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Purpose <p>To 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.</p> Methods <p>We 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.</p> Results <p>Among 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, <i>p</i> = 0.04), with increased sensitivity (80.0%) and NPV (93.8%).</p> Conclusion <p>[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.</p>

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Diagnostic accuracy of [18F]-FDG-PET/CT for lymph node staging in bladder cancer prior to radical cystectomy

  • 期刊论文

  • 发表日期：

    2025年12月23日

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  • Oscar Gouhizoun,
  • Maxime Pattou,
  • Fabienne Guéna,
  • Abderrahmane Khaddad,
  • Samy Mebroukine,
  • Gaëlle Margue,
  • Marine Gross-Goupil,
  • Felix Lefort,
  • Clément Morgat,
  • Jean Christophe Bernhard,
  • Franck Bladou,
  • Grégoire Robert,
  • Clément Klein

摘要

Purpose

To 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.

Methods

We 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.

Results

Among 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.