FDG-PET/CT for lymph node staging prior to radical cystectomy

Vilhelm Pihl; Maria Markus; Johan Abrahamsson; Mats Bläckberg; Oskar Hagberg; Petter Kollberg; Athanasios Simoulis; Elin Trägårdh; Fredrik Liedberg

doi:10.1186/s41824-023-00170-9

FDG-PET/CT for lymph node staging prior to radical cystectomy

Eur J Hybrid Imaging. 2023 Jul 24;7(1):13. doi: 10.1186/s41824-023-00170-9.

Authors

Vilhelm Pihl^{1

2}, Maria Markus^{3

2}, Johan Abrahamsson^{1

2}, Mats Bläckberg⁴, Oskar Hagberg², Petter Kollberg⁵, Athanasios Simoulis⁶, Elin Trägårdh^{3

2}, Fredrik Liedberg^{7

8}

Affiliations

¹ Department of Urology, Skåne University Hospital, Jan Waldenströms Gata 7, 205 02, Malmö, Sweden.
² Department of Translational Medicine, Lund University, Malmö, Sweden.
³ Clinical Physiology and Nuclear Medicine, Skåne University Hospital, Malmö, Sweden.
⁴ Department of Urology, Helsingborg County Hospital, Helsingborg, Sweden.
⁵ Department of Surgical and Perioperative Sciences, Urology and Andrology, Umeå University, Umeå, Sweden.
⁶ Department of Pathology, Skåne University Hospital, Malmö, Sweden.
⁷ Department of Urology, Skåne University Hospital, Jan Waldenströms Gata 7, 205 02, Malmö, Sweden. fredrik.liedberg@med.lu.se.
⁸ Department of Translational Medicine, Lund University, Malmö, Sweden. fredrik.liedberg@med.lu.se.

Abstract

Background: ¹⁸F-Fluorodeoxyglucose positron emission combined with computed tomography (FDG-PET/CT) has been proposed to improve preoperative staging in patients with bladder cancer subjected to radical cystectomy (RC).

Objective: Our aim was to assess the accuracy of FDG-PET/CT for lymph node staging ascertained at the multidisciplinary tumour board compared to lymph node status in the surgical lymphadenectomy specimen obtained at RC, and to explore potential factors associated with false-positive FDG-PET/CT results.

Design, setting and participants: Consecutive patients with bladder cancer undergoing RC with extended lymph node dissection between 2011 and 2019 without preoperative chemotherapy in a tertial referral cystectomy unit were included in the study.

Outcome measurements and statistical analyses: Sensitivity, specificity, positive and negative predictive values and likelihood ratios were calculated. Potential factors investigated for association with false-positive FDG-PET/CT were; bacteriuria within four weeks prior to FDG-PET/CT, Bacillus Calmette-Guerin (BCG) treatment within 12 months prior to FDG-PET/CT and transurethral resection of bladder tumour (TURB) within four weeks prior to FDG-PET/CT.

Results: Among 157 patients included for analysis, 44 (28%) were clinically node positive according to FDG-PET/CT. The sensitivity and specificity for detection of lymph node metastasis were 50% and 84%, respectively, and the corresponding positive predictive and negative predictive values were 61% and 76%. Positive and negative likelihood ratios were 3.0 and 0.6, respectively. No association was found between bacteriuria, previous BCG treatment or TURB within 28 days and false-positive FDG-PET/CT results.

Conclusions: Preoperative FDG-PET/CT prior to RC had a clinically meaningful high specificity (84%) but lower sensitivity (50%) for detection of lymph node metastases compared to lymph node status in an extended pelvic lymphadenectomy template. We could not identify any factors associated with false-positive FDG-PET/CT outcomes.

Keywords: Bladder cancer; FDG-PET/CT; Lymph node metastasis; Radical cystectomy; Sensitivity; Specificity; Staging.

Grants and funding

2020/0709/Cancerfonden