Abstract
In this retrospective pilot study, the feasibility of the epithelial cell adhesion molecule (EpCAM) as an imaging target for lymph node (LN) metastatic disease of urothelial cell carcinoma (UCC) of the bladder was investigated. LN metastases and LNs without metastases of patients who underwent pelvic lymph node dissection because of muscle invasive bladder cancer (MIBC) were used. Primary tumors of the same patients were used from cystectomy specimen, transurethral resections, and biopsies. A pathologist, blinded to clinical data, scored EpCAM immunoreactivity. This method determines a total immunostaining score, which is the product of a proportion score and an intensity score. EpCAM expression was observed in 19/20 (95%) LNs with UCC metastases and in 11/12 (92%) of the primary tumors. EpCAM expression was absent in 14/14 (100%) LNs without metastases. Median EpCAM expression (TIS) in LN metastases was 5 (IQR 2.0–8.0) and in the primary tumors 6 (IQR 2.3–11.0). Based on the absence of staining in LNs without metastases, EpCAM show high tumor distinctiveness. EpCAM seems to be a feasible imaging target in LN metastases of UCC of the bladder. Pre- and perioperative visualization of these metastases will improve disease staging and improve the complete resection of LN metastases in MIBC.
Highlights
Imaging is needed to determine local extension and lymph node status of muscle invasive bladder cancer (MIBC) [1]
All 34 lymph nodes were available for analyses
Since invasive tumor is needed for a proper comparison between primary tumor and matched lymph nodes, these samples were not suitable for evaluation
Summary
Imaging is needed to determine local extension and lymph node status of muscle invasive bladder cancer (MIBC) [1]. C-Choline PET/CT have been proved to be more sensitive to assess the presence of lymph node metastases in patients with bladder cancer, compared to contrast-enhanced CT. It still lacks sensitivity (10–59%) and specificity (64–90%) in diagnostic information in preoperative nodal staging of patients with invasive BC [2,3]. FDG PET/CT seems to be the best performing method to detect lymph node metastases, with the highest sensitivity and specificity compared to other imaging modalities [4,5]. Pelvic lymph node dissection remains the gold standard for nodal staging
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