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Tsikitas LA, Hopstone MD, Raman A, Duddalwar V. Imaging in Upper Tract Urothelial Carcinoma: A Review. Cancers (Basel) 2023; 15:5040. [PMID: 37894407 PMCID: PMC10605044 DOI: 10.3390/cancers15205040] [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: 08/27/2023] [Revised: 10/11/2023] [Accepted: 10/13/2023] [Indexed: 10/29/2023] Open
Abstract
Medical imaging is a critical tool in the detection, staging, and treatment planning of upper urinary tract urothelial carcinoma (UTUC). This article reviews the strengths and weaknesses of the different imaging techniques and modalities available clinically. This includes multidetector computed tomography (CT), multiparametric magnetic resonance imaging (MRI), ultrasound (US), and positron emission tomography (PET) for the detection, staging, and management of UTUC. In addition, we review the imaging techniques that are being developed and are on the horizon but have not yet made it to clinical practice. Firstly, we review the imaging findings of primary UTUC and the techniques across multiple modalities. We then discuss imaging findings of metastatic disease. Lastly, we describe the role of imaging in the surveillance after resection of primary UTUC based upon current guidelines.
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Affiliation(s)
| | | | | | - Vinay Duddalwar
- Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, USA; (L.A.T.); (M.D.H.); (A.R.)
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2
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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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3
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Abstract
The purpose of this study covered the diagnostic accuracy and usefulness of positron emission tomography/computed tomography (PET/CT) imaging in muscle invasive bladder cancer patients through previously published literature. Through 30 September, 2019, the PubMed database was searched for eligible articles that evaluated PET/CT imaging in bladder cancer patients. In general, FDG PET/CT, the most commonly used PET/CT imaging, does not show good performance for the detection of primary lesions; however, according to the literature it could accurately assess pelvic lymph node (LN) status better than other imaging technologies and it was especially helpful in determining extra-pelvic recurrences. More recently, non-FDG PET/CT imaging, such as C-11 acetate and C-11 choline, has been introduced. Although further research is required, preliminary results show the potential of these techniques to overcome the drawbacks of FDG. This concise study will overview the role of PET/CT when treating muscle-invasive bladder cancer (MIBC).
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Affiliation(s)
- Seok-Ki Kim
- Department of Nuclear Medicine, National Cancer Center, Goyang-si, Korea
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4
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Farolfi A, Koschel S, Murphy DG, Fanti S. PET imaging in urology: a rapidly growing successful collaboration. Curr Opin Urol 2020; 30:623-627. [PMID: 32701721 DOI: 10.1097/mou.0000000000000800] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW To discuss and highlight the recent findings in urological oncology focusing on nuclear medicine advances on imaging and therapy. RECENT FINDINGS Testicular tumors: F-FDG as the standard positron emission tomography (PET) tracer with proven good accuracy in detecting metastatic testicular cancer; urothelial cancer: good accuracy of F-FDG PET in detecting distant metastases but poor results in detecting local disease; prostate cancer: prostate-specific membrane antigen (PSMA) is a promising target for imaging prostate cancer with unprecedented accuracy in both staging and restaging and prospective studies were recently published. In castration-resistant prostate cancer, PSMA-targeting radionuclide therapy is showing potential as a curative possibility (e.g. using Lu-PSMA); renal cell cancer (RCC): besides FDG other PET radiotracers are under clinical evaluation (e.g. antibody-based molecular imaging, metabolic radiotracers and PSMA-based tracers). PSMA-based imaging may have applications in staging clear-cell RCC and in the selection and in the antiangiogenic treatment's response assessment. Possible role of PSMA-targeting radionuclide therapy? SUMMARY In urological oncology, the use of F-FDG has been limited by a generally low tumor uptake and physiological F-FDG excretion by the urinary system. Other radiotracers are increasing the urologist's portfolio allowing imaging of several biochemical pathways. Theragnostic possibilities are also under investigation thanks to PSMA-based tracers.
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Affiliation(s)
- Andrea Farolfi
- Nuclear Medicine Unit, University of Bologna, S. Orsola Hospital, Italy
| | - Samantha Koschel
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne
| | - Declan G Murphy
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne.,Sir Peter MacCallum Department of Oncology, University of Melbourne, Victoria, Australia
| | - Stefano Fanti
- Nuclear Medicine Unit, University of Bologna, S. Orsola Hospital, Italy
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5
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PET/CT in Renal, Bladder, and Testicular Cancer. Clin Nucl Med 2020. [DOI: 10.1007/978-3-030-39457-8_24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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6
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Mirmomen SM, Shinagare AB, Williams KE, Silverman SG, Malayeri AA. Preoperative imaging for locoregional staging of bladder cancer. Abdom Radiol (NY) 2019; 44:3843-3857. [PMID: 31377833 DOI: 10.1007/s00261-019-02168-z] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Bladder cancer is the ninth most common cancer, expected to lead to an estimated 17,670 deaths in the United States in 2019. Clinical management and prognosis of bladder cancer mainly depend on the extent of locoregional disease, particularly whether bladder muscle is involved. Therefore, bladder cancer is often divided into superficial, non-muscle-invasive bladder cancer and muscle-invasive bladder cancer; the latter often prompts consideration for cystectomy. While precise staging prior to cystectomy is crucial, the optimal preoperative imaging modality used to stage the disease remains controversial. Transurethral resection of bladder tumor (TURBT) followed by computed tomography (CT) urography is the current recommended approach for staging bladder cancer but suffers from a high rate of understaging. We review the recent literature and compare different imaging modalities for assessing the presence of muscle invasion and lymph node involvement prior to cystectomy and highlight the advantages of each modality.
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7
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Comparative sensitivity and specificity of imaging modalities in staging bladder cancer prior to radical cystectomy: a systematic review and meta-analysis. World J Urol 2018; 37:667-690. [PMID: 30120501 DOI: 10.1007/s00345-018-2439-8] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Accepted: 08/07/2018] [Indexed: 01/04/2023] Open
Abstract
PURPOSE The detection of lymph node metastases in bladder cancer has a significant impact on treatment decisions. Multiple imaging modalities are available to clinicians including magnetic resonance imaging, computed tomography and positron emission tomography. We aimed to investigate the utility of alternate imaging modalities on pre-cystectomy imaging in bladder cancer for the detection of lymph node metastases. METHODS We performed systematic search of Web of Science (including MEDLINE), EMBASE and Cochrane libraries in accordance with the PRISMA statement. Studies comparing lymph node imaging findings with final histopathology were included in our analysis. Sensitivity and specificity data were quantified using patient-based analysis. A true positive was defined as a node-positive patient on imaging and node positive on histopathology. Meta-analysis of studies was performed using a mixed-effects, hierarchical logistic regression model. RESULTS Our systematic search identified 35 articles suitable for inclusion. MRI and PET have a higher sensitivity than CT while the specificity of all modalities was similar. The summary MRI sensitivity = 0.60 (95% CI 0.44-0.74) and specificity = 0.91 (95% CI 0.82-0.96). Summary PET/CT sensitivity = 0.56 (95% CI 0.49-0.63) and specificity = 0.92 (95% CI 0.86-0.95). Summary CT sensitivity = 0.40 (95% CI 0.33-0.49) and specificity = 0.92 (95% CI 0.86-0.95). CONCLUSION MRI and PET/CT provides superior sensitivity compared to CT for detection of positive lymph nodes in bladder cancer prior to cystectomy. There is variability in the accuracy that current imaging modalities achieve across different studies. A number of other factors impact on detection accuracy and these must be considered.
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8
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Rauscher I, Eiber M, Weber WA, Gschwend JE, Horn T, Maurer T. Positron-emission tomography imaging in urological oncology: Current aspects and developments. Int J Urol 2018; 25:912-921. [DOI: 10.1111/iju.13779] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Accepted: 07/17/2018] [Indexed: 12/15/2022]
Affiliation(s)
- Isabel Rauscher
- Department of Nuclear Medicine; Klinikum rechts der Isar; Technical University of Munich; Munich Germany
| | - Matthias Eiber
- Department of Nuclear Medicine; Klinikum rechts der Isar; Technical University of Munich; Munich Germany
| | - Wolfgang A Weber
- Department of Nuclear Medicine; Klinikum rechts der Isar; Technical University of Munich; Munich Germany
| | - Jürgen E Gschwend
- Department of Urology; Klinikum rechts der Isar; Technical University of Munich; Munich Germany
| | - Thomas Horn
- Department of Urology; Klinikum rechts der Isar; Technical University of Munich; Munich Germany
| | - Tobias Maurer
- Department of Urology; Klinikum rechts der Isar; Technical University of Munich; Munich Germany
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9
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Salminen A, Jambor I, Merisaari H, Ettala O, Virtanen J, Koskinen I, Veskimae E, Sairanen J, Taimen P, Kemppainen J, Minn H, Boström PJ. 11C-acetate PET/MRI in bladder cancer staging and treatment response evaluation to neoadjuvant chemotherapy: a prospective multicenter study (ACEBIB trial). Cancer Imaging 2018; 18:25. [PMID: 30068379 PMCID: PMC6090957 DOI: 10.1186/s40644-018-0158-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Accepted: 07/18/2018] [Indexed: 12/01/2022] Open
Abstract
Background To evaluate the accuracy of 11C-acetate Positron Emission Tomography/Magnetic Resonance Imaging (PET/MRI) in bladder cancer (BC) staging and monitoring response to neoadjuvant chemotherapy (NAC). Methods Eighteen patients were prospectively enrolled. Fifteen treatment naive patients underwent 11C-acetate PET/MRI before transurethral resection of bladder tumor (TUR-BT) for primary tumor evaluation. Five patients with muscle invasive BC were imaged after NAC and prior to radical cystectomy (RC) with extended pelvic lymph node dissection (ePLND) for NAC treatment response evaluation. Two patients were part of both cohorts. 11C-acetate PET/MRI findings were correlated with histopathology. Accuracy for lymph node detection was evaluated on patient and the ePLND template (10 regions) levels. Results The sensitivity, specificity and accuracy of 11C-acetate PET/MRI for the detection of muscle invasive BC was 1.00, 0.69 and 0.73 while the area under the receiver operating characteristic curve (95% confidence interval) was 0.85 (0.55–1.0), respectively. All five NAC patients underwent chemotherapy as planned and 11C-acetate PET/MRI correctly staged three patients, overstaged one and understaged one patient compared with RC and ePLND findings. A total of 175 lymph node were removed, median of 35 (range, 27–43) per patient in five patients who had RC and ePLND while 12 (7%) harboured metastases. Sensitivity, specificity, accuracy and AUC for N-staging were 0.20, 0.96, 0.80 and 0.58 on the ePLND template (10 regions) level. Conclusions 11C-acetate PET/MRI is feasible for staging of BC although sensitivity for the detection of nodal metastases is low. Monitoring response to NAC shows promise and warrants evaluation in larger studies. Trial registration ClinicalTrials.gov Identifier: NCT01918592, registered August 8 2013
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Affiliation(s)
- Antti Salminen
- Department of Urology, University of Turku and Turku University hospital, Kiinamyllynkatu 4-8, 20520, Turku, Finland. .,Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, USA.
| | - Ivan Jambor
- Department of Radiology, University of Turku and Turku University Hospital, Turku, Finland.,Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Harri Merisaari
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Otto Ettala
- Department of Urology, University of Turku and Turku University hospital, Kiinamyllynkatu 4-8, 20520, Turku, Finland
| | - Johanna Virtanen
- Department of Radiology, University of Turku and Turku University Hospital, Turku, Finland
| | - Ilmari Koskinen
- Department of Urology, University of Helsinki and Helsinki University hospital, Helsinki, Finland
| | - Erik Veskimae
- Department of Urology, University of Tampere and Tampere University hospital, Tampere, Finland
| | - Jukka Sairanen
- Department of Urology, University of Helsinki and Helsinki University hospital, Helsinki, Finland
| | - Pekka Taimen
- Department of Pathology, Institute of Biomedicine, University of Turku and Turku University hospital, Turku, Finland
| | - Jukka Kemppainen
- Department of Clinical Physiology and nuclear imaging, University of Turku and Turku University hospital, Turku, Finland.,Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Heikki Minn
- Department of Oncology and Radiotherapy, University of Turku and Turku University hospital, Turku, Finland.,Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Peter J Boström
- Department of Urology, University of Turku and Turku University hospital, Kiinamyllynkatu 4-8, 20520, Turku, Finland
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10
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The role of PET/CT in the evaluation of patients with urothelial cancer: a systematic review and meta-analysis. Clin Transl Imaging 2018. [DOI: 10.1007/s40336-018-0269-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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11
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Choe J, Braschi-Amirfarzan M, Tirumani SH, Shinagare AB, Kim KW, Ramaiya NH, Krajewski KM. Updates for the radiologist in non-muscle-invasive, muscle-invasive, and metastatic bladder cancer. Abdom Radiol (NY) 2017; 42:2710-2724. [PMID: 28580540 DOI: 10.1007/s00261-017-1195-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Urothelial bladder cancer is a common malignancy requiring a multidisciplinary approach to treatment. Significant recent advances have been made in terms of the genetic and molecular characterization of bladder cancer subtypes, and novel treatment approaches are being investigated and approved. Given the important role of imaging in the diagnosis, staging, and follow-up of this disease, it is necessary for radiologists to remain up-to-date in terms of nomenclature and standards of care. In this review, recent developments in bladder cancer characterization and treatment will be discussed, with reference to the contributions of imaging in non-muscle-invasive, muscle-invasive, and metastatic settings.
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Affiliation(s)
- Jooae Choe
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 86 Asanbyeongwon-gil, Songpa-gu, Seoul, 138-736, Republic of Korea.
| | - Marta Braschi-Amirfarzan
- Department of Imaging, Dana Farber Cancer Institute, Harvard Medical School, 450 Brookline Avenue, Boston, MA, 02215, USA
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA
| | - Sree Harsha Tirumani
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA
| | - Atul B Shinagare
- Department of Imaging, Dana Farber Cancer Institute, Harvard Medical School, 450 Brookline Avenue, Boston, MA, 02215, USA
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA
| | - Kyung Won Kim
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 86 Asanbyeongwon-gil, Songpa-gu, Seoul, 138-736, Republic of Korea
| | - Nikhil H Ramaiya
- Department of Imaging, Dana Farber Cancer Institute, Harvard Medical School, 450 Brookline Avenue, Boston, MA, 02215, USA
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA
| | - Katherine M Krajewski
- Department of Imaging, Dana Farber Cancer Institute, Harvard Medical School, 450 Brookline Avenue, Boston, MA, 02215, USA
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA
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12
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FDG-PET/CT for response evaluation of invasive bladder cancer following neoadjuvant chemotherapy. Int Urol Nephrol 2017; 49:1585-1591. [DOI: 10.1007/s11255-017-1637-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2017] [Accepted: 06/05/2017] [Indexed: 02/07/2023]
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13
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14
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Gofrit ON, Orevi M. Diagnostic Challenges of Kidney Cancer: A Systematic Review of the Role of Positron Emission Tomography-Computerized Tomography. J Urol 2016; 196:648-57. [PMID: 27140072 DOI: 10.1016/j.juro.2016.02.2992] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/09/2016] [Indexed: 10/21/2022]
Abstract
PURPOSE Positron emission tomography-computerized tomography is a leading imaging modality for many types of solid tumors. The ability to characterize molecular processes noninvasively during a relatively fast whole-body scan is the major advantage of this technology. We reviewed the literature in an attempt to clarify the usefulness of positron emission tomography-computerized tomography in patients with a renal mass. MATERIALS AND METHODS We searched PubMed® for articles published from 2004 through September 2015 using the keywords "renal," "kidney," "mass," "tumor," "cancer," and "PET/CT." RESULTS A total of 158 relevant articles were included in the review. Most diagnostic studies used (18)F-fluorodeoxyglucose, a marker of glucose metabolism, as the radiotracer. The results were substandard, with sensitivity rates in the range of 31.5% to 77% for diagnosis of renal cell carcinomas. There were higher success rates for diagnosis of clear cell carcinomas. Carbonic anhydrase IX is an enzyme expressed in 95% of clear cell carcinomas but not in normal renal tissue or in benign or nonclear cell malignancies. A chimeric mouse-human antibody to carbonic anhydrase IX labeled with (124)I-girentuximab was demonstrated to diagnose clear cell tumors with sensitivity of 86.2% and specificity of 85.9%. For diagnosis of metastases positron emission tomography-computerized tomography with (18)F-fluorodeoxyglucose was observed to be more accurate than computerized tomography alone (94% vs 89%). Studies with other tracers also reveal encouraging results. Positron emission tomography-computerized tomography holds great promise in predicting prognosis and response to tyrosine kinase inhibitors. Current tyrosine kinase inhibitor treatments usually induce only mild lesion shrinkage. Thus, assessment of response based on changes in size of metastases is insufficient. Low (18)F-fluorodeoxyglucose uptake before treatment and decreased uptake after 2 cycles of treatment are associated with better survival. Using labeled medications as radiotracers before actual treatment may assist in selection of the most effective medication for a specific patient. CONCLUSIONS Positron emission tomography-computerized tomography with (18)F-fluorodeoxyglucose currently has lower sensitivity compared to enhanced computerized tomography for diagnosis of primary renal masses but better sensitivity for diagnosis of metastases. Predicting and monitoring response to targeted therapy could direct the clinician toward drug selection or modification during therapy. The possibility of treating patients with advanced renal cell carcinoma with (124)I-girentuximab attached to (177)Lu, a strong β-emitter, is investigated.
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Affiliation(s)
- Ofer N Gofrit
- Department of Urology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel.
| | - Marina Orevi
- Department of Nuclear Medicine, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
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15
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Abstract
The use of positron emission tomography (PET) is an established method for the diagnosis of urological malignancies. Several tracers are currently available to obtain metabolic information or directly detect molecular targets. While (18)F-FDG-PET is recognized in current guidelines for the staging of seminoma, PET is not used in clinical routine in renal malignancies due to the lack of specific tracers. Despite initial promising results in bladder cancer, no relevant additional diagnostic value with PET using (18)F-FDG or choline-based tracers could be obtained in most patients and therefore should be used with caution or only within clinical trials. In prostate cancer, however, after development of new tracers that, for example, target prostate-specific membrane antigen (PSMA), a paradigm shift in imaging can be recognized. Here, (68)Ga-PSMA-PET might be included in the future as part of standard imaging work-up.
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Affiliation(s)
- T Maurer
- Urologische Klinik und Poliklinik, Technische Universität München, Klinikum rechts der Isar, Ismaninger Straße 22, 81671, München, Deutschland,
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16
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Rais-Bahrami S, Pietryga JA, Nix JW. Contemporary role of advanced imaging for bladder cancer staging. Urol Oncol 2015; 34:124-33. [PMID: 26427696 DOI: 10.1016/j.urolonc.2015.08.018] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2015] [Revised: 08/24/2015] [Accepted: 08/26/2015] [Indexed: 10/23/2022]
Abstract
Optimized pretreatment staging of bladder urothelial carcinoma is essential in guiding appropriate treatment. This staging process relies heavily on tissue pathology from transurethral resection of bladder tumor as well as imaging for diagnosis of local, regional, nodal, or distant visceral spread. Accurate preoperative staging is critical for appropriate treatment decision making and patient counseling as these are based on the extent of disease involvement, largely classifying the cancer as having local, regional, or distant spread. Currently, the gold standard of transurethral resection of bladder tumor followed by computed tomography imaging with intravenous contrast provides excellent staging specificity in cases of more advanced bladder cancers with suspicion of spread; however, this often under stages patients that can lead to adverse oncologic outcomes in these patients undergoing radical cystectomy. Incorporation of novel imaging modalities including multiparametric magnetic resonance imaging and positron emission tomography imaging have shown promise in improving accuracy of staging for both local and distant disease in patients with bladder urothelial carcinoma.
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Affiliation(s)
- Soroush Rais-Bahrami
- Department of Urology, University of Alabama at Birmingham, Birmingham, AL; Department of Radiology, University of Alabama at Birmingham, Birmingham, AL.
| | - Jason A Pietryga
- Department of Radiology, University of Alabama at Birmingham, Birmingham, AL
| | - Jeffrey W Nix
- Department of Urology, University of Alabama at Birmingham, Birmingham, AL
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17
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Aljabery F, Lindblom G, Skoog S, Shabo I, Olsson H, Rosell J, Jahnson S. PET/CT versus conventional CT for detection of lymph node metastases in patients with locally advanced bladder cancer. BMC Urol 2015; 15:87. [PMID: 26294219 PMCID: PMC4546250 DOI: 10.1186/s12894-015-0080-z] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2015] [Accepted: 08/05/2015] [Indexed: 03/12/2023] Open
Abstract
Background We studied patients treated with radical cystectomy for locally advanced bladder cancer to compare the results of both preoperative positron emission tomography/computed tomography (PET/CT) and conventional CT with the findings of postoperative histopathological evaluation of lymph nodes. Methods Patients who had bladder cancer and were candidates for cystectomy underwent preoperative PET/CT using 18-fluorodeoxyglucose (FDG) and conventional CT. The results regarding lymph node involvement were independently evaluated by two experienced radiologists and were subsequently compared with histopathology results, the latter of which were reassessed by an experienced uropathologist (HO). Results There were 54 evaluable patients (mean age 68 years, 47 [85 %] males and 7 [15 %] females) with pT and pN status as follows: < pT2-14 (26 %), pT2-10 (18 %), and > pT2-30 (56 %); pN0 37 (69 %) and pN+ 17 (31 %). PET/CT showed positive lymph nodes in 12 patients (22 %), and 7 of those cases were confirmed by histopathology; the corresponding results for conventional CT were 11 (20 %) and 7 patients (13 %), respectively. PET/CT had 41 % sensitivity, 86 % specificity, 58 % PPV, and 76 % NPV, whereas the corresponding figures for conventional CT were 41 %, 89 %, 64 %, and 77 %. Additional analyses of the right and left side of the body or in specified anatomical regions gave similar results. Conclusions In this study, PET/CT and conventional CT had similar low sensitivity in detecting and localizing regional lymph node metastasis in bladder cancer.
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Affiliation(s)
- Firas Aljabery
- Department of Urology, Linköping University Hospital, Linköping, Sweden. .,Department of Clinical and Experimental Medicine, Faculty of Health Sciences, Linköping University, Linköping, Sweden.
| | - Gunnar Lindblom
- Department of Radiology, Linköping University Hospital, Linköping, Sweden.
| | - Susann Skoog
- Department of Radiology, Linköping University Hospital, Linköping, Sweden.
| | - Ivan Shabo
- Department of Clinical and Experimental Medicine, Faculty of Health Sciences, Linköping University, Linköping, Sweden.
| | - Hans Olsson
- Department of Clinical and Experimental Medicine, Faculty of Health Sciences, Linköping University, Linköping, Sweden.
| | - Johan Rosell
- Regional Cancer Center Southeast Sweden, County Council of Östergötland, Linköping, Sweden.
| | - Staffan Jahnson
- Department of Urology, Linköping University Hospital, Linköping, Sweden. .,Department of Clinical and Experimental Medicine, Faculty of Health Sciences, Linköping University, Linköping, Sweden.
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Abstract
Imaging plays an important role in the clinical management of cancer patients. Hybrid imaging with PET/computed tomography (CT) is having a broad impact in oncology, and in recent years PET/CT is beginning to have an impact in urooncology. In both bladder and renal cancers, there is a need to study the efficacy of other tracers than F-18 fluorodeoxyglucose (FDG), particularly tracers with limited renal excretion. Thus, new tracers are being introduced. This review focuses on the clinical role of FDG and other PET agents in renal, bladder, and testicular cancers.
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Alam IS, Arshad MA, Nguyen QD, Aboagye EO. Radiopharmaceuticals as probes to characterize tumour tissue. Eur J Nucl Med Mol Imaging 2015; 42:537-61. [PMID: 25647074 DOI: 10.1007/s00259-014-2984-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2014] [Accepted: 12/18/2014] [Indexed: 01/06/2023]
Abstract
Tumour cells exhibit several properties that allow them to grow and divide. A number of these properties are detectable by nuclear imaging methods. We discuss crucial tumour properties that can be described by current radioprobe technologies, further discuss areas of emerging radioprobe development, and finally articulate need areas that our field should aspire to develop. The review focuses largely on positron emission tomography and draws upon the seminal 'Hallmarks of Cancer' review article by Hanahan and Weinberg in 2011 placing into context the present and future roles of radiotracer imaging in characterizing tumours.
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Affiliation(s)
- Israt S Alam
- Comprehensive Cancer Imaging Centre, Imperial College London, London, W12 0NN, UK
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Rouanne M, Girma A, Neuzillet Y, Vilain D, Radulescu C, Letang N, Yonneau L, Hervé JM, Botto H, Le Stanc E, Lebret T. Potential impact of 18F-FDG PET/CT on patients selection for neoadjuvant chemotherapy before radical cystectomy. Eur J Surg Oncol 2014; 40:1724-30. [DOI: 10.1016/j.ejso.2014.08.479] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2014] [Revised: 08/21/2014] [Accepted: 08/27/2014] [Indexed: 10/24/2022] Open
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Nanni C, Zanoni L, Fanti S. Nuclear medicine in urological cancers: what is new? Future Oncol 2014; 10:2061-72. [DOI: 10.2217/fon.14.87] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
ABSTRACT The diffusion of PET/computed tomography has opened up a new role for nuclear imaging in urological oncology. Prostate cancer is evaluated with choline (11C or 18F) PET due to a lack of sensitivity of 18F-fluorodeoxyglucose (FDG). However, many new tracers, such as 18F-fluorocyclobutane-1-carboxylic acid and 68Ga-prostate-specific membrane antigen, are under investigation, offering promising results in the particular setting of radically treated patients with biochemical relapse. The performance of 18F-FDG depends on the histological type; indeed, renal cell cancer may present variable metabolic uptake. In this field, mainly antibodies labeled with positron emitters are under clinical evaluation. Finally, 18F-FDG PET/computed tomography has been proven to show good accuracy in detecting metastatic testicular and bladder cancers, despite not having valid results in detecting local disease. The urological cancer diagnostic process is currently under continuous development.
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Affiliation(s)
- Cristina Nanni
- OU Nuclear Medicine, Azienda Ospedaliero-Universitaria di Bologna Policlinico S Orsola-Malpighi, Via Massarenti, 9-40138 Bologna, Italy
| | - Lucia Zanoni
- OU Nuclear Medicine, Azienda Ospedaliero-Universitaria di Bologna Policlinico S Orsola-Malpighi, Via Massarenti, 9-40138 Bologna, Italy
| | - Stefano Fanti
- OU Nuclear Medicine, Azienda Ospedaliero-Universitaria di Bologna Policlinico S Orsola-Malpighi, Via Massarenti, 9-40138 Bologna, Italy
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Maurer T, Horn T, Souvatzoglou M, Eiber M, Beer AJ, Heck MM, Haller B, Gschwend JE, Schwaiger M, Treiber U, Krause BJ. Prognostic value of 11C-choline PET/CT and CT for predicting survival of bladder cancer patients treated with radical cystectomy. Urol Int 2014; 93:207-13. [PMID: 25012094 DOI: 10.1159/000357686] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2013] [Accepted: 11/29/2013] [Indexed: 11/19/2022]
Abstract
BACKGROUND In patients with bladder cancer (BCa) preoperative staging with (11)C-choline positron emission tomography-computed tomography (PET/CT) could be used to derive prognostic information and hence stratify patients preoperatively with respect to disease management. METHODS From June 2004 to May 2007, 44 patients with localized BCa were staged with (11)C-choline PET/CT before radical cystectomy. The results of imaging were correlated to overall survival (OS) and cumulative incidence of cancer-specific death (CSD). RESULTS There was no statistically significant difference in OS and CSD between the patient groups when stratified for organ-confined versus non-organ-confined disease or lymph node involvement defined by either (11)C-choline PET/CT (OS: p = 0.262, hazard ratio [HR] = 1.60; p = 0.527, HR = 0.76; CSD: p = 0.144, HR = 2.25; p = 0.976, HR = 0.98) or CT (OS: p = 0.518, HR = 1.34; p = 0.228, HR = 1.67; CSD: p = 0.323, HR = 1.90; p = 0.136, HR = 2.38). The limitation of this study is the small number of included patients. CONCLUSION In our prospective trial neither CT nor (11)C-choline PET/CT were able to sufficiently predict OS or CSD in BCa patients treated with radical cystectomy albeit trends and moderately increased HRs could be demonstrated without significant differences between CT or (11)C-choline PET/CT. However, these trends might prove statistically significant in bigger patient cohorts. Therefore initial transsectional imaging might be of clinical relevance in respect to prognosis and could play a role in the counseling of BCa patients.
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Affiliation(s)
- Tobias Maurer
- Department of Urology, Technische Universität München, Klinikum rechts der Isar, Munich, Germany
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Maurer T, Eiber M, Krause BJ. [Molecular multimodal hybrid imaging in prostate and bladder cancer]. Urologe A 2014; 53:469-83. [PMID: 24700188 DOI: 10.1007/s00120-014-3440-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Since the introduction of combined radiologic-nuclear imaging procedures like PET/CT and PET/MRI, new and promising diagnostic tools in bladder and prostate cancer imaging are available to physicians. Although PET-based hybrid imaging in bladder cancer is currently utilized only in selected cases, an increase in PET imaging can be observed in prostate cancer due to the development of cancer-specific PET tracers. Especially novel ligands of prostate-specific membrane antigen (PSMA) exhibit great potential to effectively influence future staging of prostate cancer. However, before recommendations for implication in routine staging can be given, evaluation in the context of prospective multicenter clinical trials are mandatory.
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Affiliation(s)
- T Maurer
- Urologische Klinik und Poliklinik, Technische Universität München, Klinikum rechts der Isar, Ismaninger Straße 22, 81671, München, Deutschland,
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24
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Buchegger F, Garibotto V, Zilli T, Allainmat L, Jorcano S, Vees H, Rager O, Steiner C, Zaidi H, Seimbille Y, Ratib O, Miralbell R. First imaging results of an intraindividual comparison of (11)C-acetate and (18)F-fluorocholine PET/CT in patients with prostate cancer at early biochemical first or second relapse after prostatectomy or radiotherapy. Eur J Nucl Med Mol Imaging 2013; 41:68-78. [PMID: 24104592 DOI: 10.1007/s00259-013-2540-6] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2013] [Accepted: 08/06/2013] [Indexed: 11/26/2022]
Abstract
PURPOSE (18)F-Fluorocholine (FCH) and (11)C-acetate (ACE) PET are widely used for detection of recurrent prostate cancer (PC). We present the first results of a comparative, prospective PET/CT study of both tracers evaluated in the same patients presenting with recurrence and low PSA to compare the diagnostic information provided by the two tracers. METHODS The study group comprised 23 patients studied for a rising PSA level after radical prostatectomy (RP, 7 patients, PSA ≤ 3 ng/ml), curative radiotherapy (RT, 7 patients, PSA ≤ 5 ng/ml) or RP and salvage RT (9 patients, PSA ≤ 5 ng/ml). Both FCH and ACE PET/CT scans were performed in a random sequence a median of 4 days (range 0 to 11 days) apart. FCH PET/CT was started at injection (307 ± 16 MBq) with a 10-min dynamic acquisition of the prostate bed, followed by a whole-body PET scan and late (45 min) imaging of the pelvis. ACE PET/CT was performed as a double whole-body PET scan starting 5 and 22 min after injection (994 ± 72 MBq), and a late view (45 min) of the prostate bed. PET/CT scans were blindly reviewed by two independent pairs of two experienced nuclear medicine physicians, discordant subgroup results being discussed to reach a consensus for positive, negative end equivocal results. RESULTS PET results were concordant in 88 out of 92 local, regional and distant findings (Cohen's kappa 0.929). In particular, results were concordant in all patients concerning local status, bone metastases and distant findings. Lymph-node results were concordant in 19 patients and different in 4 patients. On a per-patient basis results were concordant in 22 of 23 patients (14 positive, 5 negative and 3 equivocal). In only one patient was ACE PET/CT positive for nodal metastases while FCH PET/CT was overall negative; interestingly, the ACE-positive and FCH-negative lymph nodes became positive in a second FCH PET/CT scan performed a few months later. CONCLUSION Overall, ACE and FCH PET/CT showed excellent concordance, on both a per-lesion and a per-patient basis, suggesting that both tracers perform equally for recurrent prostate cancer staging.
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Affiliation(s)
- Franz Buchegger
- Nuclear Medicine Division, University Hospital of Geneva, 1211, Geneva 14, Switzerland,
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Jacobson O, Chen X. Interrogating tumor metabolism and tumor microenvironments using molecular positron emission tomography imaging. Theranostic approaches to improve therapeutics. Pharmacol Rev 2013; 65:1214-56. [PMID: 24064460 DOI: 10.1124/pr.113.007625] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Positron emission tomography (PET) is a noninvasive molecular imaging technology that is becoming increasingly important for the measurement of physiologic, biochemical, and pharmacological functions at cellular and molecular levels in patients with cancer. Formation, development, and aggressiveness of tumor involve a number of molecular pathways, including intrinsic tumor cell mutations and extrinsic interaction between tumor cells and the microenvironment. Currently, evaluation of these processes is mainly through biopsy, which is invasive and limited to the site of biopsy. Ongoing research on specific target molecules of the tumor and its microenvironment for PET imaging is showing great potential. To date, the use of PET for diagnosing local recurrence and metastatic sites of various cancers and evaluation of treatment response is mainly based on [(18)F]fluorodeoxyglucose ([(18)F]FDG), which measures glucose metabolism. However, [(18)F]FDG is not a target-specific PET tracer and does not give enough insight into tumor biology and/or its vulnerability to potential treatments. Hence, there is an increasing need for the development of selective biologic radiotracers that will yield specific biochemical information and allow for noninvasive molecular imaging. The possibility of cancer-associated targets for imaging will provide the opportunity to use PET for diagnosis and therapy response monitoring (theranostics) and thus personalized medicine. This article will focus on the review of non-[(18)F]FDG PET tracers for specific tumor biology processes and their preclinical and clinical applications.
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Affiliation(s)
- Orit Jacobson
- Laboratory of Molecular Imaging and Nanomedicine, National Institute of Biomedical Imaging and Bioengineering, National Institutes of Health, Bethesda, MD.
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Current Staging Procedures in Urinary Bladder Cancer. Diagnostics (Basel) 2013; 3:315-24. [PMID: 26824925 PMCID: PMC4665464 DOI: 10.3390/diagnostics3030315] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2013] [Revised: 06/13/2013] [Accepted: 06/18/2013] [Indexed: 01/20/2023] Open
Abstract
Currently computed tomography (CT) represents the most widely used standard imaging modality in muscle-invasive urinary bladder cancer. Visualization of local tumor or depth of invasion as well as lymph node staging, however, is often impaired. Magnetic resonance imaging (MRI) with diffusion-weighted sequences, determination of apparent diffusion coefficient (ADC) values or utilization of superparamagnetic iron nanoparticles potentially exhibits advantages in the assessment of local tumor or lymph node involvement and therefore might play a role in routine staging of urinary bladder cancer in the future. Likewise, positron emission tomography (PET) with the currently utilized tracers 18F-FDG, 11C-choline and 11C-acetate is investigated in bladder cancer patients—mostly in combination with diagnostic CT. Although promising results could be obtained for these PET/CT examinations in smaller series, their true value cannot be determined at present.
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Li Y, Yang ZQ, Ye H, Qi L, Hu JW. Application of 18F-FDG PET/CT imaging in diagnosing bladder tumor metastasis lesions. ACTA ACUST UNITED AC 2013; 33:234-237. [DOI: 10.1007/s11596-013-1103-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2012] [Indexed: 10/26/2022]
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28
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Abstract
Computed tomography (CT) represents the current standard imaging modality in muscle invasive bladder cancer; however, local tumor and lymph node staging is often impaired. Magnetic resonance imaging (MRI) with diffusion-weighted sequences, determination of apparent diffusion coefficient (ADC) values or utilization of supraparamagnetic iron nanoparticles potentially exhibits advantages in the assessment of local tumor and lymph node involvement and therefore might play a role in the staging of bladder tumor in the future. Likewise, positron emission tomography (PET) with the currently used tracers (18)F fluorodeoxyglucose ((18)F-FDG), (11)C-choline and (11)C-acetate is being investigated in bladder cancer patients, mostly in combination with diagnostic CT. Although promising results could be obtained for PET/CT investigations to some extent, the true value cannot be determined at present.
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Affiliation(s)
- T Maurer
- Urologische Klinik und Poliklinik, Technische Universität München, Klinikum rechts der Isar, Ismaninger Straße 22, 81675 München, Deutschland.
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