ABSTRACT
Introduction and Objectives
18F-fluorodeoxyglucose positron-emission tomography-computed tomography (FDG-PET/CT)
is increasingly used in the preoperative staging of patients with muscle-invasive
bladder cancer. The clinical added value of FDG-PET/CT in high-risk non-muscle invasive
bladder cancer (NMIBC) is unknown. In this study, the value of FDG-PET/CT in addition
to contrast enhanced (CE)-CT was evaluated in high-risk NMIBC before radical cystectomy
(RC).
Materials and Methods
This is a retrospective analysis of consecutive patients with high risk and very-high
risk urothelial NMIBC scheduled for RC in a tertiary referral center between 2011
and 2020. Patients underwent staging with CE-CT (chest and abdomen/pelvis) and FDG-PET/CT.
We assessed the clinical disease stage before and after FDG-PET/CT and the treatment
recommendation based on the stage before and after FDG-PET/CT. The accuracy of CT
and FDG-PET/CT for identifying metastatic disease was defined by the receiver-operating
curve using a reference-standard including histopathology/cytology (if available),
imaging and follow-up.
Results
A total of 92 patients were identified (median age: 71 years). In 14/92 (15%) patients,
FDG-PET/CT detected metastasis (12 suspicious lymph nodes and 4 distant metastases).
The disease stage changed in 11/92 (12%) patients based on additional FDG-PET/CT findings.
FDG-PET/CT led to a different treatment in 9/92 (10%) patients. According to the reference
standard, 25/92 (27%) patients had metastases. The sensitivity, specificity and accuracy
of FDG-PET/CT was 36%, 93% and 77% respectively, versus 12%, 97% and 74% of CE-CT
only. The area under the ROC curve was 0.643 for FDG-PET/CT and 0.545 for CT, P = .036.
Conclusion
The addition of FDG-PET/CT to CE-CT imaging changed the treatment in 10% of patients
and proved to be a valuable diagnostic tool in a selected subgroup of NMIBC patients
scheduled for RC.
Keywords
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Article info
Publication history
Published online: February 21, 2023
Accepted:
February 1,
2023
Received in revised form:
February 1,
2023
Received:
January 5,
2023
Publication stage
In Press Journal Pre-ProofIdentification
Copyright
© 2023 Elsevier Inc. All rights reserved.
