Al-Zubaidi Mohammed, Ong Katherine, Viswambaram Pravin, Bangash Haider, Boardman Glenn, McCombie Steve P, Oey Oliver, Swarbrick Nicole, Redfern Andrew, Ong Jeremy, Gauci Richard, Low Ronny, Hayne Dickon
Department of Urology Fiona Stanley Hospital Murdoch Australia.
UWA Medical School University of Western Australia Crawley Australia.
BJUI Compass. 2024 Feb 20;5(4):473-479. doi: 10.1002/bco2.304. eCollection 2024 Apr.
We aim to assess the clinical value of F-fluorodeoxyglucose positron (F-FDG-PET) scan in detecting nodal and distant metastasis compared with computed tomography (CT) scan in patients with urothelial carcinoma or bladder cancer, aiming to improve staging accuracy and thereby better prognosticate and determine therapy.
A retrospective review of 75 patients with invasive bladder cancer (≥T1) who were staged with both CT and F-FDG-PET within an 8-week interval was performed for the period between 2015 and 2020. Seventy-two per cent (54/75) had formal pelvic lymph node (LN) dissection or biopsy of lesions suspicious for metastases. FDG-PET definitions for positive sites were assessed depending on SUV Max (nodes with SUVmax >4 at any size, SUV > 2 for lymph nodes >8 mm, or any SUV if the lymph node was >10 mm on axial images). For CT scanning, enlarged LN by RECIST 1.1 criteria (>10 mm) as well as qualitative findings suggesting metastasis were considered positive. The analysis was based on the comparison of CT and F-FDG-PET findings to histopathology results from LN dissection or biopsies.
Sensitivity, specificity, positive predictive values (PPV) and negative predictive value (NPV) of CT versus FDG-PET for detecting metastasis, in patients who underwent pelvic LN dissection or biopsy of lesions suspicious of metastases, were 46.6% (95% CI: 21%-70%) versus 60% (95% CI: 32%-84%), 100% (95% CI: 91%-100%) versus 83.78% (95% CI: 69%-94%), 100% (95% CI: 63%-100%) versus 60% (95% CI: 32%-84%), and 82.2% (95% CI: 68%-92%) versus 83.78% (95% CI: 69%-94%), respectively. 7/75 (9.3%) patients avoided cystectomy due to F-FDG-PET features of metastases that were not detected by CT.
FDG-PET may be more sensitive than CT for metastases in the staging of bladder cancer, which resulted in significant avoidance of aggressive local management in cases with occult metastasis.
我们旨在评估氟脱氧葡萄糖正电子（F-FDG-PET）扫描在检测尿路上皮癌或膀胱癌患者的淋巴结和远处转移方面的临床价值，并与计算机断层扫描（CT）进行比较，以提高分期准确性，从而更好地进行预后评估和确定治疗方案。
对2015年至2020年期间75例浸润性膀胱癌（≥T1）患者进行回顾性研究，这些患者在8周内先后接受了CT和F-FDG-PET检查。72%（54/75）的患者进行了正式的盆腔淋巴结（LN）清扫或对可疑转移病灶进行了活检。根据SUV最大值评估FDG-PET阳性部位的定义（任何大小的淋巴结SUVmax>4，直径>8mm的淋巴结SUV>2，或轴位图像上直径>10mm的淋巴结的任何SUV值）。对于CT扫描，根据RECIST 1.1标准（>10mm）增大的LN以及提示转移的定性结果被视为阳性。分析基于CT和F-FDG-PET检查结果与LN清扫或活检的组织病理学结果的比较。
在接受盆腔LN清扫或对可疑转移病灶进行活检的患者中，CT与FDG-PET检测转移的敏感性、特异性、阳性预测值（PPV）和阴性预测值（NPV）分别为46.6%（95%CI：21%-70%）对60%（95%CI：32%-84%），100%（95%CI：91%-100%）对83.78%（95%CI：69%-94%），100%（95%CI：63%-100%）对60%（95%CI：32%-84%），以及82.2%（95%CI：68%-92%）对83.78%（95%CI：69%-94%）。7/75（9.3%）的患者因CT未检测到而F-FDG-PET显示有转移特征，从而避免了膀胱切除术。
在膀胱癌分期中，FDG-PET对转移的检测可能比CT更敏感，这使得在隐匿性转移病例中显著避免了积极的局部治疗。
