TY - JOUR
T1 - Diagnostic accuracy of preoperative lymph node staging of bladder cancer according to different lymph node locations
T2 - A multicenter cohort from the European Association of Urology – Young Academic Urologists
AU - European Association of Urology - Young Academic Urologists (EAU-YAU): Urothelial Carcinoma Working Group
AU - Lonati, Chiara
AU - Mordasini, Livio
AU - Afferi, Luca
AU - De Cobelli, Ottavio
AU - Di Trapani, Ettore
AU - Necchi, Andrea
AU - Colombo, Renzo
AU - Briganti, Alberto
AU - Montorsi, Francesco
AU - Simeone, Claudio
AU - Zamboni, Stefania
AU - Simone, Giuseppe
AU - Karnes, Robert Jeffrey
AU - Marra, Giancarlo
AU - Soria, Francesco
AU - Gontero, Paolo
AU - Shariat, Shahrokh F.
AU - Pradere, Benjamin
AU - Hendricksen, Kees
AU - Ammiwala, Maida
AU - Rink, Michael
AU - Poyet, Cédric
AU - Krajewski, Wojciech
AU - Baumeister, Philipp
AU - Mattei, Agostino
AU - Moschini, Marco
AU - Carando, Roberto
N1 - Publisher Copyright:
© 2022 Elsevier Inc.
PY - 2022/5
Y1 - 2022/5
N2 - Background: The preoperative lymph node (LN) staging of bladder cancer (BCa) addresses the subsequent therapeutic strategy and influences patient's prognosis. However, sparce evidence exists regarding the accuracy of conventional cross-sectional imaging, such as computed tomography or magnetic resonance imaging, in correctly detect LN status. We aimed to assess the diagnostic accuracy of conventional cross-sectional imaging in detecting preoperative LN involvement among BCa patients treated with radical cystectomy and pelvic lymph node dissection. Methods: We retrospectively analyzed data of 1,104 patients who underwent preoperative LN staging with computed tomography or magnetic resonance imaging and subsequent radical cystectomy with pelvic lymph node dissection for BCa between 1997 and 2017 at three tertiary referral centers. Patients receiving neoadjuvant chemotherapy were excluded. We assessed the concordance between clinical (cN) and pathological LN (pN) status, defined as the accuracy of imaging in detecting LN involvement using pathological specimen as reference; concordance was expressed according to Cohen's kappa coefficient. Location-based sub-analyses were performed, distinguishing among external iliac, intern iliac, obturator, common iliac, presacral and paraaortic LNs. Results: Among 870 cN0 patients, 68.9% were confirmed pN0 at pathological report; while among 234 cN+ patients, 50.5% were found with LN metastases at pathological specimen. Overall, conventional imaging showed slight concordance (64.9%) between cN and pN stages (sensitivity: 30%; specificity: 84%). At sub-analysis, no agreement between cN and pN status was found in each LN location, with the only exception of common iliac LNs with slight concordance (37.5%). Common iliac LNs achieved the highest sensitivity and positive likelihood ratio (15% and 2.4, respectively) compared to other LN locations. Conclusions: Overall, preoperative cross-sectional imaging exhibited a slight concordance between cN and pN status. Our location-based sub-analyses showed unsatisfactory results in each LN location- Thus, nomograms combining morphological patterns with serological and clinicopathological features are urgently required.
AB - Background: The preoperative lymph node (LN) staging of bladder cancer (BCa) addresses the subsequent therapeutic strategy and influences patient's prognosis. However, sparce evidence exists regarding the accuracy of conventional cross-sectional imaging, such as computed tomography or magnetic resonance imaging, in correctly detect LN status. We aimed to assess the diagnostic accuracy of conventional cross-sectional imaging in detecting preoperative LN involvement among BCa patients treated with radical cystectomy and pelvic lymph node dissection. Methods: We retrospectively analyzed data of 1,104 patients who underwent preoperative LN staging with computed tomography or magnetic resonance imaging and subsequent radical cystectomy with pelvic lymph node dissection for BCa between 1997 and 2017 at three tertiary referral centers. Patients receiving neoadjuvant chemotherapy were excluded. We assessed the concordance between clinical (cN) and pathological LN (pN) status, defined as the accuracy of imaging in detecting LN involvement using pathological specimen as reference; concordance was expressed according to Cohen's kappa coefficient. Location-based sub-analyses were performed, distinguishing among external iliac, intern iliac, obturator, common iliac, presacral and paraaortic LNs. Results: Among 870 cN0 patients, 68.9% were confirmed pN0 at pathological report; while among 234 cN+ patients, 50.5% were found with LN metastases at pathological specimen. Overall, conventional imaging showed slight concordance (64.9%) between cN and pN stages (sensitivity: 30%; specificity: 84%). At sub-analysis, no agreement between cN and pN status was found in each LN location, with the only exception of common iliac LNs with slight concordance (37.5%). Common iliac LNs achieved the highest sensitivity and positive likelihood ratio (15% and 2.4, respectively) compared to other LN locations. Conclusions: Overall, preoperative cross-sectional imaging exhibited a slight concordance between cN and pN status. Our location-based sub-analyses showed unsatisfactory results in each LN location- Thus, nomograms combining morphological patterns with serological and clinicopathological features are urgently required.
KW - Bladder cancer
KW - Clinical node
KW - Computed tomography
KW - Lymph node
KW - Magnetic resonance imaging
KW - Preoperative imaging
KW - Staging
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U2 - 10.1016/j.urolonc.2022.01.002
DO - 10.1016/j.urolonc.2022.01.002
M3 - Article
C2 - 35236621
AN - SCOPUS:85125456513
SN - 1078-1439
VL - 40
SP - 195.e27-195.e35
JO - Urologic Oncology: Seminars and Original Investigations
JF - Urologic Oncology: Seminars and Original Investigations
IS - 5
ER -