Focal liver masses or other solid organ findings on CTU may need further workup for metastases depending on their appearance. Peritoneal metastatic disease can also occur and can be readily assessed for with CT. Pretreatment Staging of Urothelial Cancer FDG-PET/CT Skull Base to Mid-Thigh Conventional PET is limited for the local staging of UTUC because of high FDG activity in excreted urine. The current body of literature regarding the ability of FDG-PET to stage UTUC suggests it improves sensitivity for diagnosing nodal and metastatic disease, particularly when combined with CT. FDG-PET/CT has an 82% sensitivity and an 84% specificity for the detection of lymph node metastases in patients with UTUC [121]. Presence of suspicious lymph nodes on FDG-PET/CT has also been associated with worse recurrence-free survival [121]. Additionally, higher FDG uptake in metastases was significantly and independently associated with poor chemosensitivity and worse survival outcomes [122]. A study of 233 patients by Goodfellow et al [90] found the sensitivity and specificity of CT for pelvic lymph node involvement was 45% and 98%, respectively. Using PET/CT, the sensitivity for pelvic lymph node involvement increased to 69% with a 3% reduction in specificity to 95%. In a prospective study of 25 patients by Nayak et al [91], in 9 patients who had positive lymph nodes for metastases on histopathology, CT and PET/CT scans had a sensitivity of 44% and 78%, respectively. Other authors have found the FDG-PET/CT sensitivity for the detection of nodal metastases to range between 47% and 56% and the specificity to range between 93% and 98%, with specificity often slightly lower than for CT [92]. A patient-based analysis of consecutive UTUC patients by Tanaka et al [123] showed that the sensitivity of PET/CT was significantly better than that of CT (85% versus 50%, P = . 0001).
Pretreatment Staging of Urothelial Cancer. Focal liver masses or other solid organ findings on CTU may need further workup for metastases depending on their appearance. Peritoneal metastatic disease can also occur and can be readily assessed for with CT. Pretreatment Staging of Urothelial Cancer FDG-PET/CT Skull Base to Mid-Thigh Conventional PET is limited for the local staging of UTUC because of high FDG activity in excreted urine. The current body of literature regarding the ability of FDG-PET to stage UTUC suggests it improves sensitivity for diagnosing nodal and metastatic disease, particularly when combined with CT. FDG-PET/CT has an 82% sensitivity and an 84% specificity for the detection of lymph node metastases in patients with UTUC [121]. Presence of suspicious lymph nodes on FDG-PET/CT has also been associated with worse recurrence-free survival [121]. Additionally, higher FDG uptake in metastases was significantly and independently associated with poor chemosensitivity and worse survival outcomes [122]. A study of 233 patients by Goodfellow et al [90] found the sensitivity and specificity of CT for pelvic lymph node involvement was 45% and 98%, respectively. Using PET/CT, the sensitivity for pelvic lymph node involvement increased to 69% with a 3% reduction in specificity to 95%. In a prospective study of 25 patients by Nayak et al [91], in 9 patients who had positive lymph nodes for metastases on histopathology, CT and PET/CT scans had a sensitivity of 44% and 78%, respectively. Other authors have found the FDG-PET/CT sensitivity for the detection of nodal metastases to range between 47% and 56% and the specificity to range between 93% and 98%, with specificity often slightly lower than for CT [92]. A patient-based analysis of consecutive UTUC patients by Tanaka et al [123] showed that the sensitivity of PET/CT was significantly better than that of CT (85% versus 50%, P = . 0001).