Jeong In Gab, Hong Sungwoo, You Dalsan, Hong Jun Hyuk, Ahn Hanjong, Kim Choung-Soo
Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Ann Surg Oncol. 2015 Sep;22(9):3150-6. doi: 10.1245/s10434-015-4369-7. Epub 2015 Jan 30.
The purpose of this study was to evaluate the diagnostic accuracy of [(18)F] fluorodeoxyglucose (FDG) positron emission tomography-computed tomography (PET-CT) for lymph node (LN) staging of bladder cancer patients undergoing radical cystectomy (RC) with extended pelvic lymphadenectomy compared to conventional CT.
A total of 61 patients underwent FDG PET-CT before RC and extended pelvic lymphadenectomy. A template for extended pelvic lymphadenectomy to the level of the inferior mesenteric artery was divided into 11 anatomic nodal packets. Definitive pathologic findings of resected LNs were correlated with the results of FDG PET-CT and CT alone in a patient- and nodal packet-based manner.
Among the 61 patients, pathological staging confirmed LN metastasis in 17 patients (27.9 %). In total, 627 LN packets (2580 LNs) were resected and histologically evaluated. The mean number of LNs removed was 42 (median 40; range 22-118). Of the 627 LN packets removed, 27 packets (4.3 %) were positive for LN metastasis based on pathologic analysis. On a patient-based analysis, FDG PET-CT and conventional CT showed a sensitivity of 47.1 and 29.4 %, respectively, specificity of 93.2 and 97.7 %, respectively, positive predictive value (PPV) of 72.7 and 78.2 %, respectively, and negative predictive value (NPV) of 82.0 and 78.2 %, respectively. On a nodal packet-based analysis, sensitivity, specificity, PPV, and NPV were 14.8, 97.8, 23.5, and 96.2 %, respectively, for PET-CT and 11.1, 98.7, 27.3, and 96.1 %, respectively, for conventional CT.
Combined FDG PET-CT did not improve the diagnostic accuracy of conventional CT for the detection of LN metastasis in bladder cancer patients scheduled for RC.
本研究的目的是评估[（18）F]氟脱氧葡萄糖（FDG）正电子发射断层扫描 - 计算机断层扫描（PET - CT）与传统CT相比，在接受根治性膀胱切除术（RC）并扩大盆腔淋巴结清扫术的膀胱癌患者淋巴结（LN）分期中的诊断准确性。
共有61例患者在RC和扩大盆腔淋巴结清扫术前接受了FDG PET - CT检查。将扩大盆腔淋巴结清扫至肠系膜下动脉水平的模板分为11个解剖学淋巴结组。以患者和淋巴结组为基础，将切除淋巴结的明确病理结果与FDG PET - CT和单独CT的结果进行关联。
61例患者中，病理分期证实17例（27.9%）有淋巴结转移。总共切除并进行组织学评估了627个淋巴结组（2580个淋巴结）。切除的淋巴结平均数量为42个（中位数40个；范围22 - 118个）。在切除的627个淋巴结组中，基于病理分析，27个组（4.3%）有淋巴结转移阳性。在基于患者的分析中，FDG PET - CT和传统CT的敏感性分别为47.1%和29.4%，特异性分别为93.2%和97.7%，阳性预测值（PPV）分别为72.7%和78.2%，阴性预测值（NPV）分别为82.0%和78.2%。在基于淋巴结组的分析中，PET - CT的敏感性、特异性、PPV和NPV分别为14.8%、97.8%、23.5%和96.2%，传统CT分别为11.1%、98.7%、27.3%和96.1%。
对于计划接受RC的膀胱癌患者，联合FDG PET - CT并未提高传统CT检测淋巴结转移的诊断准确性。
