Chairman of Urology department, Zahraa Hospital, University Medical Center, Lebanese University, Beirut, Lebanon.
Urology Department, Lebanese University, Faculty of Medicine, Beirut, Lebanon.
Urol Oncol. 2021 Dec;39(12):833.e9-833.e17. doi: 10.1016/j.urolonc.2021.04.027. Epub 2021 May 29.
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.
We aim to evaluate the diagnostic value of PET-CT scan, compared with CT scan alone for preoperative LN staging of BC.
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.
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.
PET-CT is more accurate than CT-scan alone for preoperative LN staging in patients with BC.
在膀胱癌（BC）患者接受根治性膀胱切除术（RC）之前进行准确的淋巴结（LN）分期对于改善患者的管理至关重要。18F-氟代脱氧葡萄糖正电子发射断层扫描-计算机断层扫描（FDG-PET-CT）在 BC 的局部区域分期中得到了广泛应用。由于缺乏大型试验，PET-CT 在 BC 术前 LN 分期中的诊断性能仍不清楚。
我们旨在评估 PET-CT 扫描与单独 CT 扫描相比在 BC 术前 LN 分期中的诊断价值。
从 2010 年 1 月至 2020 年 11 月，我们回顾性分析了 300 例接受 RC 治疗肌层浸润性 BC 和高危非肌层浸润性 BC 的患者的记录。所有患者均接受了腹部和骨盆的 PET-CT 和 CT 扫描，以评估 RC 前骨盆 LN 转移情况。如果患者接受了新辅助化疗（NAC），则将其排除在分析之外。通过将 FDG PET-CT 和单独 CT 的结果与 RC 后获得的最终组织病理学报告进行比较，确定检测骨盆 LN 转移的敏感性、特异性和准确性。
134 例患者（44.7%）的 LN 转移得到组织学证实。在基于患者的分析中，PET-CT 和 CT 的敏感性分别为 40.3%和 13.4%，特异性分别为 79.5%和 86.7%，阳性预测值（PPV）分别为 61.4%和 45%，阴性预测值（NPV）分别为 62.3%和 55.4%。PET-CT 扫描的诊断准确性取决于多个术前和术后因素。
与单独 CT 扫描相比，PET-CT 对 BC 患者的术前 LN 分期更准确。
