Abstract
Purpose
The purpose of this study was to assess the diagnostic accuracy of 18F-fluorodeoxyglucose with positron emission tomography and computed tomography (FDG–PET–CT) to predict nodal metastases in patients with bladder cancer (BC) scheduled to undergo radical cystectomy (RC).
Methods
We retrospectively reviewed records of patients diagnosed with BC and scheduled to undergo RC at our center from January 2011 through February 2015, who also underwent FDG–PET–CT at the time of diagnosis. All patients underwent RC and an extended pelvic lymph node dissection as the reference standard. The primary endpoints were the sensitivity, specificity and overall accuracy of FDG–PET–CT in detecting lymph node metastasis. We also examined its accuracy in identifying distant metastasis. In addition, we conducted a protocol-driven systematic review and meta-analysis of accuracy of FDG–PET–CT for preoperative staging of BC, as compared to CT alone, as reported in individual studies. To assess the methodological quality of eligible studies, we used the QUADAS-2 tool (a revised tool for the Quality Assessment of Diagnostic Accuracy Studies) and pooled diagnostic accuracy measures using Meta-DiSc statistical software.
Results
For detecting nodal metastases in 78 patients, the sensitivity of FDG–PET–CT was 0.56 (95 % CI 0.29–0.80) and the specificity, 0.98 (95 % CI 0.91–1.00). Pooled sensitivity and specificity for detecting lymph node metastasis were 0.57 and 0.95, respectively. Positive likelihood ratio was 9.02. All lesions that were suspicious for distant metastasis were found to be positive on biopsy.
Conclusion
FDG–PET–CT was more accurate than CT alone in staging BC in patients undergoing surgery. Standardization of FDG–PET–CT protocol and cost-effectiveness analysis are required before widespread implementation of this technology.
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Authors’ contribution
Soubra substantially contributed to project development, data collection and management, data analysis, manuscript writing and editing. Hayward contributed to data collection, data analysis and manuscript editing. Dahm substantially contributed to protocol and project development, data analysis, manuscript writing and editing. Goldfarb contributed to data collection and management and manuscript writing/editing. Froehlich contributed to protocol development and data analysis. Jha contributed to project development, data analysis and manuscript editing. Konety substantially contributed to protocol/project development, data analysis, manuscript writing and editing. We would like to thank Mary Knatterud, PhD, for her excellent editorial assistance.
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All authors have no actual or potential conflict of interest to disclose. The authors did not receive any funding for the research, authorship and/or publication of this article.
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This research has been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments. Institutional review board approval was obtained.
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Soubra, A., Hayward, D., Dahm, P. et al. The diagnostic accuracy of 18F-fluorodeoxyglucose positron emission tomography and computed tomography in staging bladder cancer: a single-institution study and a systematic review with meta-analysis. World J Urol 34, 1229–1237 (2016). https://doi.org/10.1007/s00345-016-1772-z
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DOI: https://doi.org/10.1007/s00345-016-1772-z