Diagnostic accuracy of [18F]-FDG-PET/CT for lymph node staging in bladder cancer prior to radical cystectomy

Oscar Gouhizoun, Maxime Pattou, Fabienne Guéna, Abderrahmane Khaddad, Samy Mebroukine, Gaëlle Margue, Marine Gross-Goupil, Felix Lefort, Clément Morgat, Jean Christophe Bernhard, Franck Bladou, Grégoire Robert, Clément Klein
World Journal of Urology. 2025-12-23; 44(1):
DOI: 10.1007/s00345-025-06159-2

Gouhizoun O(1), Pattou M(1), Guéna F(1), Khaddad A(1), Mebroukine S(1), Margue G(1), Gross-Goupil M(2), Lefort F(2), Morgat C(3), Bernhard JC(1), Bladou F(1),
Robert G(1), Klein C(4).

Author information:
(1)Department of Urology, University Hospital, Bordeaux, France.
(2)Department of Medical Oncology, University Hospital, Bordeaux, France.
(3)Nuclear Medicine Department, University Hospital, Bordeaux, France.
(4)Department of Urology, University Hospital, Bordeaux, France.
.

PURPOSE: To evaluate the diagnostic accuracy of [18F]-FDG-PET/CT for lymph node
(LN) staging prior to radical cystectomy (RC) in patients with bladder cancer,
with a focus on the impact of neoadjuvant chemotherapy (NAC) on performance.
METHODS: We retrospectively included all patients undergoing RC with pelvic
lymph node dissection (PLND) for muscle-invasive or high-risk non-muscle
invasive urothelial bladder cancer between January 2017 and April 2025 at a
single tertiary centre. All patients underwent preoperative [18F]-FDG-PET/CT.
Diagnostic performance was calculated using final histopathology as the
reference standard. Subgroup analysis was performed based on NAC status.
RESULTS: Among 103 patients (median age 71 years), 45 (43.7%) received NAC. The
sensitivity, specificity, positive predictive value, and negative predictive
value of [18F]-FDG-PET/CT for detecting LN metastases were 57.1%, 82.7%, 55.2%,
and 83.8%, respectively. The area under the receiver operating characteristic
curve (AUC) was 0.70 overall. In patients who received NAC, diagnostic
performance improved markedly (AUC = 0.83 vs. 0.62 without NAC, p = 0.04), with
increased sensitivity (80.0%) and NPV (93.8%). CONCLUSION: [18F]-FDG-PET/CT
demonstrates moderate diagnostic accuracy for LN staging in bladder cancer, with
good specificity but low sensitivity. Its diagnostic accuracy appears enhanced
after NAC, indicating a potential role for [18F]-FDG-PET/CT in restaging after
chemotherapy. However, more effective imaging tools are still needed to improve
locoregional staging.

DOI: 10.1007/s00345-025-06159-2
PMID: 41432986 [Indexed for MEDLINE]

Conflict of interest statement: Declarations. Competing interests: The authors
declare no competing interests. Ethics approval and consent to participate: The
study protocol and data collection were approved by the local Ethics Committee
(CER-BDX 2025-258). All patients received oral and written information and
provided informed consent for retrospective data analysis.