Abstract
Purpose
The presence of lymph node involvement (N) and distant metastasis (M) in patients with invasive bladder carcinoma is a major determinant of survival and, therefore, a pivotal element in the therapeutic management. The aim of this prospective study was to evaluate the use of 18F-fluorodeoxyglucose positron emission tomography (FDG-PET) in this indication.
Methods
Whole-body FDG-PET and computed tomography (CT) were performed in 55 patients with non-metastatic invasive bladder cancer for preoperative staging. Correlative imaging of PET with CT was performed, leading to a PET(CT) result. The imaging results were compared with the gold standard, consisting of histopathology (lymphadenectomy, guided biopsy) or clinical follow-up for 12 months, and related to overall survival using the Kaplan-Meier method.
Results
The gold standard was available in 40 patients and indicated NM-positive disease in 15 patients (12 N lesions, 8 M lesions), and NM-negative disease in 25 patients. For the diagnosis of NM-positive disease, the sensitivity, specificity and accuracy of PET(CT) were 60%, 88% and 78%, respectively. Diagnostic discordances between PET(CT) and CT alone were found in 9/40 patients, among whom PET was correct in six (15%): three with true-positive and one with true-negative distant metastases, and two with true-negative lymph nodes. Median survival time of patients in whom PET(CT) indicated NM-positive disease was 13.5 months, compared with 32.0 months in the patients with a NM-negative PET(CT) (p=0.003).
Conclusion
Addition of metabolism-based information provided by FDG-PET to CT in the preoperative staging of invasive bladder carcinoma yields a high diagnostic and prognostic accuracy.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Greenlee RT, Murray T, Bolden S, Wingo PA. Cancer statistics. CA Cancer J Clin 2000;50:7–33
Herr HW. Uncertainty, stage and outcome of invasive bladder cancer. J Urol 1994;152:401–2
Herr HW, Bochner BH, Dalbagni G, Donat SM, Reuter VE, Bajorin DF. Impact of the number of lymph nodes retrieved on outcome in patients with muscle invasive bladder cancer. J Urol 2002;167:1295–8
Stein JP, Lieskovsky G, Cote R, Groshen S, Feng AC, Boyd S, et al. Radical cystectomy in the treatment of invasive bladder cancer: long-term results in 1,054 patients. J Clin Oncol 2001;19:666–75
Bajorin DF. Plenary debate of randomized phase III trial of neoadjuvant MVAC plus cystectomy versus cystectomy alone in patients with locally advanced bladder cancer. J Clin Oncol 2001;19:17s–20s
Millikan R, Dinney C, Swanson D, Sweeney P, Ro JY, Smith TL, et al. Integrated therapy for locally advanced bladder cancer: final report of a randomized trial of cystectomy plus adjuvant M-VAC versus cystectomy with both preoperative and postoperative M-VAC. J Clin Oncol 2001;19:4005–13
Paik ML, Scolieri MJ, Brown SL, Spirnak JP, Resnick MI. Limitations of CT in staging invasive bladder cancer before radical cystectomy. J Urol 2000;163:1693–6
Herr HW, Hilton S. Routine CT scan in cystectomy patients: does it change management? Urology 1996;47:324–5
Persad R, Kabala J, Gillatt D, Penry B, Gingell JC, Smith PJ. Magnetic resonance imaging in the staging of bladder cancer. Br J Urol 1993;71:566–73
Oyen RH, Van Poppel HP, Ameye FE, Van de Voorde WA, Baert AL, Baert LV. Lymph node staging of localized prostatic carcinoma with CT and CT-guided fine-needle aspiration biopsy: prospective study of 285 patients. Radiology 1994;190:315–22
Grigsby PW, Siegel BA Dehdashti F. Lymph node staging by positron emission tomography in patients with carcinoma of the cervix. J Clin Oncol 2001;19:3745–9
Vansteenkiste J, Stroobants S, Dupont P, De Leyn PR, Verbeken EK, Deneffe GJ, et al. Prognostic importance of the standardized uptake value on fluorodeoxyglucose positron emission tomography in non-small cell lung cancer: an analysis of 125 cases. J Clin Oncol 1999;17:3201–6
Shepp LA, Vardi Y. Maximum likelihood reconstruction for emission tomography. IEEE Trans Med Imaging 1982;1:113–22
Beck J. Likelihood ratios: another enhancement of sensitivity and specificity. Arch Pathol Lab Med 1986;110:685–6
Bachor R, Kotzerke J, Reske SN, Hautmann R. Lymph node staging of bladder neck carcinoma with positron emission tomography. Urologe 1999;A 38:46–50
Kosuda S, Kison PV, Greenough R, Grossman HB, Wahl RL. Preliminary assessment of fluorine-18 fluorodeoxyglucose positron emission tomography in patients with bladder cancer. Eur J Nucl Med 1997;24:615–20
Heicappell R, Muller-Mattheis V, Reinhardt M, Vosberg H, Gerharz CD, Muller-Gartner H, et al. Staging of pelvic lymph nodes in neoplasms of the bladder and prostate by positron emission tomography with FDG. Eur Urol 1999;36:582–7
Strauss LG. Fluorine-18 deoxyglucose and false-positive results: a major problem in the diagnostics of oncological patients. Eur J Nucl Med 1996;23:1409–15
Ghoneim MA, El-Mekresh MM, El-Baz MA, el-Attar IA, Ashamallah A. Radical cystectomy for carcinoma of the bladder: critical evaluation of the results in 2,026 cases. J Urol 1997;158:393–9
Vanuytsel L, Vansteenkiste J, Stroobants S, De Leyn PR, De Wever W, Verbeken EK, et al. The impact of fluorodeoxyglucose positron emission tomography node staging on the radiation treatment volumes in patients with non-small cell lung cancer. Radiother Oncol 2000;55:317–24
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Drieskens, O., Oyen, R., Van Poppel, H. et al. FDG-PET for preoperative staging of bladder cancer. Eur J Nucl Med Mol Imaging 32, 1412–1417 (2005). https://doi.org/10.1007/s00259-005-1886-9
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00259-005-1886-9