Diagnostic Value of 18F-fluorodeoxyglucose Positron Emission Tomography with Computed Tomography for Lymph Node Staging in Patients with Upper Tract Urothelial Carcinoma

Charlotte S Voskuilen; Donald Schweitzer; Jørgen Bjerggaard Jensen; Anna M Nielsen; Steven Joniau; Tim Muilwijk; Andrea Necchi; Mounsif Azizi; Philippe E Spiess; Alberto Briganti; Marco Bandini; Karolien Goffin; Kirsten Bouchelouche; Erik van Werkhoven; Shahrokh F Shariat; Evanguelos Xylinas; Nessn H Azawi; Ja Hyeon Ku; Beat Foerster; Bas W G van Rhijn; Erik Vegt; Kees Hendricksen

doi:10.1016/j.euo.2019.09.004

Diagnostic Value of 18F-fluorodeoxyglucose Positron Emission Tomography with Computed Tomography for Lymph Node Staging in Patients with Upper Tract Urothelial Carcinoma

Charlotte S Voskuilen
, Donald Schweitzer
, Jørgen Bjerggaard Jensen
, Anna M Nielsen
, Steven Joniau
, Tim Muilwijk
, Andrea Necchi
, Mounsif Azizi
, Philippe E Spiess
, Alberto Briganti
, Marco Bandini
, Karolien Goffin
, Kirsten Bouchelouche
, Erik van Werkhoven
, Shahrokh F Shariat
, Evanguelos Xylinas
, Nessn H Azawi
, Ja Hyeon Ku
, Beat Foerster
, Bas W G van Rhijn

Erik Vegt, Kees Hendricksen

Urology

Research output: Contribution to journal › Article › Research › peer-review

Abstract

BACKGROUND: Presence of lymph node metastases (LNM) is an important prognostic factor for cancer-specific survival (CSS) in patients with upper tract urothelial carcinoma (UTUC). In various neoplasms, 18F-fluorodeoxyglucose positron emission tomography with computed tomography (FDG-PET/CT) is an established modality for preoperative lymph node (LN) staging. In UTUC, the diagnostic value of FDG-PET/CT for LN staging is unknown.

OBJECTIVE: To determine the diagnostic value of FDG-PET/CT for LN staging in patients with UTUC.

DESIGN, SETTING, AND PARTICIPANTS: Data of 152 patients with UTUC who underwent FDG-PET/CT followed by surgical treatment in eight centers between 2007 and 2017 were retrospectively collected. Patients receiving neoadjuvant chemotherapy were excluded.

OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: FDG-PET/CT results were compared with histopathology after lymph node dissection (LND). Recurrence-free survival (RFS), CSS, and overall survival (OS) were analyzed using Kaplan-Meier estimates, and compared for patients with and without suspicious LNs on FDG-PET/CT.

RESULTS AND LIMITATIONS: We included 117 patients, of whom 62 underwent LND. Seventeen patients had LNM at histopathological evaluation. Sensitivity and specificity of FDG-PET/CT for diagnosis of LNM were 82% (95% confidence interval [CI]: 57-96) and 84% (95% CI: 71-94), respectively. RFS was significantly worse in patients with LN-positive FDG-PET/CT than in those with LN-negative FDG-PET/CT (p=0.03). CSS (p=0.11) and OS (p=0.5) were similar between groups. This study is limited by its retrospective design and by its sample size. Our results warrant further validation.

CONCLUSIONS: FDG-PET/CT has 82% sensitivity and 84% specificity for the detection of LNM in patients with UTUC. Presence of suspicious LNs on FDG-PET/CT is associated with worse RFS.

PATIENT SUMMARY: In patients with upper tract urothelial cancer, positron emission tomography with computed tomography (PET/CT) scans can detect lymph node metastases with noteworthy accuracy. Presence of suspicious lymph nodes on 18F-fluorodeoxyglucose PET/CT is associated with worse recurrence-free survival.

Original language	English
Pages (from-to)	73-79
Number of pages	7
Journal	European urology oncology
Volume	3
Issue number	1
Early online date	2019
DOIs	https://doi.org/10.1016/j.euo.2019.09.004
Publication status	Published - 1 Feb 2020

Keywords

Diagnostic imaging
Lymph node metastasis
Fluorodeoxyglucose F18
Positron emission tomography
and computed tomography
Transitional cell carcinoma
Upper urinary tract

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10.1016/j.euo.2019.09.004

Cite this

Voskuilen, C. S., Schweitzer, D., Jensen, J. B., Nielsen, A. M., Joniau, S., Muilwijk, T., Necchi, A., Azizi, M., Spiess, P. E., Briganti, A., Bandini, M., Goffin, K., Bouchelouche, K., van Werkhoven, E., Shariat, S. F., Xylinas, E., Azawi, N. H., Ku, J. H., Foerster, B., ... Hendricksen, K. (2020). Diagnostic Value of 18F-fluorodeoxyglucose Positron Emission Tomography with Computed Tomography for Lymph Node Staging in Patients with Upper Tract Urothelial Carcinoma. European urology oncology, 3(1), 73-79. https://doi.org/10.1016/j.euo.2019.09.004

@article{18f74fe3112e4686ab79432c9e67a1c4,

title = "Diagnostic Value of 18F-fluorodeoxyglucose Positron Emission Tomography with Computed Tomography for Lymph Node Staging in Patients with Upper Tract Urothelial Carcinoma",

abstract = "BACKGROUND: Presence of lymph node metastases (LNM) is an important prognostic factor for cancer-specific survival (CSS) in patients with upper tract urothelial carcinoma (UTUC). In various neoplasms, 18F-fluorodeoxyglucose positron emission tomography with computed tomography (FDG-PET/CT) is an established modality for preoperative lymph node (LN) staging. In UTUC, the diagnostic value of FDG-PET/CT for LN staging is unknown.OBJECTIVE: To determine the diagnostic value of FDG-PET/CT for LN staging in patients with UTUC.DESIGN, SETTING, AND PARTICIPANTS: Data of 152 patients with UTUC who underwent FDG-PET/CT followed by surgical treatment in eight centers between 2007 and 2017 were retrospectively collected. Patients receiving neoadjuvant chemotherapy were excluded.OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: FDG-PET/CT results were compared with histopathology after lymph node dissection (LND). Recurrence-free survival (RFS), CSS, and overall survival (OS) were analyzed using Kaplan-Meier estimates, and compared for patients with and without suspicious LNs on FDG-PET/CT.RESULTS AND LIMITATIONS: We included 117 patients, of whom 62 underwent LND. Seventeen patients had LNM at histopathological evaluation. Sensitivity and specificity of FDG-PET/CT for diagnosis of LNM were 82\% (95\% confidence interval [CI]: 57-96) and 84\% (95\% CI: 71-94), respectively. RFS was significantly worse in patients with LN-positive FDG-PET/CT than in those with LN-negative FDG-PET/CT (p=0.03). CSS (p=0.11) and OS (p=0.5) were similar between groups. This study is limited by its retrospective design and by its sample size. Our results warrant further validation.CONCLUSIONS: FDG-PET/CT has 82\% sensitivity and 84\% specificity for the detection of LNM in patients with UTUC. Presence of suspicious LNs on FDG-PET/CT is associated with worse RFS.PATIENT SUMMARY: In patients with upper tract urothelial cancer, positron emission tomography with computed tomography (PET/CT) scans can detect lymph node metastases with noteworthy accuracy. Presence of suspicious lymph nodes on 18F-fluorodeoxyglucose PET/CT is associated with worse recurrence-free survival.",

keywords = "Diagnostic imaging, Lymph node metastasis, Fluorodeoxyglucose F18, Positron emission tomography, and computed tomography, Transitional cell carcinoma, Upper urinary tract",

author = "Voskuilen, \{Charlotte S\} and Donald Schweitzer and Jensen, \{J{\o}rgen Bjerggaard\} and Nielsen, \{Anna M\} and Steven Joniau and Tim Muilwijk and Andrea Necchi and Mounsif Azizi and Spiess, \{Philippe E\} and Alberto Briganti and Marco Bandini and Karolien Goffin and Kirsten Bouchelouche and \{van Werkhoven\}, Erik and Shariat, \{Shahrokh F\} and Evanguelos Xylinas and Azawi, \{Nessn H\} and Ku, \{Ja Hyeon\} and Beat Foerster and \{van Rhijn\}, \{Bas W G\} and Erik Vegt and Kees Hendricksen",

year = "2020",

month = feb,

day = "1",

doi = "10.1016/j.euo.2019.09.004",

language = "English",

volume = "3",

pages = "73--79",

journal = "European urology oncology",

issn = "2588-9311",

publisher = "Elsevier B.V.",

number = "1",

}

Voskuilen, CS, Schweitzer, D, Jensen, JB, Nielsen, AM, Joniau, S, Muilwijk, T, Necchi, A, Azizi, M, Spiess, PE, Briganti, A, Bandini, M, Goffin, K, Bouchelouche, K, van Werkhoven, E, Shariat, SF, Xylinas, E, Azawi, NH, Ku, JH, Foerster, B, van Rhijn, BWG, Vegt, E & Hendricksen, K 2020, 'Diagnostic Value of 18F-fluorodeoxyglucose Positron Emission Tomography with Computed Tomography for Lymph Node Staging in Patients with Upper Tract Urothelial Carcinoma', European urology oncology, vol. 3, no. 1, pp. 73-79. https://doi.org/10.1016/j.euo.2019.09.004

Diagnostic Value of 18F-fluorodeoxyglucose Positron Emission Tomography with Computed Tomography for Lymph Node Staging in Patients with Upper Tract Urothelial Carcinoma. / Voskuilen, Charlotte S; Schweitzer, Donald; Jensen, Jørgen Bjerggaard et al.
In: European urology oncology, Vol. 3, No. 1, 01.02.2020, p. 73-79.

Research output: Contribution to journal › Article › Research › peer-review

TY - JOUR

T1 - Diagnostic Value of 18F-fluorodeoxyglucose Positron Emission Tomography with Computed Tomography for Lymph Node Staging in Patients with Upper Tract Urothelial Carcinoma

AU - Voskuilen, Charlotte S

AU - Schweitzer, Donald

AU - Jensen, Jørgen Bjerggaard

AU - Nielsen, Anna M

AU - Joniau, Steven

AU - Muilwijk, Tim

AU - Necchi, Andrea

AU - Azizi, Mounsif

AU - Spiess, Philippe E

AU - Briganti, Alberto

AU - Bandini, Marco

AU - Goffin, Karolien

AU - Bouchelouche, Kirsten

AU - van Werkhoven, Erik

AU - Shariat, Shahrokh F

AU - Xylinas, Evanguelos

AU - Azawi, Nessn H

AU - Ku, Ja Hyeon

AU - Foerster, Beat

AU - van Rhijn, Bas W G

AU - Vegt, Erik

AU - Hendricksen, Kees

PY - 2020/2/1

Y1 - 2020/2/1

N2 - BACKGROUND: Presence of lymph node metastases (LNM) is an important prognostic factor for cancer-specific survival (CSS) in patients with upper tract urothelial carcinoma (UTUC). In various neoplasms, 18F-fluorodeoxyglucose positron emission tomography with computed tomography (FDG-PET/CT) is an established modality for preoperative lymph node (LN) staging. In UTUC, the diagnostic value of FDG-PET/CT for LN staging is unknown.OBJECTIVE: To determine the diagnostic value of FDG-PET/CT for LN staging in patients with UTUC.DESIGN, SETTING, AND PARTICIPANTS: Data of 152 patients with UTUC who underwent FDG-PET/CT followed by surgical treatment in eight centers between 2007 and 2017 were retrospectively collected. Patients receiving neoadjuvant chemotherapy were excluded.OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: FDG-PET/CT results were compared with histopathology after lymph node dissection (LND). Recurrence-free survival (RFS), CSS, and overall survival (OS) were analyzed using Kaplan-Meier estimates, and compared for patients with and without suspicious LNs on FDG-PET/CT.RESULTS AND LIMITATIONS: We included 117 patients, of whom 62 underwent LND. Seventeen patients had LNM at histopathological evaluation. Sensitivity and specificity of FDG-PET/CT for diagnosis of LNM were 82% (95% confidence interval [CI]: 57-96) and 84% (95% CI: 71-94), respectively. RFS was significantly worse in patients with LN-positive FDG-PET/CT than in those with LN-negative FDG-PET/CT (p=0.03). CSS (p=0.11) and OS (p=0.5) were similar between groups. This study is limited by its retrospective design and by its sample size. Our results warrant further validation.CONCLUSIONS: FDG-PET/CT has 82% sensitivity and 84% specificity for the detection of LNM in patients with UTUC. Presence of suspicious LNs on FDG-PET/CT is associated with worse RFS.PATIENT SUMMARY: In patients with upper tract urothelial cancer, positron emission tomography with computed tomography (PET/CT) scans can detect lymph node metastases with noteworthy accuracy. Presence of suspicious lymph nodes on 18F-fluorodeoxyglucose PET/CT is associated with worse recurrence-free survival.

AB - BACKGROUND: Presence of lymph node metastases (LNM) is an important prognostic factor for cancer-specific survival (CSS) in patients with upper tract urothelial carcinoma (UTUC). In various neoplasms, 18F-fluorodeoxyglucose positron emission tomography with computed tomography (FDG-PET/CT) is an established modality for preoperative lymph node (LN) staging. In UTUC, the diagnostic value of FDG-PET/CT for LN staging is unknown.OBJECTIVE: To determine the diagnostic value of FDG-PET/CT for LN staging in patients with UTUC.DESIGN, SETTING, AND PARTICIPANTS: Data of 152 patients with UTUC who underwent FDG-PET/CT followed by surgical treatment in eight centers between 2007 and 2017 were retrospectively collected. Patients receiving neoadjuvant chemotherapy were excluded.OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: FDG-PET/CT results were compared with histopathology after lymph node dissection (LND). Recurrence-free survival (RFS), CSS, and overall survival (OS) were analyzed using Kaplan-Meier estimates, and compared for patients with and without suspicious LNs on FDG-PET/CT.RESULTS AND LIMITATIONS: We included 117 patients, of whom 62 underwent LND. Seventeen patients had LNM at histopathological evaluation. Sensitivity and specificity of FDG-PET/CT for diagnosis of LNM were 82% (95% confidence interval [CI]: 57-96) and 84% (95% CI: 71-94), respectively. RFS was significantly worse in patients with LN-positive FDG-PET/CT than in those with LN-negative FDG-PET/CT (p=0.03). CSS (p=0.11) and OS (p=0.5) were similar between groups. This study is limited by its retrospective design and by its sample size. Our results warrant further validation.CONCLUSIONS: FDG-PET/CT has 82% sensitivity and 84% specificity for the detection of LNM in patients with UTUC. Presence of suspicious LNs on FDG-PET/CT is associated with worse RFS.PATIENT SUMMARY: In patients with upper tract urothelial cancer, positron emission tomography with computed tomography (PET/CT) scans can detect lymph node metastases with noteworthy accuracy. Presence of suspicious lymph nodes on 18F-fluorodeoxyglucose PET/CT is associated with worse recurrence-free survival.

KW - Diagnostic imaging

KW - Lymph node metastasis

KW - Fluorodeoxyglucose F18

KW - Positron emission tomography

KW - and computed tomography

KW - Transitional cell carcinoma

KW - Upper urinary tract

U2 - 10.1016/j.euo.2019.09.004

DO - 10.1016/j.euo.2019.09.004

M3 - Article

C2 - 31591037

SN - 2588-9311

VL - 3

SP - 73

EP - 79

JO - European urology oncology

JF - European urology oncology

IS - 1

ER -

Diagnostic Value of 18F-fluorodeoxyglucose Positron Emission Tomography with Computed Tomography for Lymph Node Staging in Patients with Upper Tract Urothelial Carcinoma

Abstract

Keywords

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