PT  - JOURNAL ARTICLE
AU  - Kirsten Bouchelouche
AU  - Stefan Vind-Kezunovic
AU  - Pia Ipsen
AU  - Jorgen Bjerggaard Jensen
TI  - Preoperative detection of lymph node metastases using SUVmax on 18F-FDG PET/CT in patients with high risk non-invasive and muscle invasive bladder cancer
DP  - 2016 May 01
TA  - Journal of Nuclear Medicine
PG  - 1563--1563
VI  - 57
IP  - supplement 2
4099  - http://jnm.snmjournals.org/content/57/supplement_2/1563.short
4100  - http://jnm.snmjournals.org/content/57/supplement_2/1563.full
SO  - J Nucl Med2016 May 01; 57
AB  - 1563Objectives The standard treatment for patients with muscle-invasive bladder cancer (BC) is radical cystectomy (RC). However, this gold standard only provides 5-year survival in about 50%. To improve these unsatisfactory results neoadjuvant chemotherapy (NAC) are recommended in patients with T2-T4a, cN0M0 disease. In patients with proven lymph node (LN) metastases, a more intense downstaging chemotherapy than NAC is indicated. Thus, the optimal management of patients depends on accurate staging and detection of metastatic disease. MRI and CT have only moderate accuracy for detection of LN metastases. Given the ability of FDG PET to detect metabolic activity, investigators have begun exploring the use of PET/CT in staging BC. The aim of this study was to evaluate the value of preoperative 18F-fluorodeoxyglucose (FDG) PET/CT for detection of pelvic LN metastases, and correlate SUVmax and histology of removed LNs.Methods In the period from 2011-2014, 328 consecutive patients with muscle invasive or high-risk non-invasive urothelial cancer were referred to preoperative FDG PET/CT in a large single centre. Patients with distant metastasis (n=37) or upper urothelial cancer (n=4) were excluded. 287 patients were considered for RC; 25 patients rejected the operation or operation was not needed, 41 patients were treated with radiation therapy, and 13 patients were inoperable. Cystectomy and extended pelvic lymph node dissection to the aortic bifurcation (PLND) were performed in 128 patients. Percutaneous biopsy verified PET/CT suspicious LN in 13 patients. Patients with previous NAC (n=39), previous chemotherapy or surgery (n=19) or insufficient LN dissection (n=9) were excluded. In 141 patients, histology of LNs were available for final analysis. Two experienced specialists in nuclear medicine and radiology evaluated the PET/CT scans. Results of FDG-PET/CT were compared with those of corresponding histopathologic examinations of removed LNs according to anatomical location. Anatomical locations were grouped into three regions: above the iliac bifurcations, right side below the iliac bifurcation, and left side below the iliac bifurcation.Results A total of 141 patients (110 males, 31 females) with mean ages 72 yrs (range 45-90) were available for the final analysis. In 30 patients robot RC and PLND were performed, and open RC and PLND were performed in 111 patients. Mean days from PET/CT to RC were 23 days (range 5-68). A total number of 2,479 LNs were removed for histology with mean of 19 LNs (range 7-41) per patient.View this table: Receiver operating characteristic (ROC) curve analysis was performed to identify the best SUVmax cut-off value of 3.44: A) Patients based analysis (n=141): sensitivity 77%, specificity 80%. B) Region based analysis (n=423): sensitivity 63,5%, specificity 89 %. CONCLUSIONS: Our data demonstrate that FDG PET/CT with correlation based on SUVmax is a useful tool for preoperative evaluation of pelvic LN metastases from muscle invasive and high-risk urothelial bladder cancer. This may have implication for a better selection of patients for NAC or more intensive downstaging chemotherapy in cases with localised lymph node metastatic disease.