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Comparison between the diagnostic accuracies of 18F-fluorodeoxyglucose positron emission tomography/computed tomography and conventional imaging in recurrent urothelial carcinomas: a retrospective, multicenter study

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Abstract

Purpose

To determine the performance accuracy of 18F-fluorodeoxyglucose positron emission tomography/computed tomography (FDG PET/CT) after primary tumor treatment for both bladder cancer (BC) and upper tract urothelial cancer (UTUC). To compare the accuracy of FDG PET/CT with that of contrast-enhanced-ceCT and magnetic resonance imaging (MRI).

Methods

Data of patients with recurrent urothelial carcinomas (UC) after primary treatment were collected in a retrospective, international multicenter study. Inclusion criteria were (1) patients with a known history of UC in the BC and/or in the UTUC; (2) PET/CT images after curative intent treatment of the primary tumor; (3) conventional imaging modalities (abdominal ceCT or MRI, or total body ceCT, and chest X-ray: called C.I.) performed no more than 3 months from PET/CT; (4) available standard of reference (e.g., histological data or follow-up imaging modalities) for the validation of PET/CT findings. Exclusion criteria were other abdominal tumors, chemotherapy administration prior to and/or concomitant to imaging, and non-urothelial histologic variants. Sensitivities, specificities, positive, and negative predictive values were evaluated for all patients and separately for bladder and UTUC.

Results

Overall, 287 patients were enrolled. Two-hundred thirteen patients underwent cystectomy (74.2%), 35 nephroureterectomy (12.2%), 31 both cystectomy + nephroureterectomy (10.8%), 5 both cystectomy + conservative treatment for UTUC (1.4%), and 3 (1%) other types of nephron-sparing treatments for UTUC. Neoadjuvant and adjuvant treatments were performed in 36 (12.5%) and 111 (38.7%) patients, respectively. Sensitivity and specificity (95% confidence intervals) of PET/CT for the detection of recurrent UC were 94% (91% to 96%) and 79% (68% to 88%), respectively. However, sensitivity was higher for BC than UTUC (95% vs. 85%) while specificity was lower in BC (78% vs. 85% for BC and UTUC, respectively). PET/CT and C.I. findings were available in 198 patients. The results were positively concordant in 137 patients, negatively concordant in 23 patients, and discordant in 38 patients (20 negative at C.I. vs. positive at PET/CT and 18 positives at ceCT/MRI vs. negative at PET/CT) (K Cohen = 0.426; p < 0.001). Sensitivities, specificities, and accuracies (95% confidence intervals) of PET/CT vs. C.I. for the detection of recurrent BC and UTUC were 94% (90% to 97%) vs. 86% (81% to 92%), 79% (67% to 92%) vs. 59% (44% to 74%), and 91% (87% to 95%) vs. 81% (75% to 86%), respectively.

Conclusions

FDG PET/CT has a high diagnostic accuracy for the identification of recurrent UC, particularly in patients with BC. Moreover, its accuracy outperforms C.I. for both BC and UTUC.

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Acknowledgements

The authors are thankful to Dr. Marco Bartolomei (Department of Nuclear Medicine, Hospital of Ferrara, Ferrara, Italy), Dr. Francesco Massari (Department of Oncology, Sant’Orsola-Malpighi Hospital, Bologna, Italy), Prof. Eugenio Brunocilla (Department of Urology, Sant’Orsola-Malpighi Hospital, Bologna, Italy), and Prof. Filiberto Zattoni (Department of Urology, University of Padua, Padua, Italy) for their support in the execution of the study.

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Authors and Affiliations

  1. Department of Urology, Hospital of Udine, Udine, Italy

    Fabio Zattoni

  2. Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy

    Fabio Zattoni

  3. Nuclear Medicine Department, IRCCS San Raffaele Scientific Institute, Milan, Italy

    Elena Incerti, Maria Picchio & Federico Fallanca

  4. Department of Urology, Mayo Clinic, Rochester, MN, USA

    Michele Colicchia & Jeffrey R. Karnes

  5. Department of Nuclear Medicine, Sant’Orsola-Malpighi Hospital, Bologna, Italy

    Paolo Castellucci & Stefano Fanti

  6. Nuclear Medicine Unit, Diagnostic Imaging e Laboratory Medicine Department, University Hospital of Ferrara, Ferrara, Italy

    Stefano Panareo & Ilaria Rambaldi

  7. Department of Urology, IRCCS San Raffaele Scientific Institute, Milan, Italy

    Alberto Briganti, Marco Moschini & Andrea Gallina

  8. Vita-Salute San Raffaele University, Milan, Italy

    Alberto Briganti

  9. Division of Nuclear Medicine, Mayo Clinic, Rochester, MN, USA

    Val Lowe

  10. Department of Urology, Sant’Orsola-Malpighi Hospital, Bologna, Italy

    Riccardo Schiavina

  11. Department of Human and Paediatric Pathology “Gaetano Barresi”, Urologic Section, University of Messina, Messina, Italy

    Vincenzo Ficarra

  12. Nuclear Medicine and Molecular Imaging Unit, Veneto Institute of Oncology IOV – IRCCS, Padua, Italy

    Laura Evangelista

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  1. Fabio Zattoni
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  2. Elena Incerti
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Corresponding author

Correspondence to Fabio Zattoni.

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All authors declare that have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki Declaration and its later amendments.

Informed consent

Informed consent was obtained from all individual participants included in the study.

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Zattoni, F., Incerti, E., Colicchia, M. et al. Comparison between the diagnostic accuracies of 18F-fluorodeoxyglucose positron emission tomography/computed tomography and conventional imaging in recurrent urothelial carcinomas: a retrospective, multicenter study. Abdom Radiol 43, 2391–2399 (2018). https://doi.org/10.1007/s00261-017-1443-6

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