Abstract
BackgroundWe studied patients treated with radical cystectomy for locally advanced bladder cancer to compare the results of both preoperative positron emission tomography/computed tomography (PET/CT) and conventional CT with the findings of postoperative histopathological evaluation of lymph nodes.MethodsPatients who had bladder cancer and were candidates for cystectomy underwent preoperative PET/CT using 18-fluorodeoxyglucose (FDG) and conventional CT. The results regarding lymph node involvement were independently evaluated by two experienced radiologists and were subsequently compared with histopathology results, the latter of which were reassessed by an experienced uropathologist (HO).ResultsThere were 54 evaluable patients (mean age 68 years, 47 [85 %] males and 7 [15 %] females) with pT and pN status as follows: < pT2-14 (26 %), pT2-10 (18 %), and > pT2-30 (56 %); pN0 37 (69 %) and pN+ 17 (31 %). PET/CT showed positive lymph nodes in 12 patients (22 %), and 7 of those cases were confirmed by histopathology; the corresponding results for conventional CT were 11 (20 %) and 7 patients (13 %), respectively. PET/CT had 41 % sensitivity, 86 % specificity, 58 % PPV, and 76 % NPV, whereas the corresponding figures for conventional CT were 41 %, 89 %, 64 %, and 77 %. Additional analyses of the right and left side of the body or in specified anatomical regions gave similar results.ConclusionsIn this study, PET/CT and conventional CT had similar low sensitivity in detecting and localizing regional lymph node metastasis in bladder cancer.
Highlights
We studied patients treated with radical cystectomy for locally advanced bladder cancer to compare the results of both preoperative positron emission tomography/computed tomography (PET/CT) and conventional CT with the findings of postoperative histopathological evaluation of lymph nodes
Lymph node (LN) metastasis is correlated with decreased overall survival (OS), and it is plausible that survival in patients with or without such metastasis can be improved by LN dissection [1,2,3,4,5]
Six patients had undergone PET/CT more than 2 months before cystectomy, because the surgery had been delayed for further investigations due to suspected distant metastasis
Summary
We studied patients treated with radical cystectomy for locally advanced bladder cancer to compare the results of both preoperative positron emission tomography/computed tomography (PET/CT) and conventional CT with the findings of postoperative histopathological evaluation of lymph nodes. Accurate clinical staging of localized or regionally advanced urinary bladder cancer remains a challenge. Conventional computed tomography (CT) and magnetic resonance imaging (MRI) are frequently employed as diagnostic tools for staging in evaluation of muscleinvasive bladder cancer. Both these methods use LN size as a criterion for diagnosis and false-negative rates can be as high as 40 % [11,12,13]. There is a need for a non-invasive imaging modality that can achieve more accurate preoperative staging of bladder cancer
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