Abstract
Introduction
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.
Patients and methods
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.
Results
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.
Conclusion
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.
Keywords
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Article info
Publication history
Published online: January 14, 2022
Accepted:
January 9,
2022
Received in revised form:
December 26,
2021
Received:
August 16,
2021
Identification
Copyright
© 2022 Elsevier Inc. All rights reserved.
