Impact of 18F‐fluorodeoxyglucose (FDG)‐positron‐emission tomography/computed tomography (PET/CT) on management of patients with carcinoma invading bladder muscle. (24th June 2013)

• Record Type: Journal Article
• Authors: Mertens, Laura S.; Fioole‐Bruining, Annemarie; Vegt, Erik; Vogel, Wouter V.; van, Bas W.; Horenblas, Simon
• Is Part Of: BJU international. Volume 112:Number 6(2013:Sep.)
• Page Start: 729
• Page End: 734
• Publication Date: 2013-06-24
• Subjects: Genitourinary organs -- Diseases -- Periodicals; Genitourinary organs -- Surgery -- Periodicals; Urology -- Periodicals; 616.6
• DOI: 10.1111/bju.12109
• Languages: English
• ISSNs: 1464-4096

Abstract

<abstract abstract-type="main"> <title> <x xml:space="preserve">Abstract</x> </title> <sec id="bju12109-sec-0019" sec-type="section"> <title>Objective</title> <p> <list id="bju12109-list-0001" list-type="bullet"> <list-item> <p>To evaluate the clinical impact of <sup>18</sup>F‐fluorodeoxyglucose (FDG)‐positron‐emission tomography/computed tomography (PET/CT) scanning, compared with conventional staging with contrast‐enhanced CT imaging (CECT).</p> </list-item> </list> </p> </sec> <sec id="bju12109-sec-0020" sec-type="section"> <title>Patients and Methods</title> <p> <list id="bju12109-list-0002" list-type="bullet"> <list-item> <p>The FDG‐PET/CT results of 96 consecutive patients with bladder cancer were analysed. Patients included in this study underwent standard CECT imaging of the chest and abdomen/pelvis <4 weeks before FDG‐PET/CT.</p> </list-item> <list-item> <p>Based on the original imaging reports and recorded tumour stage before and after FDG‐PET/CT imaging, the preferred treatment strategies before FDG‐PET/CT and after FDG‐PET/CT were determined for each patient using an institutional multidisciplinary guideline. One of the following treatment strategies was chosen: (i) local curative treatment; (ii) neoadjuvant/induction chemotherapy; or (iii) palliation.</p> </list-item> <list-item> <p>The changes in management decisions before and after FDG‐PET/CT were assessed.</p> </list-item> </list> </p> </sec> <sec id="bju12109-sec-0021" sec-type="section"> <title>Results</title> <p> <list id="bju12109-list-0003" list-type="bullet"> <list-item> <p>The median (range) interval between CECT and FDG‐PET/CT was 0 (029) days.</p> </list-item> <list-item> <p>In 21.9% of the patients, stage on FDG‐PET/CT and CECT were different. Upstaging by FDG‐PET/CT was more frequent than downstaging (19.8 vs 2.1%).</p> </list-item> <list-item> <p>Clinical management changed for 13.5% of patients as a result of FDG‐PET/CT upstaging. In eight patients, FDG‐PET/CT detected second primary tumours. This led to changes of bladder cancer treatment in another four of 96 patients (4.2%).</p> </list-item> <list-item> <p>All the management changes were validated by tissue confirmation of the additional lesions.</p> </list-item> </list> </p> </sec> <sec id="bju12109-sec-0022" sec-type="section"> <title>Conclusions</title> <p> <list id="bju12109-list-0004" list-type="bullet"> <list-item> <p>FDG‐PET/CT provides important additional staging information, which influences the treatment of carcinoma invading bladder muscle in almost 20% of cases.</p> </list-item> <list-item> <p>Patient selection for neoadjuvant/induction chemotherapy was improved and futile attempts at curative treatment in patients found to have metastases were avoided.</p> </list-item> </list> </p> </sec> </abstract>