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PET/CT versus conventional CT for detection of lymph node metastases in patients with locally advanced bladder cancer.
Region Östergötland, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Urology in Östergötland. Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Medicine and Health Sciences.
Region Östergötland, Center for Diagnostics, Department of Radiology in Linköping.
Region Östergötland, Center for Diagnostics, Department of Radiology in Linköping.
Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Surgery in Linköping.
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2015 (English)In: BMC urology, ISSN 1471-2490, Vol. 15, no 1, 87- p.Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: We studied patients treated with radical cystectomy for locally advanced bladder cancer to compare the results of both preoperative positron emission tomography/computed tomography (PET/CT) and conventional CT with the findings of postoperative histopathological evaluation of lymph nodes.

METHODS: Patients who had bladder cancer and were candidates for cystectomy underwent preoperative PET/CT using 18-fluorodeoxyglucose (FDG) and conventional CT. The results regarding lymph node involvement were independently evaluated by two experienced radiologists and were subsequently compared with histopathology results, the latter of which were reassessed by an experienced uropathologist (HO).

RESULTS: There were 54 evaluable patients (mean age 68 years, 47 [85 %] males and 7 [15 %] females) with pT and pN status as follows: < pT2-14 (26 %), pT2-10 (18 %), and > pT2-30 (56 %); pN0 37 (69 %) and pN+ 17 (31 %). PET/CT showed positive lymph nodes in 12 patients (22 %), and 7 of those cases were confirmed by histopathology; the corresponding results for conventional CT were 11 (20 %) and 7 patients (13 %), respectively. PET/CT had 41 % sensitivity, 86 % specificity, 58 % PPV, and 76 % NPV, whereas the corresponding figures for conventional CT were 41 %, 89 %, 64 %, and 77 %. Additional analyses of the right and left side of the body or in specified anatomical regions gave similar results.

CONCLUSIONS: In this study, PET/CT and conventional CT had similar low sensitivity in detecting and localizing regional lymph node metastasis in bladder cancer.

Place, publisher, year, edition, pages
2015. Vol. 15, no 1, 87- p.
National Category
Urology and Nephrology Cancer and Oncology
Identifiers
URN: urn:nbn:se:liu:diva-120796DOI: 10.1186/s12894-015-0080-zISI: 000359832000001PubMedID: 26294219OAI: oai:DiVA.org:liu-120796DiVA: diva2:848635
Available from: 2015-08-25 Created: 2015-08-25 Last updated: 2017-05-17
In thesis
1. Staging and tumor biological mechanisms of lymph node metastasis in invasive urinary bladder cancer
Open this publication in new window or tab >>Staging and tumor biological mechanisms of lymph node metastasis in invasive urinary bladder cancer
2017 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Aim: To study the possibility of detecting lymph node metastasis in locally advanced urinary bladder cancer (UBC) treated with radical cystectomy (RC) by using preoperative positron emission tomography/computed tomography (PET/CT) and peroperative sentinel node biopsy (SNB) technique. We also investigate the clinical significance of macrophage traits expression by cancer cells, M2-macrophage infiltration (MI) in tumor stroma and the immunohistochemical expression of biomarkers in cancer cells in relation to clinicopathologic data.

Patients and Methods: We studied prospectively 122 patients with UBC, pathological stage pT1–pT4 treated with RC and pelvic lymph node dissection (PLND) during 2005–2011 at the Department of Urology, Linköping University Hospital. In the first study, we compared the results of preoperative PET/CT and conventional CT with the findings of postoperative histopathological evaluation of lymph nodes (LNs). In the second study we investigated the value of SNB technique for detecting pathological LNs during RC in patients with UBC. W also examined the significance of the primary tumor location in the bladder in predicting the site of LN metastases, and the prognostic significance of lympho-vascular invasion (LVI) and lymph node metastasis density (LNMD) on survival. In the third study, we investigate the clinical significance of macrophage infiltration (MI) in tumor stroma and macrophage-traits expression by tumor cells. In the fourth study, we investigate the cell cycle suppression proteins p53, p21, pRb, p16, p14 ARF as well as tumors proliferative protein Ki67 and DNA repair protein ERCC1 expression in cancer cells. The results were compared with clinical and pathological characteristics and outcome.

Results: Prior to RC, PET/CT was used to detect LN metastasis in 54 patients. PET/CT had 41% sensitivity, 86% specificity, 58% PPV, and 76% NPV, whereas the corresponding figures for conventional CT were 41%, 89%, 64%, and 77%. SNB was performed during RC in 103 patients. A median number of 29 (range 7–68) nodes per patient were examined. SNs were detected in 83 out of 103 patients (81%). The sensitivity and specificity for detecting metastatic disease by SNB varied among LN stations, with average values of 67% -90%. LNMD or ≥8% and LVI were significantly related to shorter survival. In 103 patients, MI was high in 33% of cases, while moderate and low infiltration occurred in 42% and 25% of tumors respectively. Patients with tumors containing high and moderate compared to low MI had low rate of LN metastases (P=0.06) and improved survival (P=0.06), although not at significant level. The expression of different tumor suppression proteins was altered in 47-91% of the patients. There were no significant association between cancer specific survival (CSS) and any of the studied biomarkers. In case of altered p14ARF, ERCC1 or p21, CSS was low in case of low p53 immunostaining but increased in case of p53 accumulation, although not at a significant level, indicating a possible protective effect of p53 accumulation in these cases.

Conclusion: PET/ CT provided no improvement over conventional CT in detection and localization of regional LN metastases in bladder cancer. It is possible to detect the SN but the technique is not a reliable for perioperative localization of LN metastases; however, LVI and LNMD at a cut-off level of 8% had significant prognostic values. MI in the tumor microenvironment but not CD163 expression in tumor cells seems to be synergistic with the immune response against urinary bladder cancer. Our results further indicate that altered p53 might have protective effect on survival in case of altered p14ARF, p21, or ERCC1 indicating an interaction between these biomarkers.

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press, 2017. 79 p.
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 1569
National Category
Cancer and Oncology Urology and Nephrology Clinical Laboratory Medicine Surgery Gastroenterology and Hepatology
Identifiers
urn:nbn:se:liu:diva-137474 (URN)10.3384/diss.diva-137474 (DOI)9789176855546 (ISBN)
Public defence
2017-06-09, Berzeliussalen, Campus US, Linköping, 13:00 (Swedish)
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Available from: 2017-05-17 Created: 2017-05-17 Last updated: 2017-06-02Bibliographically approved

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Aljabery, FirasSkoog, SusannShabo, IvanOlsson, HansRosell, JohanJahnson, Staffan
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Department of Urology in ÖstergötlandDivision of Clinical SciencesFaculty of Medicine and Health SciencesDepartment of Radiology in LinköpingDepartment of Surgery in LinköpingDivision of Neuro and Inflammation ScienceDepartment of Clinical Pathology and Clinical GeneticsRegional Cancer Center South East Sweden
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