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Journal Article Ppublish 10 citations

PubMed: 35101381 DOI: 10.1016/j.clgc.2022.01.009

Impact of FDG- PET CT in the Management of Muscle Invasive Bladder Cancer.

Clin Genitourin Cancer 20(3):297-297.e6

Authors: Pauline Bertolaso, VĂ©ronique Brouste, Anne-Laure Cazeau, Henri de Clermont-Gallerande, Franck Bladou, Mathilde Cabart, Felix Lefort, Marine Gross-Goupil

Affiliations

  • Department of Medical Oncology, University Hospital, Bordeaux, France.
  • Clinical and Epidemiology Research Unit, Institut BergoniĂ©, Comprehensive Cancer Centre, Bordeaux, France.
  • Nuclear Medicine Department, Institut BergoniĂ©, Comprehensive Cancer Centre, Bordeaux, France.
  • Nuclear Medicine Department, University Hospital of Bordeaux, Bordeaux, France; University of Bordeaux, Bordeaux, France.
  • University of Bordeaux, Bordeaux, France; Department of Urology, University Hospital, Bordeaux, France.
  • Department of Medical Oncology, Institut BergoniĂ©, Comprehensive Cancer Centre, Bordeaux, France.
  • Department of Medical Oncology, University Hospital, Bordeaux, France.

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.

MeSH

Kidney Neoplasms, Diagnosis, Therapeutics, Prostatic Neoplasms, Urinary Bladder Neoplasms, Muscles, Positron Emission Tomography Computed Tomography

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