Utility of routine preoperative (18)F-fluorodeoxyglucose positron emission tomography/computerized tomography in identifying pathological lymph node metastases at radical cystectomy Journal Article
| Authors: | Dason, S.; Wong, N. C.; Donahue, T. F.; Meier, A.; Zheng, J.; Mannelli, L.; Di Paolo, P. L.; Dean, L. W.; McPherson, V. A.; Rosenberg, J. E.; Bajorin, D. F.; Capeanu, M.; Dalbagni, G.; Vargas, H. A.; Bochner, B. H. |
| Article Title: | Utility of routine preoperative (18)F-fluorodeoxyglucose positron emission tomography/computerized tomography in identifying pathological lymph node metastases at radical cystectomy |
| Abstract: | Purpose:We determined the diagnostic performance of 18F-FDG (fluorodeoxyglucose) positron emission tomography/computerized tomography for detecting nodal metastases in patients with muscle invasive urothelial bladder cancer before radical cystectomy.Materials and Methods:Preoperative 18F-FDG positron emission tomography/computerized tomography scans (208) were retrospectively reviewed. Scans were routinely performed in 185 patients with muscle invasive urothelial bladder cancer between August 2012 and February 2017, all of whom underwent radical cystectomy and pelvic lymph node dissection. Analyses were stratified by clinical node involvement and chemotherapy status. The diagnostic performance of 18F-FDG positron emission tomography/computerized tomography was assessed according to sensitivity, specificity, positive predictive value and negative predictive value.Results:Lymph node metastases at time of pelvic lymph node dissection were present in 21.8% of those without suspicious nodes on computerized tomography (clinically node negative) and 52.6% of those with suspicious nodes on computerized tomography (clinically node positive). Median metastatic focus size was 5 mm. In clinically node negative cases 18F-FDG positron emission tomography/computerized tomography rarely detected nodal metastases (sensitivity 7% to 23%). In clinically node positive cases negative 18F-FDG positron emission tomography/computerized tomography was useful in ruling out lymph node metastases (sensitivity 92% to 100%). This study was limited by its mixed population and focus on pelvic nodal metastases only.Conclusions:18F-FDG positron emission tomography/computerized tomography appears to be most useful for better characterization of enlarged nodes identified by computerized tomography. Routine preoperative 18F-FDG positron emission tomography/computerized tomography has limited utility in clinically node negative cases. © 2020 Lippincott Williams and Wilkins. All rights reserved. |
| Keywords: | adult; cancer chemotherapy; controlled study; human tissue; aged; middle aged; cancer surgery; major clinical study; cisplatin; gemcitabine; cancer patient; positron emission tomography; lymph node metastasis; antineoplastic agent; lymph node dissection; pelvis lymph node; lymphatic metastasis; neoplasm staging; diagnostic accuracy; preoperative evaluation; sensitivity and specificity; lymph node excision; radiopharmaceuticals; tumor volume; pelvis lymphadenectomy; pathology; diagnostic imaging; medical record review; retrospective study; bladder tumor; urinary bladder neoplasms; fluorodeoxyglucose f 18; fluorodeoxyglucose f18; positron-emission tomography; cystectomy; radiopharmaceutical agent; neoplasm invasiveness; incidental finding; carcinoma, transitional cell; transitional cell carcinoma; drug excretion; predictive value; drug urine level; diagnostic test accuracy study; muscle invasive bladder cancer; tumor invasion; preoperative chemotherapy; humans; human; male; female; priority journal; article; positron emission tomography-computed tomography; positron emission tomography computed tomography |
| Journal Title: | Journal of Urology |
| Volume: | 204 |
| Issue: | 2 |
| ISSN: | 0022-5347 |
| Publisher: | Elsevier Science, Inc. |
| Date Published: | 2020-08-01 |
| Start Page: | 254 |
| End Page: | 258; discussion 258-259 |
| Language: | English |
| DOI: | 10.1097/ju.0000000000001006 |
| PUBMED: | 32134343 |
| PROVIDER: | scopus |
| PMCID: | PMC8477436 |
| DOI/URL: | |
| Notes: | Marinela Capanu's name is misspelled on the original publication -- Article -- Export Date: 1 October 2020 -- Source: Scopus |
