Pd38-03 Detection of Lymph Node Involvement Before Radical Cystectomy: Diagnostic Performance of 18f-FDG Pet/Ct and Implications in the Therapeutic Management

You have accessJournal of UrologyBladder Cancer: Invasive IV (PD38)1 May 2024PD38-03 DETECTION OF LYMPH NODE INVOLVEMENT BEFORE RADICAL CYSTECTOMY: DIAGNOSTIC PERFORMANCE OF 18F-FDG PET/CT AND IMPLICATIONS IN THE THERAPEUTIC MANAGEMENT Mattia Longoni, Pietro Scilipoti, Chiara Re, Luigi Nocera, Giuseppe Basile, Mario De Angelis, Quarta Leonardo, Giusy Burgio, Andrea Necchi, Daniele Raggi, Roberta Lucianò, Renzo Colombo, Andrea Salonia, Alberto Briganti, Francesco Montorsi, and Marco Moschini Mattia LongoniMattia Longoni , Pietro ScilipotiPietro Scilipoti , Chiara ReChiara Re , Luigi NoceraLuigi Nocera , Giuseppe BasileGiuseppe Basile , Mario De AngelisMario De Angelis , Quarta LeonardoQuarta Leonardo , Giusy BurgioGiusy Burgio , Andrea NecchiAndrea Necchi , Daniele RaggiDaniele Raggi , Roberta LucianòRoberta Lucianò , Renzo ColomboRenzo Colombo , Andrea SaloniaAndrea Salonia , Alberto BrigantiAlberto Briganti , Francesco MontorsiFrancesco Montorsi , and Marco MoschiniMarco Moschini View All Author Informationhttps://doi.org/10.1097/01.JU.0001009424.64728.0c.03AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Nearly 25% of muscle-invasive bladder cancer (MIBC) patients without nodal involvement at conventional imaging are found to have lymph node involvement (LNI) at radical cystectomy (RC) specimen. This proportion may also be affected by the use of neoadjuvant treatments. We hypothesized that 18F-FDG PET/CT may improve staging performance and therefore help clinicians tailor patient treatment. METHODS: We relied on a cohort of 199 bladder cancer (BCa) patients undergoing RC and bilateral pelvic lymph node dissection (PLND) from 2015 to 2022. Neoadjuvant chemotherapy (NAC, n=44) or immunotherapy (NAI, n=93) was administered upon oncological evaluation (n=137,68.8%) Subsequently, pre-operative 18F-FDG PET/CT assessing pelvic LNI was performed in all patients (in the neoadjuvant group and compared to pathological findings on patient-based and region-based analyses. Point estimates for true negative, false negative, false positive, true positive, sensitivity (Se), specificity (Sp), positive predictive value (PPV), negative predictive value (NPV), and accuracy (Acc) of PET/CT were calculated. Subgroup analysis stratified according to the type of neoadjuvant treatment was performed. RESULTS: Overall, 18F-FDG PET/CT found 30 nodal positive patients (15.1%), totalling 48 positive nodal spots. At final pathological examination, a total of 4871 LNs were removed of which 237 (corresponding to 126 regions) were reported as positive. LNI was confirmed in 17/30 positive patients and 39/169 negative patients at PET/CT (Se=0.30, Sp=0.91, PPV=0.57, NPV=0.77, Acc=0.74). At per-region analysis (including 1367 nodal regions), LNI was found in 19/48 positive regions and 105/1319 negative regions at PET/CT (Se=0.15, Sp=0.98, PPV=0.40, NPV=0.92, ACC=0.90). Similar results were found in neoadjuvant subgroup (per-patient: Se=0.36, Sp=0.91, PPV=0.59, NPV=0.80, Acc=0.77; per-region: Se=0.12, Sp=0.98, PPV=0.32, NPV=0.93, ACC=0.91). CONCLUSIONS: In 8 out of 10 patients with negative pre-operative 18F-FDG PET/CT, pN0 disease was confirmed at final pathology. No differences were found considering patients treated with NAC or NAI. These findings suggest that 18F-FDG PET/CT could have a role in the correct evaluation of node metastases in BCa patients. Download PPT Source of Funding: None © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e807 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Mattia Longoni More articles by this author Pietro Scilipoti More articles by this author Chiara Re More articles by this author Luigi Nocera More articles by this author Giuseppe Basile More articles by this author Mario De Angelis More articles by this author Quarta Leonardo More articles by this author Giusy Burgio More articles by this author Andrea Necchi More articles by this author Daniele Raggi More articles by this author Roberta Lucianò More articles by this author Renzo Colombo More articles by this author Andrea Salonia More articles by this author Alberto Briganti More articles by this author Francesco Montorsi More articles by this author Marco Moschini More articles by this author Expand All Advertisement PDF downloadLoading ...