ObjectiveTo 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).Materials and MethodsThis 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.ResultsAt 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.ConclusionsIn 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.

中文翻译：

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使用 18F-氟-2-脱氧-d-葡萄糖 (18F-FDG) PET/CT 在膀胱癌患者根治性膀胱切除术前进行淋巴结评估

目的评估 18F-氟-2-脱氧-d‐葡萄糖 (18F-FDG) 正电子发射断层扫描 (PET)/计算机断层扫描 (CT) 在膀胱癌 (BCa) 根治性膀胱切除术 (RC) 和盆腔淋巴结清扫术 (PLND) 之前的淋巴结分期。材料和方法此分析基于2015 年至 2022 年间接受 RC 和双侧 PLND 的 199 名 BCa 患者组成的队列。在肿瘤学评估后进行新辅助化疗 (NAC) 或免疫治疗 (NAI)。所有患者术前均接受 18F-FDG PET/CT 以评估膀胱外疾病。计算了传统成像和 PET/CT 的真阴性、假阴性、假阳性、真阳性、敏感性、特异性、阳性预测值 (PPV)、阴性预测值 (NPV) 和准确性的点估计。对接受新辅助治疗的患者进行亚组分析。结果术前评估时，30例患者（15.1%）在18F-FDG PET/CT上有48个可疑淋巴结点。在 RC 和双侧 PLND 中，总共切除了 4871 个淋巴结 (LN)，其中 237 个淋巴结转移对应于 126 个不同区域。术前 18F-FDG PET/CT 可疑患者和阴性患者分别有 17/30 (57%) 和 39/169 (23%) 患者发现病理性淋巴结转移（敏感性 = 0.30，特异性 = 0.91，PPV = 0.57，NPV = 0.77，准确度 = 0.74）。在包括 1367 个淋巴结区域的按区域分析中，PET/CT 中可疑区域和阴性区域分别发现 LN 受累，分别为 19/48 (39%) 和 105/1319 (8%)（敏感性 = 0.15，特异性 = 0.98，PPV = 0.40，NPV = 0.92，ACC = 0.90）。接受 NAC 治疗的患者也观察到了类似的结果（n= 44, 32.1%) 和 NAI (n= 93, 67.9% [每位患者：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，ACC = 0.91]）。研究的局限性包括其回顾性设计和有限的患者数量。 结论 在术前 18F-FDG PET/CT 阴性的 10 名患者中，有 8 名患者在最终病理学中确诊为 pN0 疾病。 NAC 与 NAI 治疗没有发现差异。这些发现表明 18F-FDG PET/CT 可以在 BCa 患者淋巴结转移的术前评估中发挥作用，尽管其成本效益尚不确定。