What is it about?

The study aimed to assess the clinical value of 18 F-FDG-PET scan in detecting nodal and distant metastasis compared with computed tomography (CT) scan in patients with urothelial carcinoma or bladder cancer, to improve staging accuracy and better prognosticate and determine therapy. 75 patients with invasive bladder cancer were staged with both CT and 18 F-FDG-PET within an 8-week interval. 54 patients (72%) had formal pelvic lymph node (LN) dissection or biopsy of lesions suspicious for metastases. Sensitivity, specificity, PPV, and 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 18 F-FDG-PET features of metastases that were not detected by CT. The study concludes that FDG-PET improves the detection of metastases and may help in determining the appropriate therapy for patients with urothelial carcinoma or bladder cancer.

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Why is it important?

This research is important because it aims to improve the accuracy of staging in patients with urothelial carcinoma or bladder cancer. Accurate staging is vital in defining the most appropriate treatment option for patients with muscle-invasive bladder cancer. Radical local treatments, such as radical cystectomy, can be highly effective in treating organ-confined disease, but they are ineffective treatments with a high rate of unnecessary complications if utilized in the presence of metastatic disease. By comparing the clinical value of 18 F-fluorodeoxyglucose positron (18 F-FDG-PET) scan with computed tomography (CT) scan in detecting nodal and distant metastasis, the study provides valuable insights into improving staging accuracy and better prognosticate and determine therapy. Key Takeaways: 1. 18 F-FDG-PET scan outperformed CT scan in detecting nodal and distant metastasis in patients with urothelial carcinoma or bladder cancer. 2. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of CT versus 18 F-FDG-PET for detecting metastasis were compared in patients who underwent pelvic lymph node dissection or biopsy of lesions suspicious of metastases. 18 F-FDG-PET showed better results in terms of sensitivity and overall accuracy. 3. 18 F-FDG-PET can help avoid unnecessary cystectomy in some patients. Seven out of 75 patients (9.3%) avoided cystectomy due to 18 F-FDG-PET features of metastases that were not detected by CT. 4. This study emphasizes the importance of using 18 F-FDG-PET in addition to CT for accurate staging of muscle-invasive bladder cancer. 5. The findings of this study can contribute to better treatment planning, targeting involved nodes with lymph node dissection or radiotherapy, and potentially improving patient outcomes.

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This page is a summary of: Comparing fluorodeoxyglucose positron emission tomography with computed tomography in staging for nodal and distant metastasis in urothelial/bladder cancer, BJUI Compass, February 2024, Wiley,
DOI: 10.1002/bco2.304.
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