ArticleWorld journal of urology2025
Diagnostic accuracy of [18F]-FDG-PET/CT for lymph node staging in bladder cancer prior to radical cystectomy.
Article in World journal of urology, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
purposeTo evaluate the diagnostic accuracy of [18F]-FDG-PET/CT for lymph node (LN) staging prior to radical cystectomy (RC) in patients with bladder cancer, with a focus on the impact of neoadjuvant chemotherapy (NAC) on performance.
methodsWe retrospectively included all patients undergoing RC with pelvic lymph node dissection (PLND) for muscle-invasive or high-risk non-muscle invasive urothelial bladder cancer between January 2017 and April 2025 at a single tertiary centre. All patients underwent preoperative [18F]-FDG-PET/CT. Diagnostic performance was calculated using final histopathology as the reference standard. Subgroup analysis was performed based on NAC status.
resultsAmong 103 patients (median age 71 years), 45 (43.7%) received NAC. The sensitivity, specificity, positive predictive value, and negative predictive value of [18F]-FDG-PET/CT for detecting LN metastases were 57.1%, 82.7%, 55.2%, and 83.8%, respectively. The area under the receiver operating characteristic curve (AUC) was 0.70 overall. In patients who received NAC, diagnostic performance improved markedly (AUC = 0.83 vs. 0.62 without NAC, p = 0.04), with increased sensitivity (80.0%) and NPV (93.8%).
conclusion[18F]-FDG-PET/CT demonstrates moderate diagnostic accuracy for LN staging in bladder cancer, with good specificity but low sensitivity. Its diagnostic accuracy appears enhanced after NAC, indicating a potential role for [18F]-FDG-PET/CT in restaging after chemotherapy. However, more effective imaging tools are still needed to improve locoregional staging.
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