PET for bladder cancer – pro
Conventional PET using FDG is unsuitable for imaging bladder tumors because of its high urinary excretion. However, it is 67% sensitive, 86% specific and 80% accurate in detecting pathologic lymph nodes in patients with bladder cancer, which exceeds both CT and MRI. Although PET scans are being used as part of research projects in bladder cancer, it is not yet certain how valuable they are in helping to manage the care of patients with bladder cancer. According to a recent review article. “PET demonstrates limited utility in diagnosis and staging of bladder cancer”. A recent guideline says: “PET studies to date are not proven to enhance pretreatment staging and are not indicated until further validation and studies are completed.”
However, a more recent guideline says: “Therefore, “fluorine-18 fluorodeoxyglucose (FDG-PET) might be useful in detecting perivesical tumor growth or distant metastasis in patients with advanced bladder cancer, and for the early detection of recurrent cancer following therapy, although a major remaining pitfall is the intense FDG accumulation due to excretion in the urine…. A study correlating 18F-FDG-PET and CT results in the same patients reported sensitivity, specificity, and accuracy of 60%, 88%, and 78%, respectively, in nodal and metastasis staging, suggesting improved distant metastatic and locoregional node staging. ”
The 2009 ACR guideline rates PET as 2/10, which is “not recommended”. NCCN does not recommend PET.
Jafri SZ, Shetty M, Choyke PL, Bluth EI, Bush WH Jr, Casalino DD, Francis IR, Kawashima A, Papanicolaou N, Rosenfield AT, Sandler CM, Segal AJ, Tempany C, Resnick MI, Expert Panel on Urologic Imaging. Pretreatment staging of invasive bladder cancer. [online publication]. Reston (VA): American College of Radiology (ACR); 2005. 8 p. [51 references]
http://www.moffitt.org/moffittapps/ccj/v9n4/pdf/335
Jafri SZ, Dinan D, Francis IR, Baumgarten DA, Bluth EI, Bush WH Jr., Casalino DD, Curry NS, Israel GM, Kawashima A, Papanicolaou N, Remer Leyendecker JR, Francis IR, Casalino DD, Arellano RS, Baumgarten DA, Curry NS, Dighe M, Israel GM, Papanicolaou N, Prasad S, Ramchandani P, Remer EM, Sheth S, Fulgham P, Expert Panel on Urologic Imaging. ACR Appropriateness Criteria® pretreatment staging of invasive bladder cancer. [online publication]. Reston (VA): American College of Radiology (ACR); 2009. 9 p. [82 references
Jafri SZ, Dinan D, Francis IR, Baumgarten DA, Bluth EI, Bush WH JR, Casalino DD, Curry NS, Israel GM, Kawashima A, Papanicolaou N, Remer EM, Sandler CM, Spring DB, Fulgham P, Expert Panel on Urologic Imaging. Follow-up imaging of bladder carcinoma. [online publication]. Reston (VA): American College of Radiology (ACR); 2007. 9 p. [71 references]
nccn bladder 2018