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Master Thesis

Place du TEP scanner dans la prise en charge des tumeurs de vessie infiltrant le muscle

Abstract : Background: guidelines do not recommend FDG-Positron Emission Tomography (PET) Computed Tomography (CT) for the staging of Muscle Invasive Bladder Cancer (MIBC), but rather CT for lymph node (LN) and metastatic staging. We performed an analysis of patients (pts) with MIBC who had a FDG-PET CT for staging in two centers, and analyzed its utility in this setting. Methods: all pts who had a FDG-PET CT performed at the time of diagnosis of MIBC from January 2005 to December 2017 in Bordeaux (Bergonie Institute and University Hospital) were reviewed. Nodal and metastatic staging on CT and FDG-PET CT were done independently. The aims of the study were to evaluate the accuracy of the FDG-PET CT for LN staging and to determine the rate of treatment modification (neoadjuvant chemotherapy for curative intent, no surgery for metastatic disease), according to FDG-PET CT results. Results: among the 130 pts included, median age was 65 years. Accuracy of lymph nodes staging for CT and FDG-PET CT at initial diagnosis were analyzed for 85 pts (including 70 pts treated with neoadjuvant chemotherapy) and compared to pathological examination of resected LN. Sensitivity of FDG-PET CT was better than CT (respectively 80.8% versus 26.9%) but the specificity was low (respectively 54.2% versus 83.1%). Youden index was better for FDG-PET CT (0.35; 0.1 for CT) and it seems to be more accurate for determining LN staging of MIBC. FDG-PET CT findings allowed a treatment decisions modification in 34/130 patients (26.1%): therapeutic intensification (12 pts, 9.2%), including surgery not previously indicated (9 pts); modified radiotherapy or de-escalation (22 pts, 16.9%), mostly avoiding surgery. Conclusion: FDG-PET CT is more sensitive to detect LN involvement at initial diagnosis of MIBC. In our study, treatment decisions were modified, according to FDG-PET CT results, in a quarter of patients according to lymph node and distant metastatic staging.
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https://dumas.ccsd.cnrs.fr/dumas-02510730
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Pauline Bertolaso. Place du TEP scanner dans la prise en charge des tumeurs de vessie infiltrant le muscle. Sciences du Vivant [q-bio]. 2019. ⟨dumas-02510730⟩

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