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Zhou X, Lu Z, Zhang R, Zhang R, Huang G, Shi K, Chen H, Liu J. The Value of Dual Time Point 18F-FDG PET/CT Imaging in Differentiating Lymph Node Metastasis From Reactive Hyperplasia in Bladder Urothelial Carcinoma. Acad Radiol 2024; 31:3272-3281. [PMID: 38431484 DOI: 10.1016/j.acra.2024.02.014] [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: 12/30/2023] [Revised: 02/08/2024] [Accepted: 02/08/2024] [Indexed: 03/05/2024]
Abstract
RATIONALE AND OBJECTIVES This study explored the clinical value of dual time-point 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography (PET) imaging for differentiating lymph node metastasis from lymph nodes with reactive hyperplasia. METHODS 250 lymph nodes from 153 bladder cancer patients who underwent 18F-FDG PET/computed tomography (CT) delayed diuretic imaging were analyzed. The maximum and mean standardized uptake values (SUVmax and SUVmean, respectively), metabolic tumor volume (MTV), and related delay indices before and after PET delayed imaging were obtained. Relationships with outcomes were analyzed using nonparametric and multivariate analyses. Receiver operating characteristic curves and nomograms were drawn to predict lymph node metastasis. RESULTS Delayed PET/CT imaging showed better detection of hyperplasia and metastatic lymph nodes. Delayed imaging with a cutoff SUVmax of 2.0 or 2.5 increased the detection rate of metastatic lymph nodes by 4.1%, and 6.9%, respectively. Delayed imaging often showed speckle-like radioactive foci in lymph nodes with reactive hyperplasia and increased FDG uptake throughout the nodes in metastatic lymph nodes. The lymph node short-axis diameter, SUVmean, and delayed index of MTV (DIMTV) were independent predictors for differentiating metastatic lymph nodes from reactive hyperplasia, and their combination showed better differentiation performance than the individual predictors. In high-risk patients, the probability of lymph node metastasis was as high as 97.6%. CONCLUSION Dual time-point imaging can detect more metastatic lymph nodes. Some lymph nodes with hyperplasia show speckle-like radioactive foci on delayed imaging. The lymph node short-axis diameter, SUVmean, and DIMTV are three important parameters for predicting lymph node metastasis.
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Affiliation(s)
- Xiang Zhou
- Department of Nuclear Medicine, Institute of Clinical Nuclear Medicine, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, 1630 Dongfang Rd, Shanghai 200127, China (X.Z., Z.L., G.H., J.L.)
| | - Zehua Lu
- Department of Nuclear Medicine, Institute of Clinical Nuclear Medicine, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, 1630 Dongfang Rd, Shanghai 200127, China (X.Z., Z.L., G.H., J.L.)
| | - Ruixue Zhang
- Department of Nuclear Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University, 241 Huaihai West Road, Shanghai 200030, China (R.Z.)
| | - Ruiyun Zhang
- Department of Urology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, 1630 Dongfang Rd, Shanghai 200127, China (R.Z., H.C.)
| | - Gang Huang
- Department of Nuclear Medicine, Institute of Clinical Nuclear Medicine, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, 1630 Dongfang Rd, Shanghai 200127, China (X.Z., Z.L., G.H., J.L.)
| | - Kuangyu Shi
- Department of Nuclear Medicine, Inselspital, Bern University Hospital, University of Bern, Street Freiburgstr. 18, Bern 3010, Switzerland (K.S.)
| | - Haige Chen
- Department of Urology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, 1630 Dongfang Rd, Shanghai 200127, China (R.Z., H.C.)
| | - Jianjun Liu
- Department of Nuclear Medicine, Institute of Clinical Nuclear Medicine, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, 1630 Dongfang Rd, Shanghai 200127, China (X.Z., Z.L., G.H., J.L.).
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Grobet-Jeandin E, Lenfant L, Pinar U, Parra J, Mozer P, Renard-Penna R, Thibault C, Rouprêt M, Seisen T. Management of patients with muscle-invasive bladder cancer with clinical evidence of pelvic lymph node metastases. Nat Rev Urol 2024; 21:339-356. [PMID: 38297079 DOI: 10.1038/s41585-023-00842-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/01/2023] [Indexed: 02/02/2024]
Abstract
Identification of clinically positive pelvic lymph node metastases (cN+) in patients with muscle-invasive bladder cancer is currently challenging, as the diagnostic accuracy of available imaging modalities is limited. Conventional CT is still considered the gold-standard approach to diagnose lymph node metastases in these patients. The development of innovative diagnostic methods including radiomics, artificial intelligence-based models and molecular biomarkers might offer new perspectives for the diagnosis of cN+ disease. With regard to the treatment of these patients, multimodal strategies are likely to provide the best oncological outcomes, especially using induction chemotherapy followed by radical cystectomy and pelvic lymph node dissection in responders to chemotherapy. Additionally, the use of adjuvant nivolumab has been shown to decrease the risk of recurrence in patients who still harbour ypT2-T4a and/or ypN+ disease after surgery. Alternatively, the use of avelumab maintenance therapy can be offered to patients with unresectable cN+ tumours who have at least stable disease after induction chemotherapy alone. Lastly, patients with cN+ tumours who are not responding to induction chemotherapy are potential candidates for receiving second-line treatment with pembrolizumab.
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Affiliation(s)
- Elisabeth Grobet-Jeandin
- Sorbonne University, GRC 5, Predictive Onco-Urology, APHP, Pitié-Salpêtrière Hospital, Urology, 75013, Paris, France
- Division of Urology, Geneva University Hospitals, Geneva, Switzerland
| | - Louis Lenfant
- Sorbonne University, GRC 5, Predictive Onco-Urology, APHP, Pitié-Salpêtrière Hospital, Urology, 75013, Paris, France
| | - Ugo Pinar
- Sorbonne University, GRC 5, Predictive Onco-Urology, APHP, Pitié-Salpêtrière Hospital, Urology, 75013, Paris, France
| | - Jérôme Parra
- Sorbonne University, GRC 5, Predictive Onco-Urology, APHP, Pitié-Salpêtrière Hospital, Urology, 75013, Paris, France
| | - Pierre Mozer
- Sorbonne University, GRC 5, Predictive Onco-Urology, APHP, Pitié-Salpêtrière Hospital, Urology, 75013, Paris, France
| | - Raphaele Renard-Penna
- Sorbonne University, GRC 5, Predictive Onco-Urology, APHP, Pitié-Salpêtrière Hospital, Radiology, 75013, Paris, France
| | - Constance Thibault
- Department of medical oncology, Hôpital Européen Georges Pompidou, Institut du Cancer Paris CARPEM, AP-HP centre, Paris, France
| | - Morgan Rouprêt
- Sorbonne University, GRC 5, Predictive Onco-Urology, APHP, Pitié-Salpêtrière Hospital, Urology, 75013, Paris, France
| | - Thomas Seisen
- Sorbonne University, GRC 5, Predictive Onco-Urology, APHP, Pitié-Salpêtrière Hospital, Urology, 75013, Paris, France.
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Zennami K, Takahara K, Nukaya T, Takenaka M, Ichino M, Sasaki H, Kusaka M, Sumitomo M, Shiroki R. The Role of Lymph Node Dissection in Patients With Muscle-Invasive Bladder Cancer Who Underwent Radical Cystectomy Following Neoadjuvant Chemotherapy. Clin Genitourin Cancer 2024; 22:1-9. [PMID: 37423863 DOI: 10.1016/j.clgc.2023.06.016] [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: 05/12/2023] [Revised: 06/24/2023] [Accepted: 06/26/2023] [Indexed: 07/11/2023]
Abstract
BACKGROUND The interaction between lymph node dissection (LND) during radical cystectomy (RC) and neoadjuvant chemotherapy (NAC) remains unclear. This study aimed to evaluate the role of LND in patients undergoing RC after NAC. PATIENTS AND METHODS We retrospectively analyzed 259 patients with muscle-invasive bladder cancer (MIBC) who underwent RC following NAC at Fujita Health University Hospital and Fujita Health University Okazaki Medical Center between 2010 and 2022. Baseline characteristics, pathological outcomes, recurrence-free survival (RFS), cancer-specific survival (CSS), and overall survival (OS) were compared between propensity score (PS)-matched cohorts. RESULTS PS matching analysis resulted in 94 matched pairs from the adequate (standard or extended template) and inadequate (limited template or unilateral- or no-LND) LND groups. The median number of dissected nodes was significantly higher in the adequate LND group than in the inadequate LND group (19 vs. 5, P < .001). Similarly, a higher pathological node-positive rate (ypN+) was observed in the adequate group than in the inadequate group (18.1% vs. 7.4%, P = .03). The adequate LND group identified more ypN+ with ≤ ypT1 cases than the inadequate group (4 vs. 1). There were no statistically significant differences between the adequate and inadequate groups in RFS (P = .94), CSS (P = .54), and OS (P = .65). Subgroup analysis also showed comparable survival rates, even in patients with ≥ pT3 or cN+ disease. ypN+ was an independent predictor of OS in the Cox regression analysis, while adequate LND and the number of lymph nodes removed (≥10 or ≥15) were not associated with survival. CONCLUSIONS Although adequate LND did not show a significant therapeutic effect in RC after NAC, adequate LND may have an important diagnostic role in detecting ypN+, which is a robust predictor, and is a useful biomarker to perform appropriate adjuvant immunotherapy especially in ≤ ypT1 cases.
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Affiliation(s)
- Kenji Zennami
- Department of Urology, Fujita Health University School of Medicine, Toyoake, Japan.
| | - Kiyoshi Takahara
- Department of Urology, Fujita Health University School of Medicine, Toyoake, Japan
| | - Takuhisa Nukaya
- Department of Urology, Fujita Health University School of Medicine, Toyoake, Japan
| | - Masashi Takenaka
- Department of Urology, Fujita Health University School of Medicine, Toyoake, Japan
| | - Manabu Ichino
- Department of Urology, Fujita Health University School of Medicine, Toyoake, Japan
| | - Hitomi Sasaki
- Department of Urology, Fujita Health University School of Medicine, Toyoake, Japan
| | - Mamoru Kusaka
- Department of Urology, Fujita Health University Okazaki Medical Center, Okazaki, Japan
| | - Makoto Sumitomo
- Department of Urology, Fujita Health University School of Medicine, Toyoake, Japan
| | - Ryoichi Shiroki
- Department of Urology, Fujita Health University School of Medicine, Toyoake, Japan
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Klemm J, Laukhtina E, Shariat SF. Combination neoadjuvant therapies are paving the way for bladder preservation to become the standard for selected patients. Nat Rev Clin Oncol 2024; 21:87-88. [PMID: 37978331 DOI: 10.1038/s41571-023-00841-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2023]
Affiliation(s)
- Jakob Klemm
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Ekaterina Laukhtina
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
| | - Shahrokh F Shariat
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria.
- Karl Landsteiner Institute of Urology and Andrology, Vienna, Austria.
- Department of Urology, Weill Cornell Medical College, New York, NY, USA.
- Department of Urology, University of Texas Southwestern, Dallas, TX, USA.
- Department of Urology, Second Faculty of Medicine, Charles University, Prague, Czech Republic.
- Hourani Center for Applied Scientific Research, Al-Ahliyya Amman University, Amman, Jordan.
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Fan Z, Deng J, Wang Y, Fan X, Xie J. Bladder Cancer: Immunotherapy and Pelvic Lymph Node Dissection. Vaccines (Basel) 2024; 12:150. [PMID: 38400134 PMCID: PMC10893107 DOI: 10.3390/vaccines12020150] [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: 10/25/2023] [Revised: 12/16/2023] [Accepted: 12/28/2023] [Indexed: 02/25/2024] Open
Abstract
Bladder cancer, a common malignancy of the urinary system, is routinely treated with radiation, chemotherapy, and surgical excision. However, these strategies have inherent limitations and may also result in various side effects. Immunotherapy has garnered considerable attention in recent years as a novel therapeutic approach. It harnesses and activates the patient's immune system to recognize and eliminate cancer cells, which not only prolongs therapeutic efficacy but also minimizes the toxic side effects. Several immune checkpoint inhibitors and cancer vaccines have been developed for the treatment of bladder cancer. Whereas blocking immune checkpoints on the surface of tumor cells augments the effect of immune cells, immunization with tumor-specific antigens can elicit the production of anti-tumor immune effector cells. However, there are several challenges in applying immunotherapy against bladder cancer. For instance, the efficacy of immunotherapy varies considerably across individual patients, and only a small percentage of cancer patients are responsive. Therefore, it is crucial to identify biomarkers that can predict the efficacy of immunotherapy. Pelvic lymph nodes are routinely dissected from bladder cancer patients during surgical intervention in order to remove any metastatic tumor cells. However, some studies indicate that pelvic lymph node dissection may reduce the efficacy of immunotherapy by damaging the immune cells. Therefore, the decision to undertake pelvic lymph node removal should be incumbent on the clinical characteristics of individual patients. Thus, although immunotherapy has the advantages of lower toxic side effects and long-lasting efficacy, its application in bladder cancer still faces challenges, such as the lack of predictive biomarkers and the effects of pelvic lymph node dissection. Further research is needed to explore these issues in order to improve the efficacy of immunotherapy for bladder cancer.
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Affiliation(s)
- Zhongru Fan
- Department of Urology, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Gusu School, Nanjing Medical University, Nanjing 211166, China
| | - Junpeng Deng
- Department of Urology, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Gusu School, Nanjing Medical University, Nanjing 211166, China
| | - Yutao Wang
- Department of Urology, Peking Union Medical Hospital, Beijing 100005, China
| | - Xin Fan
- Department of Radiology, The Second Affiliated Hospital of Dalian, Medical University, Dalian 116044, China
| | - Jianjun Xie
- Department of Urology, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Gusu School, Nanjing Medical University, Nanjing 211166, China
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Laukhtina E, Quhal F, von Deimling M, Kawada T, Yanagisawa T, Rajwa P, Majdoub M, Enikeev D, Shariat SF. For Which Patients Should Bladder Preservation Be Considered After a Complete Response to Neoadjuvant Chemotherapy. Eur Urol Focus 2023; 9:900-902. [PMID: 37150628 DOI: 10.1016/j.euf.2023.04.009] [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: 10/29/2022] [Revised: 01/22/2023] [Accepted: 04/21/2023] [Indexed: 05/09/2023]
Abstract
Given the morbidity associated with radical cystectomy (RC) and the significant survival benefit for patients who experience tumor downstaging after neoadjuvant chemotherapy (NAC), there is growing interest in bladder preservation strategies for select patients who have a complete response (CR) to NAC. In this mini-review we discuss the concept of avoiding RC as an alternative option for patients who experience a clinical CR following NAC. Several studies support this concept, with comparable long-term survival outcomes observed for patients with cT0 disease after NAC and patients undergoing RC. However, the definitive approach and the optimal surveillance strategy for patients with a clinical CR who choose bladder preservation are lacking. A dynamic response-driven bladder preservation strategy is a highly anticipated option for patients and is needed to avoid debilitating overtreatment. PATIENT SUMMARY: For selected patients with bladder cancer who experience a complete response to chemotherapy before any surgery, close follow-up might be an alternative option to surgical removal of the bladder without compromising cancer control.
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Affiliation(s)
- Ekaterina Laukhtina
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
| | - Fahad Quhal
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Department of Urology, King Fahad Specialist Hospital, Dammam, Saudi Arabia
| | - Markus von Deimling
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Tatsushi Kawada
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Department of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Takafumi Yanagisawa
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
| | - Pawel Rajwa
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Department of Urology, Medical University of Silesia, Zabrze, Poland
| | - Muhammad Majdoub
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Department of Urology, Hillel Yaffe Medical Center, Hadera, Israel
| | - Dmitry Enikeev
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
| | - Shahrokh F Shariat
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia; Karl Landsteiner Institute of Urology and Andrology, Vienna, Austria; Department of Urology, Weill Cornell Medical College, New York, NY, USA; Department of Urology, University of Texas Southwestern, Dallas, TX, USA; Department of Urology, Second Faculty of Medicine, Charles University, Prague, Czechia; Division of Urology, Department of Special Surgery, Jordan University Hospital, The University of Jordan, Amman, Jordan.
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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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8
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Bacchiani M, Salamone V, Massaro E, Sandulli A, Mariottini R, Cadenar A, Di Maida F, Pradere B, Mertens LS, Longoni M, Krajewski W, Del Giudice F, D'Andrea D, Laukhtina E, Shariat SF, Minervini A, Moschini M, Mari A. Assessing the Performance of 18F-FDG PET/CT in Bladder Cancer: A Narrative Review of Current Evidence. Cancers (Basel) 2023; 15:cancers15112951. [PMID: 37296913 DOI: 10.3390/cancers15112951] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Revised: 05/16/2023] [Accepted: 05/24/2023] [Indexed: 06/12/2023] Open
Abstract
INTRODUCTION Lymph node (LN) involvement is a crucial determinant of prognosis for patients with bladder cancer, and an accurate staging is of utmost importance to better identify timely and appropriate therapeutic strategies. To improve the accuracy of LN detection, as an alternative to traditional methods such as CT or MRI, 18F-FDG PET/CT has been increasingly used. 18F-FDG PET/CT is also used in post-treatment restaging after neoadjuvant chemotherapy. The aim of this narrative literature review is to provide an overview of the current evidence on the use of 18F-FDG PET/CT in the diagnosis, staging, and restaging of bladder cancer, with a particular focus on its sensitivity and specificity for the detection of LN metastasis. We aim to provide clinicians with a better understanding of 18F-FDG PET/CT's potential benefits and limitations in clinical practice. MATERIALS AND METHODS We designed a narrative review starting from a wide search in the PubMed/MEDLINE and Embase databases, selecting full-text English articles that have examined the sensibility and specificity of PET/CT for nodal staging or restaging after neoadjuvant therapy in patients with bladder cancer. The extracted data were analyzed and synthesized using a narrative synthesis approach. The results are presented in a tabular format, with a summary of the main findings of each study. RESULTS Twenty-three studies met the inclusion criteria: fourteen studies evaluated 18F-FDG PET/CT for nodal staging, six studies examined its accuracy for restaging after neoadjuvant therapy, and three studies evaluated both applications. To date, the use of F-18 FDG PET/TC for detection of LN metastasis in bladder cancer is controversial and uncertain: some studies showed low accuracy rates, but over the years other studies have reported evidence of high sensitivity and specificity. CONCLUSIONS 18F-FDG PET/CT provides important incremental staging and restaging information that can potentially influence clinical management in MIBC patients. Standardization and development of a scoring system are necessary for its wider adoption. Well-designed randomized controlled trials in larger populations are necessary to provide consistent recommendations and consolidate the role of 18F-FDG PET/CT in the management of bladder cancer patients.
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Affiliation(s)
- Mara Bacchiani
- Oncologic Minimally Invasive Urology and Andrology Unit, Department of Experimental and Clinical Medicine, Careggi Hospital, University of Florence, 50121 Florence, Italy
| | - Vincenzo Salamone
- Oncologic Minimally Invasive Urology and Andrology Unit, Department of Experimental and Clinical Medicine, Careggi Hospital, University of Florence, 50121 Florence, Italy
| | - Eleana Massaro
- Oncologic Minimally Invasive Urology and Andrology Unit, Department of Experimental and Clinical Medicine, Careggi Hospital, University of Florence, 50121 Florence, Italy
| | - Alessandro Sandulli
- Oncologic Minimally Invasive Urology and Andrology Unit, Department of Experimental and Clinical Medicine, Careggi Hospital, University of Florence, 50121 Florence, Italy
| | - Riccardo Mariottini
- Oncologic Minimally Invasive Urology and Andrology Unit, Department of Experimental and Clinical Medicine, Careggi Hospital, University of Florence, 50121 Florence, Italy
| | - Anna Cadenar
- Oncologic Minimally Invasive Urology and Andrology Unit, Department of Experimental and Clinical Medicine, Careggi Hospital, University of Florence, 50121 Florence, Italy
| | - Fabrizio Di Maida
- Oncologic Minimally Invasive Urology and Andrology Unit, Department of Experimental and Clinical Medicine, Careggi Hospital, University of Florence, 50121 Florence, Italy
| | - Benjamin Pradere
- Department of Urology, La Croix du Sud Hôpital, Quint Fonsegrives, 31000 Toulouse, France
| | - Laura S Mertens
- Department of Urology, The Netherlands Cancer Institute, 1066 Amsterdam, The Netherlands
| | - Mattia Longoni
- Department of Urology and Division of Experimental Oncology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy
| | - Wojciech Krajewski
- Department of Minimally Invasive and Robotic Urology, Wrocław Medical University, 50-367 Wroclaw, Poland
| | - Francesco Del Giudice
- Department of Maternal-Infant and Urological Sciences, Policlinico Umberto I Hospital, Sapienza University of Rome, 00185 Rome, Italy
| | - David D'Andrea
- Comprehensive Cancer Center, Department of Urology, Medical University of Vienna, Vienna General Hospital, Währinger Gürtel 18-20, 1090 Vienna, Austria
| | - Ekaterina Laukhtina
- Comprehensive Cancer Center, Department of Urology, Medical University of Vienna, Vienna General Hospital, Währinger Gürtel 18-20, 1090 Vienna, Austria
| | - Shahrokh F Shariat
- Comprehensive Cancer Center, Department of Urology, Medical University of Vienna, Vienna General Hospital, Währinger Gürtel 18-20, 1090 Vienna, Austria
- Institute for Urology and Reproductive Health, Sechenov University, 119435 Moscow, Russia
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA
- Department of Urology, Second Faculty of Medicine, Charles University, 15006 Prague, Czech Republic
- Department of Urology, Weill Cornell Medical College, New York, NY 10065, USA
- Karl Landsteiner Institute of Urology and Andrology, 1090 Vienna, Austria
- Hourani Center for Applied Scientific Research, Al-Ahliyya Amman University, Amman 19328, Jordan
| | - Andrea Minervini
- Oncologic Minimally Invasive Urology and Andrology Unit, Department of Experimental and Clinical Medicine, Careggi Hospital, University of Florence, 50121 Florence, Italy
| | - Marco Moschini
- Department of Urology and Division of Experimental Oncology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy
| | - Andrea Mari
- Oncologic Minimally Invasive Urology and Andrology Unit, Department of Experimental and Clinical Medicine, Careggi Hospital, University of Florence, 50121 Florence, Italy
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Zhang-Yin J, Girard A, Marchal E, Lebret T, Homo Seban M, Uhl M, Bertaux M. PET Imaging in Bladder Cancer: An Update and Future Direction. Pharmaceuticals (Basel) 2023; 16:ph16040606. [PMID: 37111363 PMCID: PMC10144644 DOI: 10.3390/ph16040606] [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: 02/21/2023] [Revised: 04/11/2023] [Accepted: 04/12/2023] [Indexed: 04/29/2023] Open
Abstract
Molecular imaging with positron emission tomography is a powerful tool in bladder cancer management. In this review, we aim to address the current place of the PET imaging in bladder cancer care and offer perspectives on potential future radiopharmaceutical and technological advancements. A special focus is given to the following: the role of [18F] 2-[18F]fluoro-2-deoxy-D-glucose positron emission tomography in the clinical management of bladder cancer patients, especially for staging and follow-up; treatment guided by [18F]FDG PET/CT; the role of [18F]FDG PET/MRI, the other PET radiopharmaceuticals beyond [18F]FDG, such as [68Ga]- or [18F]-labeled fibroblast activation protein inhibitor; and the application of artificial intelligence.
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Affiliation(s)
- Jules Zhang-Yin
- Department of Nuclear Medicine, Clinique Sud Luxembourg, Vivalia, B-6700 Arlon, Belgium
| | - Antoine Girard
- Department of Nuclear Medicine, Amiens-Picardy University Hospital, 80054 Amiens, France
| | - Etienne Marchal
- Department of Nuclear Medicine, Amiens-Picardy University Hospital, 80054 Amiens, France
| | - Thierry Lebret
- Department of Urology, Foch Hospital, 92150 Suresnes, France
| | - Marie Homo Seban
- Department of Nuclear Medicine, Foch Hospital, 92150 Suresnes, France
| | - Marine Uhl
- Department of Urology and Renal Transplantation, Amiens-Picardy University Hospital, 80054 Amiens, France
| | - Marc Bertaux
- Department of Nuclear Medicine, Foch Hospital, 92150 Suresnes, France
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10
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Radiomics Signature Using Manual Versus Automated Segmentation for Lymph Node Staging of Bladder Cancer. Eur Urol Focus 2023; 9:145-153. [PMID: 36115774 DOI: 10.1016/j.euf.2022.08.015] [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: 06/08/2022] [Revised: 07/26/2022] [Accepted: 08/30/2022] [Indexed: 11/23/2022]
Abstract
BACKGROUND Bladder cancer (BC) treatment algorithms depend on accurate tumor staging. To date, computed tomography (CT) is recommended for assessment of lymph node (LN) metastatic spread in muscle-invasive and high-risk BC. However, the diagnostic efficacy of radiologist-evaluated CT imaging studies is limited. OBJECTIVE To evaluate the performance of quantitative radiomics signatures for detection of LN metastases in BC. DESIGN, SETTING, AND PARTICIPANTS Of 1354 patients with BC who underwent radical cystectomy (RC) with lymphadenectomy who were screened, 391 with pathological nodal staging (pN0: n = 297; pN+: n = 94) were included and randomized into training (n = 274) and test (n = 117) cohorts. Pelvic LNs were segmented manually and automatically. A total of 1004 radiomics features were extracted from each LN and a machine learning model was trained to assess pN status using histopathology labels as the ground truth. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Radiologist assessment was compared to radiomics-based analysis using manual and automated LN segmentations for detection of LN metastases in BC. Statistical analysis was performed using the receiver operating characteristics curve method and evaluated in terms of sensitivity, specificity, and area under the curve (AUC). RESULTS AND LIMITATIONS In total, 1845 LNs were manually segmented. Automated segmentation correctly located 361/557 LNs in the test cohort. Manual and automatic masks achieved an AUC of 0.80 (95% confidence interval [CI] 0.69-0.91; p = 0.64) and 0.70 (95% CI: 0.58-0.82; p = 0.17), respectively, in the test cohort compared to radiologist assessment, with an AUC of 0.78 (95% CI 0.67-0.89). A combined model of a manually segmented radiomics signature and radiologist assessment reached an AUC of 0.81 (95% CI 0.71-0.92; p = 0.63). CONCLUSIONS A radiomics signature allowed discrimination of nodal status with high diagnostic accuracy. The model based on manual LN segmentation outperformed the fully automated approach. PATIENT SUMMARY For patients with bladder cancer, evaluation of computed tomography (CT) scans before surgery using a computer-based method for image analysis, called radiomics, may help in standardizing and improving the accuracy of assessment of lymph nodes. This could be a valuable tool for optimizing treatment options.
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11
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Hensley PJ, Panebianco V, Pietzak E, Kutikov A, Vikram R, Galsky MD, Shariat S, Roupret M, Kamat AM. Contemporary Staging for Muscle-Invasive Bladder Cancer: Accuracy and Limitations. Eur Urol Oncol 2022; 5:403-411. [DOI: 10.1016/j.euo.2022.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Revised: 03/30/2022] [Accepted: 04/21/2022] [Indexed: 11/15/2022]
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12
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Starmans MPA, Ho LS, Smits F, Beije N, de Kruijff I, de Jong JJ, Somford DM, Boevé ER, te Slaa E, Cauberg ECC, Klaver S, van der Heijden AG, Wijburg CJ, van de Luijtgaarden ACM, van Melick HHE, Cauffman E, de Vries P, Jacobs R, Niessen WJ, Visser JJ, Klein S, Boormans JL, van der Veldt AAM. Optimization of Preoperative Lymph Node Staging in Patients with Muscle-Invasive Bladder Cancer Using Radiomics on Computed Tomography. J Pers Med 2022; 12:726. [PMID: 35629148 PMCID: PMC9147130 DOI: 10.3390/jpm12050726] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 04/27/2022] [Accepted: 04/27/2022] [Indexed: 12/10/2022] Open
Abstract
Approximately 25% of the patients with muscle-invasive bladder cancer (MIBC) who are clinically node negative have occult lymph node metastases at radical cystectomy (RC) and pelvic lymph node dissection. The aim of this study was to evaluate preoperative CT-based radiomics to differentiate between pN+ and pN0 disease in patients with clinical stage cT2-T4aN0-N1M0 MIBC. Patients with cT2-T4aN0-N1M0 MIBC, of whom preoperative CT scans and pathology reports were available, were included from the prospective, multicenter CirGuidance trial. After manual segmentation of the lymph nodes, 564 radiomics features were extracted. A combination of different machine-learning methods was used to develop various decision models to differentiate between patients with pN+ and pN0 disease. A total of 209 patients (159 pN0; 50 pN+) were included, with a total of 3153 segmented lymph nodes. None of the individual radiomics features showed significant differences between pN+ and pN0 disease, and none of the radiomics models performed substantially better than random guessing. Hence, CT-based radiomics does not contribute to differentiation between pN+ and pN0 disease in patients with cT2-T4aN0-N1M0 MIBC.
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Affiliation(s)
- Martijn P. A. Starmans
- Department of Radiology and Nuclear Medicine, Erasmus MC, 3015 GD Rotterdam, The Netherlands; (L.S.H.); (F.S.); (W.J.N.); (J.J.V.); (S.K.); (A.A.M.v.d.V.)
| | - Li Shen Ho
- Department of Radiology and Nuclear Medicine, Erasmus MC, 3015 GD Rotterdam, The Netherlands; (L.S.H.); (F.S.); (W.J.N.); (J.J.V.); (S.K.); (A.A.M.v.d.V.)
| | - Fokko Smits
- Department of Radiology and Nuclear Medicine, Erasmus MC, 3015 GD Rotterdam, The Netherlands; (L.S.H.); (F.S.); (W.J.N.); (J.J.V.); (S.K.); (A.A.M.v.d.V.)
| | - Nick Beije
- Department of Medical Oncology, Erasmus MC Cancer Institute, 3015 GD Rotterdam, The Netherlands; (N.B.); (I.d.K.)
| | - Inge de Kruijff
- Department of Medical Oncology, Erasmus MC Cancer Institute, 3015 GD Rotterdam, The Netherlands; (N.B.); (I.d.K.)
| | - Joep J. de Jong
- Department of Urology, Erasmus MC, 3015 GD Rotterdam, The Netherlands; (J.J.d.J.); (J.L.B.)
| | - Diederik M. Somford
- Department of Urology, Canisius-Wilhelmina Hospital, 6532 SZ Nijmegen, The Netherlands;
| | - Egbert R. Boevé
- Department of Urology, Franciscus Gasthuis & Vlietland, 3045 PM Rotterdam, The Netherlands;
| | - Ed te Slaa
- Department of Urology, Isala, 8025 AB Zwolle, The Netherlands; (E.t.S.); (E.C.C.C.)
| | | | - Sjoerd Klaver
- Department of Urology, Maasstad, 3079 DZ Rotterdam, The Netherlands;
| | | | - Carl J. Wijburg
- Department of Urology, Rijnstate, 6815 AD Arnhem, The Netherlands;
| | | | - Harm H. E. van Melick
- Department of Urology, St Antonius Ziekenhuis, Nieuwegein, 3543 AZ Utrecht, The Netherlands;
| | - Ella Cauffman
- Department of Urology, Zuyderland, 6162 BG Sittard, The Netherlands; (E.C.); (P.d.V.); (R.J.)
| | - Peter de Vries
- Department of Urology, Zuyderland, 6162 BG Sittard, The Netherlands; (E.C.); (P.d.V.); (R.J.)
| | - Rens Jacobs
- Department of Urology, Zuyderland, 6162 BG Sittard, The Netherlands; (E.C.); (P.d.V.); (R.J.)
| | - Wiro J. Niessen
- Department of Radiology and Nuclear Medicine, Erasmus MC, 3015 GD Rotterdam, The Netherlands; (L.S.H.); (F.S.); (W.J.N.); (J.J.V.); (S.K.); (A.A.M.v.d.V.)
| | - Jacob J. Visser
- Department of Radiology and Nuclear Medicine, Erasmus MC, 3015 GD Rotterdam, The Netherlands; (L.S.H.); (F.S.); (W.J.N.); (J.J.V.); (S.K.); (A.A.M.v.d.V.)
| | - Stefan Klein
- Department of Radiology and Nuclear Medicine, Erasmus MC, 3015 GD Rotterdam, The Netherlands; (L.S.H.); (F.S.); (W.J.N.); (J.J.V.); (S.K.); (A.A.M.v.d.V.)
| | - Joost L. Boormans
- Department of Urology, Erasmus MC, 3015 GD Rotterdam, The Netherlands; (J.J.d.J.); (J.L.B.)
| | - Astrid A. M. van der Veldt
- Department of Radiology and Nuclear Medicine, Erasmus MC, 3015 GD Rotterdam, The Netherlands; (L.S.H.); (F.S.); (W.J.N.); (J.J.V.); (S.K.); (A.A.M.v.d.V.)
- Department of Medical Oncology, Erasmus MC Cancer Institute, 3015 GD Rotterdam, The Netherlands; (N.B.); (I.d.K.)
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13
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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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14
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Jena R, Shrivastava N, Sharma AP, Choudhary GR, Srivastava A. The Adequacy of Pelvic Lymphadenectomy During Radical Cystectomy for Carcinoma Urinary Bladder: A Narrative Review of Literature. Front Surg 2021; 8:687636. [PMID: 34222323 PMCID: PMC8247657 DOI: 10.3389/fsurg.2021.687636] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 05/19/2021] [Indexed: 11/24/2022] Open
Abstract
An adequate pelvic lymph node dissection (PLND) is an essential part of radical cystectomy for muscle invasive bladder cancer. However, the definition of what constitutes an adequate PLND is often shrouded in controversy. Various authors have defined different anatomic templates of PLND based on levels of pelvic lymph nodes. Some have suggested other surrogate markers of the adequacy of PLND, namely lymph node count and lymph node density. While individual studies have shown the efficacy and reliability of some of the above markers, none of them have been recommended forthright due to the absence of robust prospective data. The use of non-standardized nomenclature while referring to the above variables has made this matter more complex. Most of older data seems to favor use of extended template of PLND over the standard template. On the other hand, one recent randomized controlled trial (RCT) did not show any benefit of one template over the other in terms of survival benefit, but the study design allowed for a large margin of bias. Therefore, we conducted a systematic search of literature using EMBASE, Medline, and PubMed using PRISMA-P checklist for articles in English Language published over last 20 years. Out of 132 relevant articles, 47 articles were included in the final review. We have reviewed existing literature and guidelines and have attempted to provide a few suggestions toward a uniform nomenclature for the various anatomical descriptions and the extent of PLND done while doing a radical cystectomy. The results of another large RCT (SWOG S1011) are awaited and until we have a definitive evidence, we should adhere to these suggestions as much as possible and deal with each patient on a case to case basis.
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Affiliation(s)
- Rahul Jena
- Department of Urology, All India Institute of Medical Sciences, Jodhpur, India
| | - Nikita Shrivastava
- Department of Urology, All India Institute of Medical Sciences, Jodhpur, India
| | - Aditya Prakash Sharma
- Department of Urology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | | | - Aneesh Srivastava
- Department of Urology and Renal Transplant, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
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15
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Moussa M, Chakra MA, Saad W, Dellis A, Papatsoris A. The role of 18F-FDG PET/CT scan compared to CT-scan alone for lymph node staging before radical cystectomy in patients with bladder cancer. Urol Oncol 2021; 39:833.e9-833.e17. [PMID: 34059435 DOI: 10.1016/j.urolonc.2021.04.027] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 04/09/2021] [Accepted: 04/17/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND Accurate Lymph node (LN) staging before radical cystectomy (RC) in patients with bladder cancer (BC) is crucial to improve patient's management. 18F-fluorodeoxyglucose positron-emission tomography-computed tomography (FDG-PET-CT) become widely used in the loco-regional staging of BC. The diagnostic performance of PET-CT in preoperative LN staging of BC is still unknown due to lacking large trials. OBJECTIVES We aim to evaluate the diagnostic value of PET-CT scan, compared with CT scan alone for preoperative LN staging of BC. PATIENTS AND METHODS From January 2010 to November 2020, we retrospectively reviewed the records of 300 patients undergoing RC for muscle-invasive BC and high-risk non-muscle-invasive BC. All patients had PET-CT and CT of abdomen and pelvis to assess for pelvic LN metastases before RC. Patients were excluded from analysis if they had neoadjuvant chemotherapy (NAC). Sensitivity, specificity, and accuracy for detecting pelvic LN metastases were determined by comparing the results of the FDG PET-CT and CT alone to the final histopathology reports obtained after RC. RESULTS LN metastasis was confirmed histology in 134 patients (44.7%). On a patient-based analysis, PET-CT, and CT showed a sensitivity of 40.3% and 13.4 %, respectively, a specificity of 79.5% and 86.7 %, respectively, positive predictive value (PPV) of 61.4% and 45%, respectively, and negative predictive value (NPV) of 62.3% and 55.4%, respectively. The diagnostic accuracy of PET-CT scan depends on multiple preoperative and postoperative factors. CONCLUSION PET-CT is more accurate than CT-scan alone for preoperative LN staging in patients with BC.
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Affiliation(s)
- Mohamad Moussa
- Chairman of Urology department, Zahraa Hospital, University Medical Center, Lebanese University, Beirut, Lebanon
| | - Mohamad Abou Chakra
- Urology Department, Lebanese University, Faculty of Medicine, Beirut, Lebanon.
| | - Wajih Saad
- Head of Oncology department, Zahraa Hospital, University Medical Center, Lebanese University, Beirut, Lebanon
| | - Athanasios Dellis
- Department of Urology/General Surgery, Areteion Hospital, Athens, Greece
| | - Athanasios Papatsoris
- 2nd Department of Urology, School of Medicine, Sismanoglio Hospital, National and Kapodistrian University of Athens, Athens, Greece
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16
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Małkiewicz B, Kiełb P, Gurwin A, Knecht K, Wilk K, Dobruch J, Zdrojowy R. The Usefulness of Lymphadenectomy in Bladder Cancer-Current Status. ACTA ACUST UNITED AC 2021; 57:medicina57050415. [PMID: 33922894 PMCID: PMC8145304 DOI: 10.3390/medicina57050415] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Revised: 04/19/2021] [Accepted: 04/23/2021] [Indexed: 12/13/2022]
Abstract
The purpose of this review is to present the current status of lymph node dissection (LND) during radical cystectomy in patients with bladder cancer (BCa). Despite the growing body of evidence of LND utility at the time of radical cystectomy (RC) in high-risk nonmuscle-invasive and muscle-invasive BCa (MIBC), therapeutic and prognostic value and optimal extent of LND remain unsolved issues. Recently published results of the first prospective, a randomized trial assessing the therapeutic benefit of extended versus limited LND during RC, failed to demonstrate survival improvement with the extended template. Although LND is the most accurate staging procedure, the direct therapeutic effect is still not evident from the current literature, limiting the possibility of establishing clear recommendations. This indicates the need for robust and adequately powered clinical trials.
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Affiliation(s)
- Bartosz Małkiewicz
- Department of Urology and Oncologic Urology, Wroclaw Medical University, 50-556 Wroclaw, Poland; (P.K.); (A.G.); (K.K.); (K.W.); (R.Z.)
- Correspondence: ; Tel.: +48-506-158-136
| | - Paweł Kiełb
- Department of Urology and Oncologic Urology, Wroclaw Medical University, 50-556 Wroclaw, Poland; (P.K.); (A.G.); (K.K.); (K.W.); (R.Z.)
| | - Adam Gurwin
- Department of Urology and Oncologic Urology, Wroclaw Medical University, 50-556 Wroclaw, Poland; (P.K.); (A.G.); (K.K.); (K.W.); (R.Z.)
| | - Klaudia Knecht
- Department of Urology and Oncologic Urology, Wroclaw Medical University, 50-556 Wroclaw, Poland; (P.K.); (A.G.); (K.K.); (K.W.); (R.Z.)
| | - Karol Wilk
- Department of Urology and Oncologic Urology, Wroclaw Medical University, 50-556 Wroclaw, Poland; (P.K.); (A.G.); (K.K.); (K.W.); (R.Z.)
| | - Jakub Dobruch
- First Department of Urology, Centre of Postgraduate Medical Education, 01-813 Warsaw, Poland;
| | - Romuald Zdrojowy
- Department of Urology and Oncologic Urology, Wroclaw Medical University, 50-556 Wroclaw, Poland; (P.K.); (A.G.); (K.K.); (K.W.); (R.Z.)
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17
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Wong VK, Ganeshan D, Jensen CT, Devine CE. Imaging and Management of Bladder Cancer. Cancers (Basel) 2021; 13:cancers13061396. [PMID: 33808614 PMCID: PMC8003397 DOI: 10.3390/cancers13061396] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 03/16/2021] [Indexed: 12/25/2022] Open
Abstract
Simple Summary Bladder cancer is a complex disease, the sixth most common cancer, and one of the most expensive cancers to treat. In the last few decades, there has been a significant decrease in the bladder cancer-related mortality rate, potentially related to decreased smoking prevalence, improvements in diagnosing bladder cancer, and advances in treatment. Those advances in diagnostic tools and therapies and greater understanding of the disease are helping to evolve how bladder cancer is managed. The purpose of this article is to provide a review of bladder cancer pathology, diagnosis, staging, radiologic imaging, and management, and highlight recent developments and research. Abstract Methods: Keyword searches of Medline, PubMed, and the Cochrane Library for manuscripts published in English, and searches of references cited in selected articles to identify additional relevant papers. Abstracts sponsored by various societies including the American Urological Association (AUA), European Association of Urology (EAU), and European Society for Medical Oncology (ESMO) were also searched. Background: Bladder cancer is the sixth most common cancer in the United States, and one of the most expensive in terms of cancer care. The overwhelming majority are urothelial carcinomas, more often non-muscle invasive rather than muscle-invasive. Bladder cancer is usually diagnosed after work up for hematuria. While the workup for gross hematuria remains CT urography and cystoscopy, the workup for microscopic hematuria was recently updated in 2020 by the American Urologic Association with a more risk-based approach. Bladder cancer is confirmed and staged by transurethral resection of bladder tumor. One of the main goals in staging is determining the presence or absence of muscle invasion by tumor which has wide implications in regards to management and prognosis. CT urography is the main imaging technique in the workup of bladder cancer. There is growing interest in advanced imaging techniques such as multiparametric MRI for local staging, as well as standardized imaging and reporting system with the recently created Vesicle Imaging Reporting and Data System (VI-RADS). Therapies for bladder cancer are rapidly evolving with immune checkpoint inhibitors, particularly programmed death ligand 1 (PD-L1) and programmed cell death protein 1 (PD-1) inhibitors, as well as another class of immunotherapy called an antibody-drug conjugate which consists of a cytotoxic drug conjugated to monoclonal antibodies against a specific target. Conclusion: Bladder cancer is a complex disease, and its management is evolving. Advances in therapy, understanding of the disease, and advanced imaging have ushered in a period of rapid change in the care of bladder cancer patients.
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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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18F-fluoro-2-deoxy-D-glucose positron emission tomography/computed tomography in muscle-invasive bladder cancer. Curr Opin Urol 2020; 30:654-664. [PMID: 32701719 DOI: 10.1097/mou.0000000000000798] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
PURPOSE OF REVIEW In this narrative review, we assessed the role of F-fluoro-2-deoxy-D-glucose-positron emission tomography/CT (FDG-PET/CT) in preoperative staging and response evaluation of neoadjuvant chemotherapy in muscle-invasive bladder carcinoma (MIBC), and to assess its incremental value to contrast-enhanced (CE)CT and MRI in terms of patient management at initial diagnosis and detection of recurrence. RECENT FINDINGS A literature search in PubMed yielded 46 original reports, of which 15 compared FDG-PET/CT with CECT and one with MRI. For primary tumor assessment, FDG-PET/CT proved not accurate enough (13 reports; n = 7-70). For lymph node assessment, sensitivity of FDG-PET/CT is superior to CT with comparable specificity in 19 studies (n = 15-233). For detection of distant metastases, data from eight studies (n = 43-79) suggests that FDG-PET/CT is accurate, although comparative studies are lacking. Limited evidence (four studies, n = 19-50) suggests that FDG-PET/CT is not accurate for response evaluation of neoadjuvant chemotherapy. FDG-PET/CT incited change(s) in patient management in 18-68% of patients (five reports; n = 57-103). For detection of recurrence, seven studies (n = 29-287) indicated that FDG-PET/CT is accurate. SUMMARY Most studies evaluated FDG-PET/CT for lymph node assessment and reported higher sensitivity than CT, with comparable specificity. FDG-PET/CT showed incremental value to CECT for recurrence and often incited change(s) in patient management.
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Utilization of imaging for staging in bladder cancer: is there a role for MRI or PET-computed tomography? Curr Opin Urol 2020; 30:377-386. [PMID: 32168196 DOI: 10.1097/mou.0000000000000743] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
PURPOSE OF REVIEW Accurate staging of bladder cancer is essential to guide appropriate management. In this review, we discuss the principles, applications and performance of multiparametric MRI (mpMRI) and PET-computer tomography (PET-CT) for local and distant staging of bladder cancer. RECENT FINDINGS Bladder mpMRI has a high diagnostic performance in local staging of bladder cancer, superior to other imaging modalities. It can accurately differentiate muscle invasive bladder cancer (MIBC) from non-MIBC (NMIBC), as well as ≤T2 from ≥T3 stages. mpMRI can be used to assess pelvic lymph nodes, although its sensitivity is relatively low. For the assessment of the upper urinary tract, CT urography is the imaging modality of choice. magnetic resonance urography is a viable alternative to CT in selected cases. Although PET-CT is accurate for nodal and distant staging of bladder cancer, there is no clear evidence on its superior diagnostic performance compared with contrast-enhanced CT. SUMMARY mpMRI is the most accurate imaging modality for local staging of bladder cancer, capable to accurately distinguish MIBC from NMIBC. Nodal and distant staging relies primarily on contrast-enhanced CT.
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Aydh A, Abufaraj M, Mori K, Quhal F, Pradere B, Motlagh RS, Mostafaei H, Karakiewicz PI, Shariat SF. Performance of fluoro-2-deoxy-D-glucose positron emission tomography-computed tomography imaging for lymph node staging in bladder and upper tract urothelial carcinoma: a systematic review. Arab J Urol 2020; 19:59-66. [PMID: 33763249 PMCID: PMC7954498 DOI: 10.1080/2090598x.2020.1858012] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Objective: To evaluate the current literature on the accuracy of fluoro-2-deoxy-D-glucose positron emission tomography-computed tomography (FDG PET-CT) for lymph node (LN) staging in urothelial carcinoma (UC), as robust evidence on the value of this technology in UC is still lacking. Methods: The Medical Literature Analysis and Retrieval System Online (MEDLINE)/PubMed, Cochrane Library, and Scopus databases were searched for eligible studies. We included all original studies evaluating FDG PET-CT in bladder or upper tract UC. The search results were restricted to the English language, and included prospective and retrospective studies without time restriction. We included only studies reporting the sensitivity and specificity of FDG PET-CT in detecting UC LN metastases. Results: We identified 23 articles meeting our inclusion criteria. In the preoperative setting, the sensitivity of FDG PET-CT for detecting LN metastases in patients with bladder cancer was widely variable ranging from 23% to 89%; the specificity ranged from 81% to 100%; and the overall accuracy ranged from 65% to 89%. During bladder cancer monitoring the sensitivity for detecting LN metastases ranged from 75% to 92% and the specificity ranged from 60% to 92%. The sensitivity for LN staging in upper tract UC ranged between 82% and 95%, with a specificity of 84–91%. Conclusion: Despite the inconsistencies in sensitivity between the reports, FDG PET-CT seems to have a high specificity for LN staging in patients with UC. Future prospective, well-designed studies are necessary to evaluate the role of FDG PET-CT in UC management. Abbreviations: FDG: fluoro-2-deoxy-D-glucose; LN: lymph node; PET: positron emission tomography; PRISMA: Preferred Reporting Items for Systematic Reviews and Meta-analyses; PSMA: prostate-specific membrane antigen; (N)(P)PV: (negative) (positive) predictive value; QUADAS-2: Quality Assessment of Diagnostic Accuracy Studies-2; SUVmax: maximum standard uptake value; (UT)UC: (upper urinary tract) urothelial carcinoma
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Affiliation(s)
- Abdulmajeed Aydh
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria.,Department of Urology, King Faisal Medical City, Abha, Saudi Arabia
| | - Mohammad Abufaraj
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria.,Division of Urology, Department of Special Surgery, Jordan University Hospital, the University of Jordan, Amman, Jordan
| | - Keiichiro Mori
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria.,Department of Urology, Jikei University School of Medicine, Tokyo, Japan
| | - Fahad Quhal
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria.,Department of Urology, King Fahad Specialist Hospital, Dammam, Saudi Arabia
| | - Benjamin Pradere
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria.,Department of Urology, University Hospital of Tours, To Urs, France
| | - Reza Sari Motlagh
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria.,Men's Health and Reproductive Health Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hadi Mostafaei
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria.,Research Center for Evidence Based Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Pierre I Karakiewicz
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montreal Health Center, Montreal, Canada
| | - Shahrokh F Shariat
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria.,Division of Urology, Department of Special Surgery, Jordan University Hospital, the University of Jordan, Amman, Jordan.,Departments of Urology, Weill Cornell Medical College, New York, NY, USA.,Department of Urology, University of Texas Southwestern, Dallas, TX, USA.,Department of Urology, Second Faculty of Medicine, Charles University, Prague, Czech Republic.,European Association of Urology Research Foundation, Arnhem, The Netherlands.,Department of Urology, Karl Landsteiner Institute, Vienna, Austria.,Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
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22
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Kutluhan MA, Özsoy E, Başkak F, Ürkmez A, Topaktaş R, Koca O. How reliable are imaging techniques in aging males with bladder cancer? Aging Male 2020; 23:1339-1345. [PMID: 32401117 DOI: 10.1080/13685538.2020.1766014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Abstract
INTRODUCTION The aim of this study was to evaluate consistency between clinical lymph node positivity and pathological lymph node positivity in patients undergoing open radical cystectomy and pelvic lymph node dissection due to bladder cancer. MATERIAL AND METHOD A total of 135 patients who had open radical cystectomy, extended lymph node dissection, and clear preoperative contrast-enhanced abdominopelvic computed tomography (CT) or magnetic resonance imaging (MRI) images were included in the study. Positive clinical lymph nodes and positive pathological lymph nodeswere recorded. The largest positive clinical and pathological lymph nodeswere recorded. In terms of clinical lymph node involvement, compatibility between radiological findings and pathological results was evaluated. RESULTS In the CT group, the sensitivity was 25.81%, specificity was 95.45%, positive predictive value (PPV) was 66.67%, negative predictive value (NPV) was 78.50%, and accuracy was 77.31%. In the MRI group, the sensitivity was 50.00%, specificity was 100%, PPV was 100%, NPV was 76.92%, and accuracy was 81.25%. For consistency between pathological lymph nodes and clinical lymph nodes according to the imaging type, there was no statistically significant difference in the sensitivity, specificity, NPV, and accuracy rates between the imaging techniques (p > 0.05). However, the PPV was significantly higher in the MRI group than the CT group (100% vs.66.67%, respectively; p = 0.014). CONCLUSION Positive lymph nodes play a critical role in the prognosis of patients with bladder cancer and the sensitivity of contrast-enhanced abdominopelvic CT and MRI used routinely in clinical practice is low in lymph node detection. MRI seems more reliable than CT in lymph node detection.
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Affiliation(s)
- Musab Ali Kutluhan
- Department of Urology, Istanbul, Health Sciences University, Fatih Sultan Mehmet Training and Research Hospital, Turkey
| | - Emrah Özsoy
- Department of Urology, Health Sciences University, Haydarpasa Numune Training and Research Hospital, Istanbul, Turkey
| | - Fulya Başkak
- Department of Radiology, Health Sciences University, Haydarpasa Numune Training and Research Hospital, Istanbul, Turkey
| | - Ahmet Ürkmez
- Department of Urology, Istanbul, Health Sciences University, Fatih Sultan Mehmet Training and Research Hospital, Turkey
| | - Ramazan Topaktaş
- Department of Urology, Health Sciences University, Haydarpasa Numune Training and Research Hospital, Istanbul, Turkey
| | - Orhan Koca
- Medistate Private Hospital, Istanbul, Turkey
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23
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Fonteyne V, De Man K, Decaestecker K, De Visschere P, Dirix P, De Meerleer G, Berghen C, Ost P, Villeirs G. PET–CT for staging patients with muscle invasive bladder cancer: is it more than just a fancy tool? Clin Transl Imaging 2020. [DOI: 10.1007/s40336-020-00397-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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24
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Girard A, Vila Reyes H, Shaish H, Grellier JF, Dercle L, Salaün PY, Delcroix O, Rouanne M. The Role of 18F-FDG PET/CT in Guiding Precision Medicine for Invasive Bladder Carcinoma. Front Oncol 2020; 10:565086. [PMID: 33117695 PMCID: PMC7574640 DOI: 10.3389/fonc.2020.565086] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Accepted: 09/09/2020] [Indexed: 12/17/2022] Open
Abstract
Bladder cancer (BC) is the 10th most common cancer worldwide. Approximately one quarter of patients with BC have muscle-invasive disease (MIBC). Muscle-invasive disease carries a poor prognosis and choosing the optimal treatment option is critical to improve patients’ outcomes. Ongoing research supports the role of 2-deoxy-2-(18F)fluoro-D-glucose positron emission tomography (18F-FDG PET) in guiding patient-specific management decisions throughout the course of MIBC. As an imaging modality, 18F-FDG PET is acquired simultaneously with either computed tomography (CT) or MRI to offer a hybrid approach combining anatomical and metabolic information that complement each other. At initial staging, 18F-FDG PET/CT enhances the detection of extravesical disease, particularly in patients classified as oligometastatic by conventional imaging. 18F-FDG PET/CT has value in monitoring response to neoadjuvant and systemic chemotherapy, as well as in localizing relapse after treatment. In the new era of immunotherapy, 18F-FDG PET/CT may also be useful to monitor treatment efficacy as well as to detect immune-related adverse events. With the advent of artificial intelligence techniques such as radiomics and deep learning, these hybrid medical images can be mined for quantitative data, providing incremental value over current standard-of-care clinical and biological data. This approach has the potential to produce a major paradigm shift toward data-driven precision medicine with the ultimate goal of personalized medicine. In this review, we highlight current literature reporting the role of 18F-FDG PET in supporting personalized management decisions for patients with MIBC. Specific topics reviewed include the incremental value of 18F-FDG PET in prognostication, pre-operative planning, response assessment, prediction of recurrence, and diagnosing drug toxicity.
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Affiliation(s)
- Antoine Girard
- Department of Nuclear Medicine, Centre Eugène Marquis, Université Rennes 1, Rennes, France
| | - Helena Vila Reyes
- Department of Urology, Columbia University Irving Medical Center - New York Presbyterian Hospital, New York, NY, United States
| | - Hiram Shaish
- Department of Radiology, Columbia University Medical Center, New York, NY, United States
| | | | - Laurent Dercle
- Department of Radiology, New York Presbyterian Hospital - Columbia University Medical Center, New York, NY, United States
| | - Pierre-Yves Salaün
- Department of Nuclear Medicine, Centre Hospitalier Régional Universitaire de Brest, Brest cedex, France
| | - Olivier Delcroix
- Department of Nuclear Medicine, Centre Hospitalier Régional Universitaire de Brest, Brest cedex, France
| | - Mathieu Rouanne
- Department of Urology, Hôpital Foch, Université Versailles-Saint-Quentin-en-Yvelines, Université Paris-Saclay, Suresnes, France
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25
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Omorphos NP, Piedad JCP, Vasdev N. Guideline of guidelines: Muscle-invasive bladder cancer. Turk J Urol 2020; 47:S71-S78. [PMID: 32966207 DOI: 10.5152/tud.2020.20337] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Accepted: 08/10/2020] [Indexed: 11/22/2022]
Abstract
Muscle-invasive bladder cancer accounts for 25% of bladder cancer cases and represents a spectrum of disease, which can result in significant morbidity and mortality for anyone affected. Current management has evolved through years of research and clinical practice. It is based on a risk-benefit approach, which is often tailored to the individual requirements of patients and involves cystectomy, neoadjuvant and adjuvant therapies, and multimodal surveillance paradigms to achieve high survival rates. Multiple guidelines exist to assist the clinicians in this decision-making process, but their adherence is often variable. In this article, we aimed to review the 4 most commonly used guidelines from the European Association of Urology, the National Institute for Health and Care Excellence, the National Comprehensive Cancer Network, and the American Urological Association.
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Affiliation(s)
- Nicolas Pavlos Omorphos
- Hertfordshire and Bedfordshire Urological Cancer Centre, Department of Urology, Lister Hospital, Stevenage, UK
| | - John Carlo Pansaon Piedad
- Hertfordshire and Bedfordshire Urological Cancer Centre, Department of Urology, Lister Hospital, Stevenage, UK
| | - Nikhil Vasdev
- Hertfordshire and Bedfordshire Urological Cancer Centre, Department of Urology, Lister Hospital, Stevenage, UK.,School of Medicine and Life Sciences, University of Hertfordshire, Hatfield, UK
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26
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O'Shea A, Kilcoyne A, Hedgire SS, Harisinghani MG. Pelvic lymph nodes and pathways of disease spread in male pelvic malignancies. Abdom Radiol (NY) 2020; 45:2198-2212. [PMID: 31673716 DOI: 10.1007/s00261-019-02285-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
PURPOSE Accurate nodal staging for male urogenital malignancies has important implications for therapy and prognosis. Male pelvic malignancies, including prostatic, penile, testicular, and bladder cancer, typically metastasize to regional lymph nodes first which is reported by the N-stage. Spread beyond these groups to non-regional nodes is regarded as M-stage disease. METHODS In this review, we discuss the typical patterns of male pelvic lymphatic drainage and the tumor-specific regional nodal chains. RESULTS The impact of tumor-specific imaging features and the implications of previous treatments on staging are discussed. CONCLUSIONS While anatomic imaging, including CT and MRI, is the most widely employed imaging modality at present, newer functional imaging techniques have demonstrated promise in the accurate identification and characterization of nodal metastases.
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Affiliation(s)
- Aileen O'Shea
- Division of Abdominal Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, USA.
| | - Aoife Kilcoyne
- Division of Abdominal Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, USA
| | - Sandeep S Hedgire
- Division of Cardiovascular Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, USA
| | - Mukesh G Harisinghani
- Division of Abdominal Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, USA
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27
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Marjara J, Hilli J, Davis RM, Bhat AP. Metastatic retro-crural lymph nodes from transitional cell carcinoma of bladder successfully treated with single session cryoablation. Radiol Case Rep 2020; 15:1197-1201. [PMID: 32550958 PMCID: PMC7292893 DOI: 10.1016/j.radcr.2020.05.022] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 05/10/2020] [Accepted: 05/11/2020] [Indexed: 01/09/2023] Open
Abstract
Bladder cancer (BC) is a relatively common tumor, with a male preponderance. High-grade muscle invasive bladder cancer (MIBC) has a very high incidence of pelvic lymph node metastasis at presentation. Involvement of the retro-crural lymph nodes, although has been described in other pelvic tumors, is very uncommon for BC. Cryoablation in the retro-crural region is extremely challenging due to the proximity to the critical structures like inferior venacava and aorta and has not been extensively reported. We describe a 56-year old male patient with MIBC who underwent extensive treatments including radical cystoprostatectomy, chemoradiation and immunotherapy, ultimately with localized disease in the retro-crural region. Single session cryoablation of these lymph nodes was performed with a curative intent yielding a positive response that has persisted for more than 2 years.
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Affiliation(s)
- Jasraj Marjara
- University of Missouri-Columbia School of Medicine, One Hospital Drive, Columbia, MO, USA
| | - Jaffar Hilli
- Department of Medicine, Division of Hematology and Oncology, University of Missouri-Columbia, One Hospital Drive, Columbia, MO, USA
| | - Ryan M Davis
- Department of Radiology, Section of Vascular and Interventional Radiology, University of Missouri-Columbia, One Hospital Drive, Columbia, MO, 65212, USA
| | - Ambarish P Bhat
- Department of Radiology, Section of Vascular and Interventional Radiology, University of Missouri-Columbia, One Hospital Drive, Columbia, MO, 65212, USA
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28
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Grivas N, van den Bergh RCN, Brouwer OR, KleinJan GH, Ramirez-Backhaus M, Wilthagen EA, van der Poel HG. Pelvic lymph node distribution and metastases of prostate and bladder cancer: a systematic literature review and template proposal. World J Urol 2020; 39:751-759. [PMID: 32495153 DOI: 10.1007/s00345-020-03281-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 05/25/2020] [Indexed: 10/24/2022] Open
Abstract
PURPOSE To systematically review the relevant literature that evaluates the LN topographical distribution and propose a uniform template. METHODS A bibliographic search of PubMed/Medline, Embase and SCOPUS was performed for studies reporting data of LN imaging and/or nodal resection. RESULTS 101 and 26 articles met the inclusion criteria for PCa and BCa, respectively. In PCa, the most common locations of positive LNs for surgical and imaging studies were external iliac (both 38 studies), followed by obturator (38 and 37, respectively). Similarly, in BCa, the most common location of positive nodes for surgical and imaging studies were external iliac (19 and 4, respectively), followed by obturator (15 and 3 studies, respectively). In PCa, median percentages of positive external iliac nodes/patient were 12.2% and 11.6% for surgical and imaging studies, respectively while corresponding rates for BCa were 3.9% and 17.6%. There were high risks of bias across studies as well as high heterogeneity in the definition of the anatomic boundaries of lymphadenectomy templates. CONCLUSIONS This review highlights the lack of detailed information on exact LN templates and metastases location, which in turn hinders generation of high-quality evidence on optimal lymphadenectomy templates. Our proposed template is applicable for both imaging and surgical description and could facilitate the translation of anatomical location from imaging to surgical resection.
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Affiliation(s)
- Nikolaos Grivas
- Department of Urology, The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CX, Amsterdam, Netherlands.
| | | | - Oscar R Brouwer
- Department of Urology, The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CX, Amsterdam, Netherlands
| | - Gijs H KleinJan
- Department of Urology, Leiden University Medical Center, Leiden, Netherlands
| | | | - Erica A Wilthagen
- Scientific Information Service, The Netherlands Cancer Institute, Amsterdam, Netherlands
| | - Henk G van der Poel
- Department of Urology, The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CX, Amsterdam, Netherlands
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29
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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: 33] [Impact Index Per Article: 6.6] [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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30
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Choi SY, You D, Hong B, Hong JH, Ahn H, Kim CS. Impact of lymph node dissection in radical cystectomy for bladder cancer: How many vs how far? Surg Oncol 2019; 30:109-116. [PMID: 31500772 DOI: 10.1016/j.suronc.2019.06.008] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Revised: 05/31/2019] [Accepted: 06/27/2019] [Indexed: 10/26/2022]
Abstract
PURPOSE To determine whether the extent or number of lymph nodes (LNs) is important in muscle-invasive bladder cancer and high-risk non-muscle-invasive bladder cancer patients' oncologic outcomes. METHODS A total of 448 patients who underwent radical cystectomy with lymphadenectomy of standard, extended, and super-extended template were included. Exclusion criteria were neoadjuvant chemotherapy and limited lymphadenectomy. Disease-free survival (DFS) including local recurrence and distant metastasis, cancer-specific survival (CSS), and overall survival (OS) were estimated using the Kaplan-Meier method. Cox hazard regression was applied to analyze risk factors. RESULTS Standard (n = 124), extended (n = 216), and super-extended group (n = 108) did not show significant differences in the estimated 5-year DFS, CSS and OS rates. On multivariate analysis, the number of removed LNs was a significant factor for distant metastasis-free (hazard ratio [HR] 0.981, p = 0.0222), CSS (HR 0.980, p = 0.0021) and OS (HR 0.984, p = 0.0032). However, the template was not significant in distant metastasis-free survival, CSS and OS. On Kaplan-Meier curve, the number of removed LN showed significant differences in DFS, CSS, and OS. In the subgroup of positive LNs, number of removed LNs was associated with favorable DFS (HR = 0.969, p = 0.0115), CSS (HR = 0.967, p = 0.0068) and OS (HR = 0.971, p = 0.0028). CONCLUSION The number of removed LNs was a more important factor for CSS and OS than the extent of lymphadenectomy. Meticulous and extended LN dissection can be helpful in controlling recurrence, and its survival benefit might be maximized in cases with positive LN. Meanwhile, the survival benefit of super-extended lymphadenectomy was limited for this patient population.
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Affiliation(s)
- Se Young Choi
- Department of Urology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, 102 Heukseok-ro, Dongjak-gu, Seoul, 06973, South Korea
| | - Dalsan You
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, South Korea
| | - Bumsik Hong
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, South Korea
| | - Jun Hyuk Hong
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, South Korea
| | - Hanjong Ahn
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, South Korea
| | - Choung-Soo Kim
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, South Korea.
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31
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Integrated analysis of 18F-FDG PET/CT improves preoperative lymph node staging for patients with invasive bladder cancer. Eur Radiol 2019; 29:4286-4293. [PMID: 30666449 DOI: 10.1007/s00330-018-5959-0] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Revised: 11/26/2018] [Accepted: 12/05/2018] [Indexed: 12/19/2022]
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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32
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Frączek M, Kamecki H, Kamecka A, Sosnowski R, Sklinda K, Czarniecki M, Królicki L, Walecki J. Evaluation of lymph node status in patients with urothelial carcinoma-still in search of the perfect imaging modality: a systematic review. Transl Androl Urol 2018; 7:783-803. [PMID: 30456182 PMCID: PMC6212628 DOI: 10.21037/tau.2018.08.28] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
While accurate lymph node status evaluation in urothelial carcinoma patients is essential for the correct disease staging and, hence, establishing the most beneficial treatment strategy, the diagnostic performance of routine imaging in regards to this issue is not satisfactory. For the purpose of this article, we systematically reviewed the contemporary literature on the sensitivity and specificity of particular imaging modalities which have been studied for detecting lymph node metastases in patients diagnosed with urothelial carcinoma. The evidence reviewed shows that computed tomography (CT), although recognized as the imaging modality of choice, is associated with marked limitations, resulting in its low sensitivity for lymph node involvement detection in urothelial carcinoma patients, with no study reporting a value higher than 46% using standard cut-off values. Markedly higher sensitivity rates may be achieved with magnetic resonance imaging (MRI), especially when using ultrasmall superparamagnetic iron oxide as the contrast agent, however, no uniform protocol has been systematically studied up to date. The vast majority of recent evidence concerns positron emission tomography (PET), which is being reported to improve the diagnostic performance of CT alone, as has been demonstrated in multiple articles, which investigated the accuracy of PET/CT at primary or post-treatment staging of urothelial carcinoma patients. However, there has been substantial heterogeneity in terms of methodology and results between those studies, making it premature to draw any definitive conclusions. The results of this review lead to a conclusion, that while CT, despite being not fully satisfactory, still remains the gold-standard method of imaging for staging purposes in urothelial carcinoma, other imaging modalities are under investigation, with promising results.
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Affiliation(s)
- Michał Frączek
- Department of Radiology, Medical Center of Postgraduate Education, Warsaw, Poland
| | - Hubert Kamecki
- Department of Urogenital Cancer, Oncology Center-M. Skłodowska-Curie Institute, Warsaw, Poland
| | - Anna Kamecka
- Department of Pediatric Radiology, Public Children's Teaching Hospital, Warsaw, Poland
| | - Roman Sosnowski
- Department of Urogenital Cancer, Oncology Center-M. Skłodowska-Curie Institute, Warsaw, Poland
| | - Katarzyna Sklinda
- Department of Radiology, Medical Center of Postgraduate Education, Warsaw, Poland
| | - Marcin Czarniecki
- Molecular Imaging Program, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Leszek Królicki
- Department of Nuclear Medicine, Medical University of Warsaw, Warsaw, Poland
| | - Jerzy Walecki
- Department of Radiology, Medical Center of Postgraduate Education, Warsaw, Poland
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33
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Shankar PR, Barkmeier D, Hadjiiski L, Cohan RH. A pictorial review of bladder cancer nodal metastases. Transl Androl Urol 2018; 7:804-813. [PMID: 30456183 PMCID: PMC6212631 DOI: 10.21037/tau.2018.08.25] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2018] [Accepted: 08/20/2018] [Indexed: 11/29/2022] Open
Abstract
Lymph node involvement in bladder cancer is common and has prognostic implications. Early and accurate identification of metastatic lymph nodes is, therefore, important in ensuring appropriate patient triage and management. The purpose of this review is to provide a pictorial and educational overview of the staging and imaging appearance of metastatic lymph nodes in bladder cancer. Additionally, a secondary aim of this manuscript is to provide a review of the diagnostic accuracy of common imaging modalities available for detecting metastatic lymph nodes in affected patients.
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Affiliation(s)
| | | | | | - Richard H Cohan
- Department of Radiology, Michigan Medicine, Ann Arbor, MI, USA
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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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Fernández MI, Brausi M, Clark PE, Cookson MS, Grossman HB, Khochikar M, Kiemeney LA, Malavaud B, Sanchez-Salas R, Soloway MS, Svatek RS, Vikram R, Vrieling A, Kamat AM. Epidemiology, prevention, screening, diagnosis, and evaluation: update of the ICUD-SIU joint consultation on bladder cancer. World J Urol 2018; 37:3-13. [PMID: 30105454 DOI: 10.1007/s00345-018-2436-y] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Accepted: 08/06/2018] [Indexed: 12/23/2022] Open
Abstract
PURPOSE To update current recommendations on prevention, screening, diagnosis, and evaluation of bladder cancer (BC) based on a thorough assessment of the most recent literature on these topics. METHODS A non-systematic review was performed, including articles until June 2017. A variety of original articles, reviews, and editorials were selected according to their epidemiologic, demographic, and clinical relevance. Assessment of the level of evidence and grade of recommendations was performed according to the International Consultation on Urological Diseases grading system. RESULTS BC is the ninth most common cancer worldwide with 430,000 new cases in 2012. Currently, approximately 165,000 people die from the disease annually. Absolute incidence and prevalence of BC are expected to rise significantly during the next decades because of population ageing. Tobacco smoking is still the main risk factor, accounting for about 50% of cases. Smoking cessation is, therefore, the most relevant recommendation in terms of prevention, as the risk of developing BC drops almost 40% within 5 years of cessation. BC screening is not recommended for the general population. BC diagnosis remains mainly based on cystoscopy, but development of new endoscopic and imaging technologies may rapidly change the diagnosis algorithm. The same applies for local, regional, and distant staging modalities. CONCLUSIONS A thorough understanding of epidemiology, risk factors, early detection strategies, diagnosis, and evaluation is essential for correct, evidence-based management of BC patients. Recent developments in endoscopic techniques and imaging raise the hope for providing better risk-adopted approaches and thereby improving clinical outcomes.
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Affiliation(s)
- Mario I Fernández
- Department of Urology, Clínica Alemana, Santiago, Chile.,Faculty of Medicine, Clínica Alemana Universidad del Desarrollo, Santiago, Chile
| | | | - Peter E Clark
- Department of Urology, Atrium Health, Levine Cancer Institute, Charlotte, NC, USA
| | - Michael S Cookson
- Department of Urology, The University of Oklahoma Health Sciences Center & The Stephenson Cancer Center, Oklahoma City, OK, USA
| | - H Barton Grossman
- Department of Urology, Unit 1373, The University of Texas MD Anderson Cancer Center, 1155 Pressler, Houston, TX, 77030, USA
| | - Makarand Khochikar
- Department of Urology, Siddhi Vinayak Ganapati Cancer Hospital, Miraj, India
| | - Lambertus A Kiemeney
- Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Bernard Malavaud
- Department of Urology, Toulouse Cancer Institute, Toulouse, France
| | | | - Mark S Soloway
- Department of Urology, Memorial Healthcare System, Miami, FL, USA
| | - Robert S Svatek
- Department of Urology, University of Texas Health, San Antonio, TX, USA
| | - Raghunandan Vikram
- Department of Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Alina Vrieling
- Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Ashish M Kamat
- Department of Urology, Unit 1373, The University of Texas MD Anderson Cancer Center, 1155 Pressler, Houston, TX, 77030, USA.
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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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Ha H, Koo P, Kim SJ. Diagnostic Accuracy of F-18 FDG PET/CT for Preoperative Lymph Node Staging in Newly Diagnosed Bladder Cancer Patients: A Systematic Review and Meta-Analysis. Oncology 2018; 95:31-38. [DOI: 10.1159/000488200] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2017] [Accepted: 03/06/2018] [Indexed: 11/19/2022]
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Salmanoglu E, Halpern E, Trabulsi EJ, Kim S, Thakur ML. A glance at imaging bladder cancer. Clin Transl Imaging 2018; 6:257-269. [PMID: 30456208 DOI: 10.1007/s40336-018-0284-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Purpose Early and accurate diagnosis of Bladder cancer (BCa) will contribute extensively to the management of the disease. The purpose of this review was to briefly describe the conventional imaging methods and other novel imaging modalities used for early detection of BCa and outline their pros and cons. Methods Literature search was performed on Pubmed, PMC, and Google scholar for the period of January 2014 to February 2018 and using such words as "bladder cancer, bladder tumor, bladder cancer detection, diagnosis and imaging". Results A total of 81 published papers were retrieved and are included in the review. For patients with hematuria and suspected of BCa, cystoscopy and CT are most commonly recommended. Ultrasonography, MRI, PET/CT using 18F-FDG or 11C-choline and recently PET/MRI using 18F-FDG also play a prominent role in detection of BCa. Conclusion For initial diagnosis of BCa, cystoscopy is generally performed. However, cystoscopy can not accurately detect carcinoma insitu (CIS) and can not distinguish benign masses from malignant lesions. CT is used in two modes, CT and computed tomographic urography (CTU), both for dignosis and staging of BCa. However, they cannot differentiate T1 and T2 BCa. MRI is performed to diagnose invasive BCa and can differentiate muscle invasive bladder carcinoma (MIBC) from non-muscle invasive bladder carcinoma (NMIBC). However, CT and MRI have low sensitivity for nodal staging. For nodal staging PET/CT is preferred. PET/MRI provides better differentiation of normal and pathologic structures as compared with PET/CT. Nonetheless none of the approaches can address all issues related for the management of BCa. Novel imaging methods that target specific biomarkers, image BCa early and accurately, and stage the disease are warranted.
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Affiliation(s)
- Ebru Salmanoglu
- Department of Radiology, Thomas Jefferson University, Philadelphia, PA 19107
- Department of Nuclear Medicine, Kahramanmaras Sutcu Imam University Faculty of Medicine, Avsar Kampus, Kahramanmaras, Turkey 46040
| | - Ethan Halpern
- Department of Radiology, Thomas Jefferson University, Philadelphia, PA 19107
- Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA 19107
| | - Edouard J Trabulsi
- Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA 19107
- Department of Urology, Thomas Jefferson University, Philadelphia, PA 19107
| | - Sung Kim
- Department of Radiology, Thomas Jefferson University, Philadelphia, PA 19107
| | - Mathew L Thakur
- Department of Radiology, Thomas Jefferson University, Philadelphia, PA 19107
- Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA 19107
- Department of Urology, Thomas Jefferson University, Philadelphia, PA 19107
- Department of Radiation Oncology, Thomas Jefferson University, Philadelphia, PA 19107
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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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41
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Hugen CM, Duddalwar V, Daneshmand S. Preoperative Imaging for Clinical Staging Prior to Radical Cystectomy. Curr Urol Rep 2016; 17:62. [PMID: 27432379 DOI: 10.1007/s11934-016-0618-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
The importance of patient selection for quality outcomes following radical cystectomy is critical. Clinical staging is one of the key elements necessary for patient selection, and staging relies on accurate preoperative imaging. Many imaging modalities are available and have been utilized for preoperative staging with published operating characteristics. In this update, we review recently published literature for advances in preoperative imaging prior to radical cystectomy.
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Affiliation(s)
- Cory M Hugen
- University of Southern California Institute of Urology, 1441 Eastlake Ave MS 7416, Los Angeles, CA, 90033, USA
| | - Vinay Duddalwar
- University of Southern California Department of Radiology, 1441 Eastlake Ave, Los Angeles, CA, 90033, USA
| | - Siamak Daneshmand
- University of Southern California Institute of Urology, 1441 Eastlake Ave MS 7416, Los Angeles, CA, 90033, USA.
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Pichler R, De Zordo T, Fritz J, Kroiss A, Aigner F, Heidegger I, Virgolini I, Horninger W, Uprimny C. Pelvic Lymph Node Staging by Combined 18F-FDG-PET/CT Imaging in Bladder Cancer Prior to Radical Cystectomy. Clin Genitourin Cancer 2016; 15:e387-e395. [PMID: 27601364 DOI: 10.1016/j.clgc.2016.08.009] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2016] [Accepted: 08/01/2016] [Indexed: 11/15/2022]
Abstract
BACKGROUND Accurate lymph node (LN) staging in bladder cancer before radical cystectomy is essential as LN metastases have an independent prognostic value. Most studies used a cutoff of > 10 mm in detecting pelvic LN spread. The aim of this study was to evaluate the diagnostic accuracy of contrast-enhanced computed tomography (CT) and 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography (PET) alone, or combined for preoperative pelvic LN staging. PATIENTS AND METHODS We retrospectively analyzed the data of 70 bladder cancer patients that were staged with 18F-FDG-PET/CT before radical cystectomy between 2012 and 2015. 18F-FDG-PET images were analyzed visually and semi-quantitatively by calculating the maximum standardized uptake value. CT scans were reviewed using different cutoffs of pelvic LNs, with the best cutoff at 8 mm (area under the curve = 0.684). RESULTS Metastatic LNs were confirmed in 53 (2.8%) of 1906 resected LNs in 11 (15.7%) patients. Sensitivity, specificity, and accuracy were 54.5%, 89.8%, and 84.3% for 18F-FDG-PET alone; 45.5%, 91.5%, and 84.3% for CT (LNs > 8 mm) alone; and 27.3%, 96.6%, and 85.7% for CT (LNs > 10 mm) alone, respectively. Combined 18F-FDG-PET/CT resulted in a nonsignificant increase of diagnostic accuracy using a cutoff > 8 mm for LN evaluation (63.6%, 86.4%, and 82.9%, respectively). A significant improvement of sensitivity to 63.6% was achieved only when LNs > 10 mm were considered suspicious (P = .046), but this reduced specificity to 88.1% (P = .025). CONCLUSIONS Combined 18F-FDG-PET/CT does not seem to be justified in preoperative staging if the threshold of pelvic LNs is set > 8 mm.
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Affiliation(s)
- Renate Pichler
- Department of Urology, Medical University Innsbruck, Innsbruck, Austria.
| | - Tobias De Zordo
- Department of Radiology, Medical University Innsbruck, Innsbruck, Austria
| | - Josef Fritz
- Department of Medical Statistics, Informatics, and Health Economics, Medical University Innsbruck, Innsbruck, Austria
| | - Alexander Kroiss
- Department of Nuclear Medicine, Medical University Innsbruck, Innsbruck, Austria
| | - Friedrich Aigner
- Department of Radiology, Medical University Innsbruck, Innsbruck, Austria
| | - Isabel Heidegger
- Department of Urology, Medical University Innsbruck, Innsbruck, Austria
| | - Irene Virgolini
- Department of Nuclear Medicine, Medical University Innsbruck, Innsbruck, Austria
| | | | - Christian Uprimny
- Department of Nuclear Medicine, Medical University Innsbruck, Innsbruck, Austria
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Abstract
PURPOSE OF REVIEW Muscle-invasive bladder cancer (MIBC) comprises approximately one-third of bladder cancers and is associated with significant morbidity and mortality. Accurate staging of bladder cancer is essential because of significantly different treatment options and the consequences of inaccurate staging. The current recommended method for staging is transurethral resection of the bladder tumor followed by contrast-enhanced computed tomography (CT). In this review, we discuss cross-sectional imaging approaches used to assess local, nodal, and distant metastases in MIBC. RECENT FINDINGS Determining the most accurate imaging method for staging MIBC is a contentious issue. CT with contrast is a practical approach; however, there is potential for understaging of small lymph nodes or foci of metastasis. Multiparametric MRI is emerging as the imaging modality of choice in tumor staging, with a reported accuracy of more than 90%. Locoregional lymph node metastasis can also be accurately evaluated using functional MRI and specific contrast agents with paramagnetic characteristics. PET/CT with conventional radiotracers is a common imaging modality for staging distant metastases. SUMMARY Conventional imaging methods for evaluating MIBC are of limited use. However, recent advances in molecular imaging, targeted contrast agents, and functional MRI have shown promising results for the staging of bladder cancer.
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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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Horn T, Zahel T, Adt N, Schmid SC, Heck MM, Thalgott MK, Hatzichristodoulou G, Haller B, Autenrieth M, Kübler HR, Gschwend JE, Holzapfel K, Maurer T. Evaluation of Computed Tomography for Lymph Node Staging in Bladder Cancer Prior to Radical Cystectomy. Urol Int 2015; 96:51-6. [DOI: 10.1159/000440889] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2015] [Accepted: 09/07/2015] [Indexed: 11/19/2022]
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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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