Open
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 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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Affiliation(s)
- Vilhelm Pihl
- Department of Urology, Skåne University Hospital, Jan Waldenströms Gata 7, 205 02, Malmö, Sweden
- Department of Translational Medicine, Lund University, Malmö, Sweden
| | - Maria Markus
- Clinical Physiology and Nuclear Medicine, Skåne University Hospital, Malmö, Sweden
- Department of Translational Medicine, Lund University, Malmö, Sweden
| | - Johan Abrahamsson
- Department of Urology, Skåne University Hospital, Jan Waldenströms Gata 7, 205 02, Malmö, Sweden
- Department of Translational Medicine, Lund University, Malmö, Sweden
| | - Mats Bläckberg
- Department of Urology, Helsingborg County Hospital, Helsingborg, Sweden
| | - Oskar Hagberg
- Department of Translational Medicine, Lund University, Malmö, Sweden
| | - Petter Kollberg
- Department of Surgical and Perioperative Sciences, Urology and Andrology, Umeå University, Umeå, Sweden
| | | | - Elin Trägårdh
- Clinical Physiology and Nuclear Medicine, Skåne University Hospital, Malmö, Sweden
- Department of Translational Medicine, Lund University, Malmö, Sweden
| | - Fredrik Liedberg
- Department of Urology, Skåne University Hospital, Jan Waldenströms Gata 7, 205 02, Malmö, Sweden.
- Department of Translational Medicine, Lund University, Malmö, Sweden.
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van Ginkel N, van Gennep EJ, Oosterbaan L, Greidanus J, Boellaard TN, Wondergem M, Vis AN, de Reijke TM, van Rhijn BWG, Mertens LS. Added Clinical Value of 18F-FDG-PET/CT to Stage Patients With High-Risk Non-Muscle Invasive Bladder Cancer Before Radical Cystectomy. Clin Genitourin Cancer 2023; 21:342-348. [PMID: 36918302 DOI: 10.1016/j.clgc.2023.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 02/01/2023] [Accepted: 02/01/2023] [Indexed: 02/24/2023]
Abstract
INTRODUCTION AND OBJECTIVES 18F-fluorodeoxyglucose positron-emission tomography-computed tomography (FDG-PET/CT) is increasingly used in the preoperative staging of patients with muscle-invasive bladder cancer. The clinical added value of FDG-PET/CT in high-risk non-muscle invasive bladder cancer (NMIBC) is unknown. In this study, the value of FDG-PET/CT in addition to contrast enhanced (CE)-CT was evaluated in high-risk NMIBC before radical cystectomy (RC). MATERIALS AND METHODS This is a retrospective analysis of consecutive patients with high risk and very-high risk urothelial NMIBC scheduled for RC in a tertiary referral center between 2011 and 2020. Patients underwent staging with CE-CT (chest and abdomen/pelvis) and FDG-PET/CT. We assessed the clinical disease stage before and after FDG-PET/CT and the treatment recommendation based on the stage before and after FDG-PET/CT. The accuracy of CT and FDG-PET/CT for identifying metastatic disease was defined by the receiver-operating curve using a reference-standard including histopathology/cytology (if available), imaging and follow-up. RESULTS A total of 92 patients were identified (median age: 71 years). In 14/92 (15%) patients, FDG-PET/CT detected metastasis (12 suspicious lymph nodes and 4 distant metastases). The disease stage changed in 11/92 (12%) patients based on additional FDG-PET/CT findings. FDG-PET/CT led to a different treatment in 9/92 (10%) patients. According to the reference standard, 25/92 (27%) patients had metastases. The sensitivity, specificity and accuracy of FDG-PET/CT was 36%, 93% and 77% respectively, versus 12%, 97% and 74% of CE-CT only. The area under the ROC curve was 0.643 for FDG-PET/CT and 0.545 for CT, P = .036. CONCLUSION The addition of FDG-PET/CT to CE-CT imaging changed the treatment in 10% of patients and proved to be a valuable diagnostic tool in a selected subgroup of NMIBC patients scheduled for RC.
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Affiliation(s)
- Noor van Ginkel
- Department of Urology, Amsterdam UMC, location VUmc, Amsterdam, The Netherlands; Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - Erik J van Gennep
- Department of Surgical Oncology (Urology), Netherlands Cancer Institute - Antoni van Leeuwenhoek hospital, Amsterdam, The Netherlands; Department of Urology, Leiden UMC, Leiden, The Netherlands
| | - Liselot Oosterbaan
- Department of Surgical Oncology (Urology), Netherlands Cancer Institute - Antoni van Leeuwenhoek hospital, Amsterdam, The Netherlands
| | - Joyce Greidanus
- Department of Radiology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Thierry N Boellaard
- Department of Radiology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Maurits Wondergem
- Department of Nuclear Medicine, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - André N Vis
- Department of Urology, Amsterdam UMC, location VUmc, Amsterdam, The Netherlands
| | - Theo M de Reijke
- Department of Urology, Amsterdam UMC, location VUmc, Amsterdam, The Netherlands
| | - Bas W G van Rhijn
- Department of Surgical Oncology (Urology), Netherlands Cancer Institute - Antoni van Leeuwenhoek hospital, Amsterdam, The Netherlands; Department of Urology, Caritas St. Josef Medical Center, University of Regensburg, Regensburg, Germany
| | - Laura S Mertens
- Department of Surgical Oncology (Urology), Netherlands Cancer Institute - Antoni van Leeuwenhoek hospital, Amsterdam, The Netherlands.
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Bouchelouche K. PET/CT in Bladder Cancer: An Update. Semin Nucl Med 2022; 52:475-485. [PMID: 34996595 DOI: 10.1053/j.semnuclmed.2021.12.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Accepted: 12/06/2021] [Indexed: 11/11/2022]
Abstract
In the urinary tract, bladder cancer is the most common malignancy. It is a heterogenous cancer type with approximately 30% presenting as muscle invasive bladder cancer with a high risk of metastatic spread associated with risk of death from distant metastases. The other 70% of bladder cancer patients present with superficial tumors with tendency of recurrence but in general not life-threatening. Like in other malignancies, accurate and precise staging of bladder cancer is one of the mainstays at the time of diagnosis to select the optimal treatment for each patient. The detection of metastatic spread is of utmost importance for selection of treatment strategy. Hybrid imaging med with FDG PET/CT is widely used in the clinical management of a variety of malignancies. FDG PET/CT is increasingly used for primary staging of muscle invasive bladder cancer and for detection of recurrence after radical cystectomy. Few studies have used FDG PET/CT for response evaluation of neoadjuvant, induction chemotherapy or immunotherapy. Furthermore, small studies have tested non-FDG PET agents with little or no urinary excretions of the tracer. This review provides an update on PET/CT in bladder cancer.
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Affiliation(s)
- Kirsten Bouchelouche
- Department of Nuclear Medicine & PET Centre, Aarhus University Hospital, Aarhus, Denmark.
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8
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PET imaging in renal and bladder cancers. Nucl Med Mol Imaging 2022. [DOI: 10.1016/b978-0-12-822960-6.00139-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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