Objectives: To retrospectively evaluate the value of CT for lymph node (LN) staging in bladder cancer. Methods: Two uroradiologists reviewed CT scans of 231 patients who underwent radical cystectomy and pelvic lymphadenectomy according to a predefined 12-field template. A 5-step model was used to grade the radiological likelihood of a LN to represent malignant spread based on size, configuration and structure as well as regional clustering. Statistical analyses were performed both on patient- and field-based levels. Results: LN metastases were found in 59 of 231 patients (25.5%). On a patient-based level, sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy were 52.6, 93.6, 73.2, 85.6 and 83.4%, respectively. Using the field-based approach, a total of 1,649 anatomical fields were evaluable, of which 114 fields showed malignancy (6.9%). On a field basis, sensitivity, specificity, PPV, NPV and accuracy were 30.2, 98, 51.5, 94.5 and 93.3%, respectively. Concerning local staging (pT category), the overall accuracy was 78%; overstaging occurred in 6% and understaging in 16%. Conclusions: In line with prior studies, the sensitivity of CT imaging for the detection of LN metastases was low, while high values for specificity were achieved. This was further underlined by analyzing standardized anatomical fields. Concerning local staging, postoperative changes after TURB-T rarely led to overstaging.

Keywords:
Local staging, Staging, Computed tomography, Lymph node, Bladder cancer
1.
Gakis G, Efstathiou J, Lerner SP, Cookson MS, Keegan KA, Guru KA, Shipley WU, Heidenreich A, Schoenberg MP, Sagaloswky AI, et al: ICUD-EAU International Consultation on Bladder Cancer 2012: radical cystectomy and bladder preservation for muscle-invasive urothelial carcinoma of the bladder. Eur Urol 2013;63:45-57.
2.
Nishiyama H, Habuchi T, Watanabe J, Teramukai S, Tada H, Ono Y, Ohshima S, Fujimoto K, Hirao Y, Fukushima M, et al: Clinical outcome of a large-scale multi-institutional retrospective study for locally advanced bladder cancer: a survey including 1131 patients treated during 1990-2000 in Japan. Eur Urol 2004;45:176-181.
3.
Stein JP, Lieskovsky G, Cote R, Groshen S, Feng AC, Boyd S, Skinner E, Bochner B, Thangathurai D, Mikhail M, et al: Radical cystectomy in the treatment of invasive bladder cancer: long-term results in 1,054 patients. J Clin Oncol 2001;19:666-675.
4.
Herr HW, Dotan Z, Donat SM, Bajorin DF: Defining optimal therapy for muscle invasive bladder cancer. J Urol 2007;177:437-443.
5.
Paik ML, Scolieri MJ, Brown SL, Spirnak JP, Resnick MI: Limitations of computerized tomography in staging invasive bladder cancer before radical cystectomy. J Urol 2000;163:1693-1696.
6.
Grossman HB, Natale RB, Tangen CM, Speights VO, Vogelzang NJ, Trump DL, deVere White RW, Sarosdy MF, Wood DP Jr, Raghavan D, et al: Neoadjuvant chemotherapy plus cystectomy compared with cystectomy alone for locally advanced bladder cancer. N Engl J Med 2003;349:859-866.
7.
Advanced Bladder Cancer Meta-analysis Collaboration: Neoadjuvant chemotherapy in invasive bladder cancer: a systematic review and meta-analysis. Lancet 2003;361:1927-1934.
8.
Maurer T, Souvatzoglou M, Kubler H, Opercan K, Schmidt S, Herrmann K, Stollfuss J, Weirich G, Haller B, Gschwend JE, et al: Diagnostic efficacy of [11C]choline positron emission tomography/computed tomography compared with conventional computed tomography in lymph node staging of patients with bladder cancer prior to radical cystectomy. Eur Urol 2012;61:1031-1038.
9.
Shariat SF, Palapattu GS, Karakiewicz PI, Rogers CG, Vazina A, Bastian PJ, Schoenberg MP, Lerner SP, Sagalowsky AI, Lotan Y: Discrepancy between clinical and pathologic stage: impact on prognosis after radical cystectomy. Eur Urol 2007;51:137-149; discussion 149-151.
10.
Baltaci S, Resorlu B, Yagci C, Turkolmez K, Gogus C, Beduk Y: Computerized tomography for detecting perivesical infiltration and lymph node metastasis in invasive bladder carcinoma. Urol Int 2008;81:399-402.
11.
Tritschler S, Mosler C, Straub J, Buchner A, Karl A, Graser A, Stief C, Tilki D: Staging of muscle-invasive bladder cancer: can computerized tomography help us to decide on local treatment? World J Urol 2012;30:827-831.
12.
Ficarra V, Dalpiaz O, Alrabi N, Novara G, Galfano A, Artibani W: Correlation between clinical and pathological staging in a series of radical cystectomies for bladder carcinoma. BJU Int 2005;95:786-790.
13.
Kundra V, Silverman PM: Imaging in oncology from the University of Texas M. D. Anderson Cancer Center. Imaging in the diagnosis, staging, and follow-up of cancer of the urinary bladder. AJR Am J Roentgenol 2003;180:1045-1054.
14.
Husband JE: Computer tomography and magnetic resonance imaging in the evaluation of bladder cancer. J Belge Radiol 1995;78:350-355.
15.
Yang WT, Lam WW, Yu MY, Cheung TH, Metreweli C: Comparison of dynamic helical CT and dynamic MR imaging in the evaluation of pelvic lymph nodes in cervical carcinoma. AJR Am J Roentgenol 2000;175:759-766.
16.
Kim SH, Kim SC, Choi BI, Han MC: Uterine cervical carcinoma: evaluation of pelvic lymph node metastasis with MR imaging. Radiology 1994;190:807-811.
17.
Kim SH, Choi BI, Lee HP, Kang SB, Choi YM, Han MC, Kim CW: Uterine cervical carcinoma: comparison of CT and MR findings. Radiology 1990;175:45-51.
18.
Genders TS, Spronk S, Stijnen T, Steyerberg EW, Lesaffre E, Hunink MG: Methods for calculating sensitivity and specificity of clustered data: a tutorial. Radiology 2012;265:910-916.
19.
Maurer T, Beer AJ, Wester HJ, Kubler H, Schwaiger M, Eiber M: Positron emission tomography/magnetic resonance imaging with 68Gallium-labeled ligand of prostate-specific membrane antigen: promising novel option in prostate cancer imaging? Int J Urol 2014;21:1286-1288.
20.
Goodfellow H, Viney Z, Hughes P, Rankin S, Rottenberg G, Hughes S, Evison F, Dasgupta P, O'Brien T, Khan MS: Role of fluorodeoxyglucose positron emission tomography (FDG PET)-computed tomography (CT) in the staging of bladder cancer. BJU Int 2014;114:389-395.
21.
Jeong IG, Hong S, You D, Hong JH, Ahn H, Kim CS: FDG PET-CT for lymph node staging of bladder cancer: a prospective study of patients with extended pelvic lymphadenectomy. Ann Surg Oncol 2015;22:3150-3156.
© 2015 S. Karger AG, Basel
2015
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