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

Fabio Zattoni, Elena Incerti, Michele Colicchia, Paolo Castellucci, Stefano Panareo, Maria Picchio, Federico Fallanca, Alberto Briganti, Marco Moschini, Andrea Gallina, Robert Jeffrey Karnes, Val Lowe, Stefano Fanti, Riccardo Schiavina, Ilaria Rambaldi, Vincenzo Ficarra, Laura Evangelista

Research output: Contribution to journalArticle

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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.

Original languageEnglish (US)
Pages (from-to)1-9
Number of pages9
JournalAbdominal Radiology
DOIs
StateAccepted/In press - Jan 4 2018

Fingerprint

Fluorodeoxyglucose F18
Multicenter Studies
Retrospective Studies
Carcinoma
Urinary Bladder Neoplasms
Neoplasms
Cystectomy
Magnetic Resonance Imaging
Sensitivity and Specificity
Positron Emission Tomography Computed Tomography
Confidence Intervals
Neoadjuvant Therapy
Nephrons
Therapeutics
Urinary Bladder
Thorax
X-Rays

Keywords

  • Bladder cancer
  • Conventional imaging
  • FDG PET/CT
  • Recurrent urothelial carcinoma
  • Upper tract urothelial cancer

ASJC Scopus subject areas

  • Radiological and Ultrasound Technology
  • Radiology Nuclear Medicine and imaging
  • Gastroenterology
  • Urology

Cite this

Comparison between the diagnostic accuracies of 18F-fluorodeoxyglucose positron emission tomography/computed tomography and conventional imaging in recurrent urothelial carcinomas : a retrospective, multicenter study. / Zattoni, Fabio; Incerti, Elena; Colicchia, Michele; Castellucci, Paolo; Panareo, Stefano; Picchio, Maria; Fallanca, Federico; Briganti, Alberto; Moschini, Marco; Gallina, Andrea; Karnes, Robert Jeffrey; Lowe, Val; Fanti, Stefano; Schiavina, Riccardo; Rambaldi, Ilaria; Ficarra, Vincenzo; Evangelista, Laura.

In: Abdominal Radiology, 04.01.2018, p. 1-9.

Research output: Contribution to journalArticle

Zattoni, F, Incerti, E, Colicchia, M, Castellucci, P, Panareo, S, Picchio, M, Fallanca, F, Briganti, A, Moschini, M, Gallina, A, Karnes, RJ, Lowe, V, Fanti, S, Schiavina, R, Rambaldi, I, Ficarra, V & Evangelista, L 2018, 'Comparison between the diagnostic accuracies of 18F-fluorodeoxyglucose positron emission tomography/computed tomography and conventional imaging in recurrent urothelial carcinomas: a retrospective, multicenter study', Abdominal Radiology, pp. 1-9. https://doi.org/10.1007/s00261-017-1443-6
Zattoni, Fabio ; Incerti, Elena ; Colicchia, Michele ; Castellucci, Paolo ; Panareo, Stefano ; Picchio, Maria ; Fallanca, Federico ; Briganti, Alberto ; Moschini, Marco ; Gallina, Andrea ; Karnes, Robert Jeffrey ; Lowe, Val ; Fanti, Stefano ; Schiavina, Riccardo ; Rambaldi, Ilaria ; Ficarra, Vincenzo ; Evangelista, Laura. / Comparison between the diagnostic accuracies of 18F-fluorodeoxyglucose positron emission tomography/computed tomography and conventional imaging in recurrent urothelial carcinomas : a retrospective, multicenter study. In: Abdominal Radiology. 2018 ; pp. 1-9.
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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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author = "Fabio Zattoni and Elena Incerti and Michele Colicchia and Paolo Castellucci and Stefano Panareo and Maria Picchio and Federico Fallanca and Alberto Briganti and Marco Moschini and Andrea Gallina and Karnes, {Robert Jeffrey} and Val Lowe and Stefano Fanti and Riccardo Schiavina and Ilaria Rambaldi and Vincenzo Ficarra and Laura Evangelista",
year = "2018",
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day = "4",
doi = "10.1007/s00261-017-1443-6",
language = "English (US)",
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journal = "Abdominal Radiology",
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TY - JOUR

T1 - Comparison between the diagnostic accuracies of 18F-fluorodeoxyglucose positron emission tomography/computed tomography and conventional imaging in recurrent urothelial carcinomas

T2 - a retrospective, multicenter study

AU - Zattoni, Fabio

AU - Incerti, Elena

AU - Colicchia, Michele

AU - Castellucci, Paolo

AU - Panareo, Stefano

AU - Picchio, Maria

AU - Fallanca, Federico

AU - Briganti, Alberto

AU - Moschini, Marco

AU - Gallina, Andrea

AU - Karnes, Robert Jeffrey

AU - Lowe, Val

AU - Fanti, Stefano

AU - Schiavina, Riccardo

AU - Rambaldi, Ilaria

AU - Ficarra, Vincenzo

AU - Evangelista, Laura

PY - 2018/1/4

Y1 - 2018/1/4

N2 - 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.

AB - 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.

KW - Bladder cancer

KW - Conventional imaging

KW - FDG PET/CT

KW - Recurrent urothelial carcinoma

KW - Upper tract urothelial cancer

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