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

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.

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

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.

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.

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.

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.

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.

European urology oncology. 2019 Oct 04 [Epub ahead of print]

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

Department of Urology, Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands., Department of Urology, Aarhus University Hospital, Aarhus, Denmark., Department of Urology, UZ Leuven, Leuven, Belgium., Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy., Department of Genitourinary Oncology, Moffitt Cancer Center, Tampa, FL, USA., Division of Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Vita-Salute San Raffaele University, Milan, Italy., Department of Nuclear Medicine, UZ Leuven, Leuven, Belgium; Department of Imaging and Pathology, KU Leuven, Leuven, Belgium., Department of Nuclear Medicine and PET-Centre, Aarhus University Hospital, Aarhus, Denmark., Department of Biometrics, Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands., Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Institute for Urology and Reproductive Health, I.M. Sechenov First Moscow State Medical University, Moscow, Russia., Department of Urology, Bichat-Claude Bernard Hospital, Paris, France., Department of Urology, Zealand University Hospital, Roskilde, Denmark., Department of Urology, Seoul National University Hospital, Seoul, South Korea., Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria., Department of Nuclear Medicine, Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands., Department of Urology, Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands. Electronic address: .