Abstract：
OBJECTIVE: To assess the diagnostic performance of 18F-fluoro-2-deoxy-d-glucose (18F-FDG) positron emission tomograpy (PET)/computed tomography (CT) in nodal staging before radical cystectomy (RC) and pelvic lymph node dissection (PLND) for bladder cancer (BCa).
METHODS: This analysis was based on a cohort of 199 BCa patients undergoing RC and bilateral PLND between 2015 and 2022. Neoadjuvant chemotherapy (NAC) or immunotherapy (NAI) was administered after oncological evaluation. All patients received preoperative 18F-FDG PET/CT to assess extravesical disease. Point estimates for true negative, false negative, false positive, true positive, sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of conventional imaging and PET/CT were calculated. Subgroup analysis in patients receiving neoadjuvant treatment was performed.
RESULTS: At preoperative evaluation, 30 patients (15.1%) had 48 suspicious nodal spots on 18F-FDG PET/CT. At RC and bilateral PLND, a total of 4871 lymph nodes (LNs) were removed with 237 node metastases corresponding to 126 different regions. Pathological node metastases were found in 17/30 (57%) vs 39/169 patients (23%) with suspicious vs negative preoperative 18F-FDG PET/CT, respectively (sensitivity = 0.30, specificity = 0.91, PPV = 0.57, NPV = 0.77, accuracy = 0.74). On per-region analysis including 1367 nodal regions, LN involvement was found in 19/48 (39%) vs 105/1319 (8%) suspicious vs negative regions at PET/CT, respectively (sensitivity = 0.15, specificity = 0.98, PPV = 0.40, NPV = 0.92, ACC = 0.90). Similar results were observed for patients receiving NAC (n = 44, 32.1%) and NAI (n = 93, 67.9% [per-patient: sensitivity = 0.36, specificity = 0.91, PPV = 0.59, NPV = 0.80, accuracy = 0.77; per-region: sensitivity = 0.12, specificity = 0.98, PPV = 0.32, NPV = 0.93, ACC = 0.91]). Study limitations include its retrospective design and limited patient numbers.
CONCLUSIONS: In eight out of 10 patients with negative preoperative 18F-FDG PET/CT, pN0 disease was confirmed at final pathology. No differences were found based on NAC vs NAI treatment. These findings suggest that 18F-FDG PET/CT could play a role in the preoperative evaluation of nodal metastases in BCa patients, although its cost-effectiveness is uncertain.
METHODS: This analysis was based on a cohort of 199 BCa patients undergoing RC and bilateral PLND between 2015 and 2022. Neoadjuvant chemotherapy (NAC) or immunotherapy (NAI) was administered after oncological evaluation. All patients received preoperative 18F-FDG PET/CT to assess extravesical disease. Point estimates for true negative, false negative, false positive, true positive, sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of conventional imaging and PET/CT were calculated. Subgroup analysis in patients receiving neoadjuvant treatment was performed.
RESULTS: At preoperative evaluation, 30 patients (15.1%) had 48 suspicious nodal spots on 18F-FDG PET/CT. At RC and bilateral PLND, a total of 4871 lymph nodes (LNs) were removed with 237 node metastases corresponding to 126 different regions. Pathological node metastases were found in 17/30 (57%) vs 39/169 patients (23%) with suspicious vs negative preoperative 18F-FDG PET/CT, respectively (sensitivity = 0.30, specificity = 0.91, PPV = 0.57, NPV = 0.77, accuracy = 0.74). On per-region analysis including 1367 nodal regions, LN involvement was found in 19/48 (39%) vs 105/1319 (8%) suspicious vs negative regions at PET/CT, respectively (sensitivity = 0.15, specificity = 0.98, PPV = 0.40, NPV = 0.92, ACC = 0.90). Similar results were observed for patients receiving NAC (n = 44, 32.1%) and NAI (n = 93, 67.9% [per-patient: sensitivity = 0.36, specificity = 0.91, PPV = 0.59, NPV = 0.80, accuracy = 0.77; per-region: sensitivity = 0.12, specificity = 0.98, PPV = 0.32, NPV = 0.93, ACC = 0.91]). Study limitations include its retrospective design and limited patient numbers.
CONCLUSIONS: In eight out of 10 patients with negative preoperative 18F-FDG PET/CT, pN0 disease was confirmed at final pathology. No differences were found based on NAC vs NAI treatment. These findings suggest that 18F-FDG PET/CT could play a role in the preoperative evaluation of nodal metastases in BCa patients, although its cost-effectiveness is uncertain.
摘要：
目的：评估18F-2-脱氧-d-葡萄糖（18F-FDG）正电子发射断层显像（PET）/计算机断层扫描（CT）在根治性膀胱切除术（RC）和盆腔淋巴结清扫术（PLND）前淋巴结分期中的诊断性能。
方法：该分析基于2015年至2022年期间接受RC和双侧PLND的199名BCa患者的队列。肿瘤评估后给予新辅助化疗(NAC)或免疫疗法(NAI)。所有患者术前均接受18F-FDGPET/CT检查以评估血管外疾病。真负的点估计，假阴性,假阳性,真积极，灵敏度,特异性，阳性预测值(PPV)，负预测值(NPV)，计算常规成像和PET/CT的准确性。对接受新辅助治疗的患者进行亚组分析。
结果：术前评估，30例患者（15.1%）在18F-FDGPET/CT上有48个可疑淋巴结点。在RC和双边PLND，总共切除了4871个淋巴结(LN),对应126个不同区域的237个淋巴结转移.病理淋巴结转移在17/30（57％）和39/169（23％）患者中发现，术前可疑与阴性的18F-FDGPET/CT，分别（敏感性=0.30，特异性=0.91，PPV=0.57，NPV=0.77，准确性=0.74）。在包括1367个节点区域在内的每个区域的分析中，在PET/CT中发现LN受累于19/48（39％）和105/1319（8％）可疑和阴性区域，（敏感性=0.15，特异性=0.98，PPV=0.40，NPV=0.92，ACC=0.90）。对于接受NAC（n=44，32.1％）和NAI（n=93，67.9％[每个患者：敏感性=0.36，特异性=0.91，PPV=0.59，NPV=0.80，准确性=0.77；每个区域：敏感性=0.12，特异性=0.98，PPV=0.32，NPV=0.93，=0.91]ACC）的患者也观察到类似的结果。研究的局限性包括其回顾性设计和患者数量有限。
结论：在10例术前18F-FDGPET/CT阴性的患者中，有8例，pN0疾病在最终病理证实。基于NAC与NAI治疗没有发现差异。这些结果表明，18F-FDGPET/CT可在BCa患者的淋巴结转移的术前评估中发挥作用。尽管它的成本效益是不确定的。
方法：该分析基于2015年至2022年期间接受RC和双侧PLND的199名BCa患者的队列。肿瘤评估后给予新辅助化疗(NAC)或免疫疗法(NAI)。所有患者术前均接受18F-FDGPET/CT检查以评估血管外疾病。真负的点估计，假阴性,假阳性,真积极，灵敏度,特异性，阳性预测值(PPV)，负预测值(NPV)，计算常规成像和PET/CT的准确性。对接受新辅助治疗的患者进行亚组分析。
结果：术前评估，30例患者（15.1%）在18F-FDGPET/CT上有48个可疑淋巴结点。在RC和双边PLND，总共切除了4871个淋巴结(LN),对应126个不同区域的237个淋巴结转移.病理淋巴结转移在17/30（57％）和39/169（23％）患者中发现，术前可疑与阴性的18F-FDGPET/CT，分别（敏感性=0.30，特异性=0.91，PPV=0.57，NPV=0.77，准确性=0.74）。在包括1367个节点区域在内的每个区域的分析中，在PET/CT中发现LN受累于19/48（39％）和105/1319（8％）可疑和阴性区域，（敏感性=0.15，特异性=0.98，PPV=0.40，NPV=0.92，ACC=0.90）。对于接受NAC（n=44，32.1％）和NAI（n=93，67.9％[每个患者：敏感性=0.36，特异性=0.91，PPV=0.59，NPV=0.80，准确性=0.77；每个区域：敏感性=0.12，特异性=0.98，PPV=0.32，NPV=0.93，=0.91]ACC）的患者也观察到类似的结果。研究的局限性包括其回顾性设计和患者数量有限。
结论：在10例术前18F-FDGPET/CT阴性的患者中，有8例，pN0疾病在最终病理证实。基于NAC与NAI治疗没有发现差异。这些结果表明，18F-FDGPET/CT可在BCa患者的淋巴结转移的术前评估中发挥作用。尽管它的成本效益是不确定的。
