Bertolaso Pauline, Brouste Véronique, Cazeau Anne-Laure, de Clermont-Gallerande Henri, Bladou Franck, Cabart Mathilde, Lefort Felix, Gross-Goupil Marine
Department of Medical Oncology, University Hospital, Bordeaux, France.
Clinical and Epidemiology Research Unit, Institut Bergonié, Comprehensive Cancer Centre, Bordeaux, France.
Clin Genitourin Cancer. 2022 Jun;20(3):297-297.e6. doi: 10.1016/j.clgc.2022.01.009. Epub 2022 Jan 14.
Guidelines do not recommend FDG-PET CT for the staging of MIBC as a standard. The objectives of the study are to assess the accuracy of the FDG-PET CT for LN staging and to determine the rate of treatment modification according to FDG-PET CT results in MIBC.
From January 2005 to December 2017, we carried out a retrospective analysis of patients with MIBC who had a FDG-PET CT for staging in two expert centres in Bordeaux, France, and analyzed its clinical value in this setting. Nodal and metastatic staging on CT scan (CT) and FDG-PET CT were done independently.
Accuracy of LN staging from CT and FDG-PET CT at initial diagnosis was analyzed in 85 patients (including 70 patients treated with neoadjuvant chemotherapy (NAC)) and compared to pathological examination of resected LN. Sensitivity of FDG-PET CT was better than CT (80.8% versus 26.9%) but the specificity was low (54.2% vs. 83.1%). The Youden index was better for FDG-PET CT (0.35; 0.1 for CT) and FDG-PET CT appeared to be more accurate for determining LN staging of MIBC. FDG-PET CT findings enabled a treatment decision modification in 34/130 patients (26.1%): a therapeutic intensification (9.2%), including surgery not previously planned and/or modified fields of radiotherapy; or a de-escalation (16.9%), mostly avoiding surgery.
FDG-PET CT was more sensitive for detection of LN involvement at initial diagnosis of MIBC than CT alone. In our study, treatment decisions were modified, according to FDG-PET CT results, in almost a quarter of patients.
指南不推荐将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）作为肌层浸润性膀胱癌（MIBC）分期的标准方法。本研究的目的是评估FDG-PET CT在淋巴结分期方面的准确性，并根据FDG-PET CT结果确定MIBC治疗方案改变的比例。
2005年1月至2017年12月，我们对在法国波尔多的两个专家中心进行FDG-PET CT分期的MIBC患者进行了回顾性分析，并分析了其在该情况下的临床价值。CT扫描（CT）和FDG-PET CT的淋巴结及转移灶分期是独立进行的。
对85例患者（包括70例接受新辅助化疗（NAC）的患者）在初始诊断时CT和FDG-PET CT的淋巴结分期准确性进行了分析，并与切除淋巴结的病理检查结果进行比较。FDG-PET CT的敏感性优于CT（80.8%对26.9%），但特异性较低（54.2%对83.1%）。FDG-PET CT的约登指数更高（0.35；CT为0.1），且FDG-PET CT在确定MIBC淋巴结分期方面似乎更准确。FDG-PET CT检查结果使130例患者中的34例（26.1%）治疗决策发生改变：强化治疗（9.2%），包括进行之前未计划的手术和/或调整放疗范围；或降级治疗（16.9%），主要是避免手术。
在MIBC初始诊断时，FDG-PET CT检测淋巴结受累情况比单独使用CT更敏感。在我们的研究中，近四分之一的患者根据FDG-PET CT结果改变了治疗决策。
