Introduction: In patients with nonmetastatic invasive bladder cancer (T2 or higher, M0) or recurrent high-risk non-muscle invasive disease (T1G3 with or without Tis, M0), locoregional lymph node metastasis is an important prognostic factor. The standard imaging modalities for staging (computed tomography [CT] or magnetic resonance imaging [MRI]) have an accuracy range of 70-90% for lymph-node staging. Fluorine-18 2-fluoro-2-deoxy-D-glucose positron emission tomography/computed tomography (FDG-PET/CT) has been approved for imaging in many malignancies but not for bladder cancer. This study investigated the value of FDG- PET/CT for preoperative lymph-node staging of patients with MIBC. We present our preliminary results. Patients and Methods: Between September 2012 and February 2013, 10 patients (8 male, 2 female) with bladder cancer underwent FDG-PET/CT and a thoraco-abdominal CT scan. Four patients were found to be recurrent T1G3 at TUR-B, five T2G3 and one T2G2. Independently from the results for lymphnode status at FDG-PET/CT or at abdominal CT scan, all patients underwent radical cystectomy and lymphadenectomy. Results of FDG-PET/CT and CT for N-staging were compared to histopathology findings. Complete data are available for 8 patients. Results: Among the 8 patients, 3 patients had metastatically involved locoregional lymph nodes, diagnosed on histopathology. In all these patients, the lymph-nodes demonstrated increased FDG uptake on PET/CT; the same nodes were not considered as metastatic at abdominal CT scan. Five patients had lymph-nodes with a normal FDG uptake on PET/CT: these nodes were found nonmetastatic at histopathology. Only 1 patient had nodes suspected for metastases at CT scan but not at FDGPET/CT: these lymph- nodes were found nonmetastatic at histopathology. The accordance between histopathology and FDG-PET/CT findings was 100%. Discussion and Conclusion: Our preliminary data show that FDG-PET/CT may provide better accuracy in N-staging of bladder cancer; our study is still ongoing because a larger sample (at least 50-75 patients) is needed. According to our results and to data in the Literature, larger prospective studies are needed to elucidate the effective role of FDG-PET/CT in N-staging of bladder cancer.

Investigating the role of FDG-PET/CT for preoperative lymph-node staging of bladder cancer: our preliminary experience

BUFFARDI, Andrea;PARENTE, Antonella;DESTEFANIS, Paolo Giuseppe;BOSIO, Andrea;DALMASSO, Ettore;GONTERO, Paolo;BISI, Gianni;FREA, Bruno
2013

Abstract

Introduction: In patients with nonmetastatic invasive bladder cancer (T2 or higher, M0) or recurrent high-risk non-muscle invasive disease (T1G3 with or without Tis, M0), locoregional lymph node metastasis is an important prognostic factor. The standard imaging modalities for staging (computed tomography [CT] or magnetic resonance imaging [MRI]) have an accuracy range of 70-90% for lymph-node staging. Fluorine-18 2-fluoro-2-deoxy-D-glucose positron emission tomography/computed tomography (FDG-PET/CT) has been approved for imaging in many malignancies but not for bladder cancer. This study investigated the value of FDG- PET/CT for preoperative lymph-node staging of patients with MIBC. We present our preliminary results. Patients and Methods: Between September 2012 and February 2013, 10 patients (8 male, 2 female) with bladder cancer underwent FDG-PET/CT and a thoraco-abdominal CT scan. Four patients were found to be recurrent T1G3 at TUR-B, five T2G3 and one T2G2. Independently from the results for lymphnode status at FDG-PET/CT or at abdominal CT scan, all patients underwent radical cystectomy and lymphadenectomy. Results of FDG-PET/CT and CT for N-staging were compared to histopathology findings. Complete data are available for 8 patients. Results: Among the 8 patients, 3 patients had metastatically involved locoregional lymph nodes, diagnosed on histopathology. In all these patients, the lymph-nodes demonstrated increased FDG uptake on PET/CT; the same nodes were not considered as metastatic at abdominal CT scan. Five patients had lymph-nodes with a normal FDG uptake on PET/CT: these nodes were found nonmetastatic at histopathology. Only 1 patient had nodes suspected for metastases at CT scan but not at FDGPET/CT: these lymph- nodes were found nonmetastatic at histopathology. The accordance between histopathology and FDG-PET/CT findings was 100%. Discussion and Conclusion: Our preliminary data show that FDG-PET/CT may provide better accuracy in N-staging of bladder cancer; our study is still ongoing because a larger sample (at least 50-75 patients) is needed. According to our results and to data in the Literature, larger prospective studies are needed to elucidate the effective role of FDG-PET/CT in N-staging of bladder cancer.
Congresso Società Italiana di Urologia Oncologica SIURO
Firenze
9-11 giugno 2013
33
2290
2291
FDG-PET/CT; bladder cancer
Andrea Buffardi; Antonella Parente; Paolo Destefanis; Marilena Bellò; Andrea Bosio; Ettore Dalmasso; Eugenio Alessandria; Paolo Gontero; Gianni Bisi; Bruno Frea
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/2318/154952
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