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Impact of 18 F ‐fluorodeoxyglucose ( FDG )‐positron‐emission tomography/computed tomography ( PET / CT ) on management of patients with carcinoma invading bladder muscle
Author(s) -
Mertens Laura S.,
FiooleBruining Annemarie,
Vegt Erik,
Vogel Wouter V.,
Rhijn Bas W.,
Horenblas Simon
Publication year - 2013
Publication title -
bju international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.773
H-Index - 148
eISSN - 1464-410X
pISSN - 1464-4096
DOI - 10.1111/bju.12109
Subject(s) - medicine , positron emission tomography , nuclear medicine , radiology , bladder cancer , fluorodeoxyglucose , pet ct , cancer
Objective To evaluate the clinical impact of 18 F ‐fluorodeoxyglucose ( FDG )‐positron‐emission tomography/computed tomography ( PET / CT ) scanning, compared with conventional staging with contrast‐enhanced CT imaging ( CECT ).Patients and Methods 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 . 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. The changes in management decisions before and after FDG‐PET / CT were assessed.Results The median (range) interval between CECT and FDG‐PET / CT was 0 (029) days. 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%). 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%). All the management changes were validated by tissue confirmation of the additional lesions.ConclusionsFDG‐PET / CT provides important additional staging information, which influences the treatment of carcinoma invading bladder muscle in almost 20% of cases. Patient selection for neoadjuvant/induction chemotherapy was improved and futile attempts at curative treatment in patients found to have metastases were avoided.