[(18)F]Fluorodeoxyglucose - positron emission tomography/computed tomography improves staging in patients with high-risk muscle-invasive bladder cancer scheduled for radical cystectomy

• Published in: Scandinavian journal of urology Vol. 49; no. 4; p. 296
• Main Authors: Kollberg, Petter, Almquist, Helen, Bläckberg, Mats, Cronberg, Carin, Garpered, Sabine, Gudjonsson, Sigurdur, Kleist, Jakob, Lyttkens, Kerstin, Patschan, Oliver, Liedberg, Fredrik
• Format: Journal Article
• Language: English
• Published: England 2015
• Subjects: Adult; Aged; Aged, 80 and over; Carcinoma, Transitional Cell - diagnostic imaging; Carcinoma, Transitional Cell - surgery; Cohort Studies; Cystectomy; Female; Fluorodeoxyglucose F18; Humans; Male; Middle Aged; Multimodal Imaging; Muscle, Smooth - diagnostic imaging; Muscle, Smooth - pathology; Neoplasm Metastasis - diagnosis; Neoplasm Staging; Positron-Emission Tomography; Prospective Studies; Radiopharmaceuticals; Tomography, X-Ray Computed; Urinary Bladder Neoplasms - diagnostic imaging; Urinary Bladder Neoplasms - surgery; computed tomography; radical cystectomy; positron emission tomography; Bladder cancer
• ISSN: 2168-1813
• DOI: 10.3109/21681805.2014.990053

The aim of this study was to evaluate the clinical use of [(18)F]fluorodeoxyglucose-positron emission tomography/computed tomography (FDG-PET/CT) in addition to conventional preoperative radiological investigations in a defined group of patients with high-risk muscle-invasive bladder cancer.
In total, 103 patients with high-risk muscle-invasive bladder cancer defined as stage T3/T4 disease or as stage T2 with hydronephrosis or high-risk histological features, who were provisionally scheduled to undergo cystectomy, were prospectively recruited to the study. The patients were referred to FDG-PET/CT in addition to standard preoperative investigation with computed tomography (CT). The final treatment decision was reached at a multidisciplinary conference based on all available information including the FDG-PET/CT findings.
Compared to CT alone, FDG-PET/CT provided more supplemental findings suggesting malignant manifestations in 48 (47%) of the 103 patients. The additional FDG-PET/CT findings led to an altered provisional treatment plan in 28 out of 103 patients (27%), detection of disseminated bladder cancer and subsequent cancellation of the initially intended cystectomy in 16 patients, and identification of disseminated disease and treatment with induction chemotherapy before radical cystectomy in 12 patients.
Preoperative FDG-PET/CT changed the treatment plan for a considerable proportion (27%) of the present patients. Accordingly, such examination can potentially improve the preoperative staging of cystectomy patients with high-risk features, and may also reduce the number of futile operations in patients with advanced disease who are beyond cure.