Combining FDG-PET/CT resulted in a nonsignificant increase in diagnostic accuracy using an 8-mm cutoff for lymph node evaluation (64%, 86%, and 83%, respectively). Girard et al [94] proposed using the maximum standardized uptake value associated with axial-based lymph node size to improve the detection of regional lymph node metastasis in 61 patients with clinically localized MIBC, showing that combining maximum standardized uptake value and axial-based lymph node size criteria using FDG-PET/CT can improve the diagnostic accuracy for preoperative lymph staging in patients with MIBC. A meta-analysis showed a combined sensitivity of 82% and a specificity of 89% for detecting metastatic lesions from bladder cancer with FDG-PET [95]. Goodfellow et al [90] compared FDG-PET with CT in detecting metastatic disease outside of the pelvis from bladder cancer and found a higher sensitivity for FDG-PET at 54%, compared with 41% for CT, whereas both imaging modalities had similar specificities of 97% and 98%, respectively. Kibel et al [96] conducted a prospective study of FDG-PET/CT for MIBC in patients with no evidence of metastatic disease through traditional staging methods. In this study, FDG-PET/CT had a sensitivity of 70%, a specificity of 94%, a PPV of 78%, and a negative predictive value of 91%. FDG-PET/CT can have a significant impact on the clinical decisions for patients with bladder cancer. A clinical impact analysis conducted by Apolo et al [97], which analyzed the patients with bladder cancer through the National Oncology PET registry, found that FDG-PET/CT results changed the treatment plan in 68% of patients. Even after accounting for the possibility that a different imaging test may have led to the same management strategy, FDG- PET/CT still altered treatment plans in 47% of patients.
Pretreatment Staging of Urothelial Cancer. Combining FDG-PET/CT resulted in a nonsignificant increase in diagnostic accuracy using an 8-mm cutoff for lymph node evaluation (64%, 86%, and 83%, respectively). Girard et al [94] proposed using the maximum standardized uptake value associated with axial-based lymph node size to improve the detection of regional lymph node metastasis in 61 patients with clinically localized MIBC, showing that combining maximum standardized uptake value and axial-based lymph node size criteria using FDG-PET/CT can improve the diagnostic accuracy for preoperative lymph staging in patients with MIBC. A meta-analysis showed a combined sensitivity of 82% and a specificity of 89% for detecting metastatic lesions from bladder cancer with FDG-PET [95]. Goodfellow et al [90] compared FDG-PET with CT in detecting metastatic disease outside of the pelvis from bladder cancer and found a higher sensitivity for FDG-PET at 54%, compared with 41% for CT, whereas both imaging modalities had similar specificities of 97% and 98%, respectively. Kibel et al [96] conducted a prospective study of FDG-PET/CT for MIBC in patients with no evidence of metastatic disease through traditional staging methods. In this study, FDG-PET/CT had a sensitivity of 70%, a specificity of 94%, a PPV of 78%, and a negative predictive value of 91%. FDG-PET/CT can have a significant impact on the clinical decisions for patients with bladder cancer. A clinical impact analysis conducted by Apolo et al [97], which analyzed the patients with bladder cancer through the National Oncology PET registry, found that FDG-PET/CT results changed the treatment plan in 68% of patients. Even after accounting for the possibility that a different imaging test may have led to the same management strategy, FDG- PET/CT still altered treatment plans in 47% of patients.