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FDG PET–CT for Lymph Node Staging of Bladder Cancer: A Prospective Study of Patients with Extended Pelvic Lymphadenectomy

  • Urologic Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

The purpose of this study was to evaluate the diagnostic accuracy of [18F] fluorodeoxyglucose (FDG) positron emission tomography–computed tomography (PET–CT) for lymph node (LN) staging of bladder cancer patients undergoing radical cystectomy (RC) with extended pelvic lymphadenectomy compared to conventional CT.

Methods

A total of 61 patients underwent FDG PET–CT before RC and extended pelvic lymphadenectomy. A template for extended pelvic lymphadenectomy to the level of the inferior mesenteric artery was divided into 11 anatomic nodal packets. Definitive pathologic findings of resected LNs were correlated with the results of FDG PET–CT and CT alone in a patient- and nodal packet-based manner.

Results

Among the 61 patients, pathological staging confirmed LN metastasis in 17 patients (27.9 %). In total, 627 LN packets (2580 LNs) were resected and histologically evaluated. The mean number of LNs removed was 42 (median 40; range 22–118). Of the 627 LN packets removed, 27 packets (4.3 %) were positive for LN metastasis based on pathologic analysis. On a patient-based analysis, FDG PET–CT and conventional CT showed a sensitivity of 47.1 and 29.4 %, respectively, specificity of 93.2 and 97.7 %, respectively, positive predictive value (PPV) of 72.7 and 78.2 %, respectively, and negative predictive value (NPV) of 82.0 and 78.2 %, respectively. On a nodal packet-based analysis, sensitivity, specificity, PPV, and NPV were 14.8, 97.8, 23.5, and 96.2 %, respectively, for PET-CT and 11.1, 98.7, 27.3, and 96.1 %, respectively, for conventional CT.

Conclusions

Combined FDG PET–CT did not improve the diagnostic accuracy of conventional CT for the detection of LN metastasis in bladder cancer patients scheduled for RC.

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Acknowledgment

We thank Drs. Hyuk Jae Choi, Jeong Kon Kim, Kyung Sik Cho, and Jong Jin Lee for their dedicated review of the conventional CT and FDG-PET CT analysis and critical revision of the manuscript.

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Authors and Affiliations

  1. Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea

    In Gab Jeong MD, PhD, Dalsan You MD, PhD, Jun Hyuk Hong MD, PhD, Hanjong Ahn MD, PhD & Choung-Soo Kim MD, PhD

  2. Department of Urology, University of Dankook College of Medicine, Cheonan, Korea

    Sungwoo Hong MD

Authors
  1. In Gab Jeong MD, PhD
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  2. Sungwoo Hong MD
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  3. Dalsan You MD, PhD
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  4. Jun Hyuk Hong MD, PhD
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  5. Hanjong Ahn MD, PhD
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  6. Choung-Soo Kim MD, PhD
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Corresponding author

Correspondence to Choung-Soo Kim MD, PhD.

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Jeong, I.G., Hong, S., You, D. et al. FDG PET–CT for Lymph Node Staging of Bladder Cancer: A Prospective Study of Patients with Extended Pelvic Lymphadenectomy. Ann Surg Oncol 22, 3150–3156 (2015). https://doi.org/10.1245/s10434-015-4369-7

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  • DOI: https://doi.org/10.1245/s10434-015-4369-7

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