比较氟脱氧葡萄糖正电子发射断层扫描与计算机断层扫描在尿路/膀胱癌结节和远处转移分期中的作用

IF 1.6 Q3 UROLOGY & NEPHROLOGY BJUI compass Pub Date : 2024-02-20 DOI:10.1002/bco2.304

Mohammed Al-Zubaidi, Katherine Ong, Pravin Viswambaram, Haider Bangash, Glenn Boardman, Steve P. McCombie, Oliver Oey, Nicole Swarbrick, Andrew Redfern, Jeremy Ong, Richard Gauci, Ronny Low, Dickon Hayne

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引用次数: 0

摘要

我们旨在评估与计算机断层扫描（CT）相比，18F-氟脱氧葡萄糖正电子（18F-FDG-PET）扫描在检测尿路上皮癌或膀胱癌患者结节和远处转移方面的临床价值，目的是提高分期的准确性，从而更好地预后和确定治疗方法。该研究对 2015 年至 2020 年期间 75 例浸润性膀胱癌（≥T1）患者进行了回顾性研究，这些患者在 8 周间隔内同时接受了 CT 和 18F-FDG-PET 的分期。72%（54/75）的患者进行了正式的盆腔淋巴结 (LN) 清除术或可疑转移病灶活检。FDG-PET 对阳性部位的定义根据 SUV Max 进行评估（任何大小的淋巴结 SUVmax >4，淋巴结 >8 mm 的 SUV > 2，或轴向图像上淋巴结 >10 mm 的任何 SUV）。就 CT 扫描而言，根据 RECIST 1.1 标准（>10 毫米），淋巴结肿大以及定性结果显示转移均被视为阳性。CT 与 FDG-PET 检测转移的灵敏度、特异性、阳性预测值（PPV）和阴性预测值（NPV）分别为 46.6%（95% CI：10.0%）和 46.6%（95% CI：10.0%）。6%（95% CI：21%-70%）对 60%（95% CI：32%-84%）、100%（95% CI：91%-100%）对 83.78%（95% CI：69%-94%）、100%（95% CI：63%-100%）对 60%（95% CI：32%-84%）和 82.2%（95% CI：68%-92%）对 83.78%（95% CI：69%-94%）。在膀胱癌分期中，FDG-PET对转移灶的敏感性可能高于CT，这使得有隐匿性转移的病例显著避免了积极的局部治疗。

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Comparing fluorodeoxyglucose positron emission tomography with computed tomography in staging for nodal and distant metastasis in urothelial/bladder cancer

Objectives

We aim to assess the clinical value of ¹⁸F-fluorodeoxyglucose positron (¹⁸F-FDG-PET) scan in detecting nodal and distant metastasis compared with computed tomography (CT) scan in patients with urothelial carcinoma or bladder cancer, aiming to improve staging accuracy and thereby better prognosticate and determine therapy.

Methods

A retrospective review of 75 patients with invasive bladder cancer (≥T1) who were staged with both CT and ¹⁸F-FDG-PET within an 8-week interval was performed for the period between 2015 and 2020. Seventy-two per cent (54/75) had formal pelvic lymph node (LN) dissection or biopsy of lesions suspicious for metastases. FDG-PET definitions for positive sites were assessed depending on SUV Max (nodes with SUVmax >4 at any size, SUV > 2 for lymph nodes >8 mm, or any SUV if the lymph node was >10 mm on axial images). For CT scanning, enlarged LN by RECIST 1.1 criteria (>10 mm) as well as qualitative findings suggesting metastasis were considered positive. The analysis was based on the comparison of CT and ¹⁸F-FDG-PET findings to histopathology results from LN dissection or biopsies.

Results

Sensitivity, specificity, positive predictive values (PPV) and negative predictive value (NPV) of CT versus FDG-PET for detecting metastasis, in patients who underwent pelvic LN dissection or biopsy of lesions suspicious of metastases, were 46.6% (95% CI: 21%–70%) versus 60% (95% CI: 32%–84%), 100% (95% CI: 91%–100%) versus 83.78% (95% CI: 69%–94%), 100% (95% CI: 63%–100%) versus 60% (95% CI: 32%–84%), and 82.2% (95% CI: 68%–92%) versus 83.78% (95% CI: 69%–94%), respectively. 7/75 (9.3%) patients avoided cystectomy due to ¹⁸F-FDG-PET features of metastases that were not detected by CT.

Conclusion

FDG-PET may be more sensitive than CT for metastases in the staging of bladder cancer, which resulted in significant avoidance of aggressive local management in cases with occult metastasis.

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