ABSTRACT
BACKGROUND: The detection of lymph node metastases in bladder cancer has a major impact on treatment decisions and patients prognosis. Due to limited value of conventional imaging, the place of molecular and functional imaging needs to be precised, particularly in the neoadjuvant setting. METHODS: From June 2011 to June 2013, 102 patients with clinically localized BCa were simultaneously staged with (18)F-FDG PET/CT before RC. This study assessed the diagnostic accuracy of (18)F-FDG PET/CT for the detection of metastases in normal-sized lymph nodes using extended pelvic lymph node dissection and histopathology as the reference standard. RESULTS: A total of 1211 LNs were examined histopathologically. Sixty-seven (5.5%) metastatic nodes were found in 26/102 patients (25.5%). Lymph node density was 22%. On patient-based analysis, sensitivity, specificity, predictive positive value (PPV), negative positive value (NPV) and accuracy for (18)F-FDG PET/CT were calculated as 50%, 96.2%, 80%, 86.2% and 85.3% respectively. On a field-based analysis, sensitivity, specificity, PPV, NPV and accuracy for (18)F-FDG PET/CT were calculated as 50.0%, 99.0%, 71.9%, 97.4%, and 96.5% respectively. The majority of missed metastases were micrometastasis <5 mm in long axis diameter. CONCLUSIONS: (18)F-FDG PET/CT improves diagnostic efficacy for lymph node staging in patients staged N0 with conventional cross-sectional imaging. (18)F-FDG PET/CT could be used as a surrogate marker for detection of metastases in non-enlarged pelvic lymph nodes and enhances management strategy guiding patients selection for neoadjuvant chemotherapy.
Subject(s)
Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Cystectomy , Fluorodeoxyglucose F18 , Lymph Nodes/pathology , Neoadjuvant Therapy/methods , Positron-Emission Tomography , Tomography, X-Ray Computed , Urinary Bladder Neoplasms/diagnostic imaging , Urinary Bladder Neoplasms/surgery , Adult , Aged , Contrast Media , Cystectomy/methods , Female , Humans , Lymph Nodes/diagnostic imaging , Lymphatic Metastasis , Male , Middle Aged , Multimodal Imaging/methods , Neoplasm Staging , Positron-Emission Tomography/methods , Predictive Value of Tests , Radiopharmaceuticals , Sensitivity and Specificity , Urinary Bladder Neoplasms/drug therapy , Urinary Bladder Neoplasms/pathologySubject(s)
Battered Child Syndrome/diagnostic imaging , Bone and Bones/diagnostic imaging , Age Factors , Bone and Bones/injuries , Bony Callus/diagnostic imaging , Child , Child, Preschool , Fractures, Bone/diagnostic imaging , Humans , Infant , Predictive Value of Tests , Radionuclide Imaging , Radiopharmaceuticals , Sensitivity and SpecificityABSTRACT
During the last 4 years, we have performed 1200 renal scintigraphies in children under the age of 6 years: 57% of dynamic renal scintigraphies using MAG3 for antenatally diagnosed uropathies (mainly pelvic dilatations and megaureters), 36% of static renal scintigraphies using DMSA for renal sequelae of pyelonephritis with or without vesicoureteric reflux, and 6% of direct isotope cystography for follow-up of vesicoureteric reflux. Renal scintigraphy, which provides low radiation hazards (1 mSv), is now a major imaging modality for paediatric urinary tract disease.
