title: 11C-choline PET/CT and bladder cancer: lymph node metastasis assessment with pathological specimens as reference standard.
abstract: OBJECTIVE
  The aim of this study was to evaluate the potential role of C-choline-PET/CT in nodal assessment in patients with bladder cancer (BCa) using the pathological specimen as reference standard.
  
  
  METHODS
  Fifty-nine patients with proven BCa were retrospectively enrolled from April 2011 to January 2014 (mean [SD] age, 70.1 [9] years; range 49-85 years). Of 59 patients, 39 (staging group) were referred to C-choline-PET/CT for preoperative lymph node (LN) evaluation before radical cystectomy and extended pelvic LN dissection. Of the 59 patients, 29 (restaging group) had C-choline-PET/CT for suspected BCa relapse after primary radical surgery. In both groups, C-choline-PET/CT findings were correlated with histology. Sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were calculated to assess C-choline-PET/CT feasibility in LN assessment. Age, TNM, histology, and previous chemotherapy were analyzed as additional predictive factors.
  
  
  RESULTS
  C-choline-PET/CT overall detection rate was 62.7% (37/59 patients). On a regional-based analysis, C-choline-PET/CT was considered positive for primary cancer and/or local relapse in bladder bed in 54.2% of the patients (32/59). Pathological LN uptake was reported in 23.7% of the patients (14/59) and systemic choline deposit (bone or lung) in 11.8% of the patients (7/59). Considering LN metastasis detection, compared with histological analysis, C-choline-PET/CT showed in the whole population a sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of 59%, 90%, 71%, 84%, and 81%, respectively. No other investigated factors reached statistical significance.
  
  
  CONCLUSIONS
  C-choline-PET/CT may provide additional diagnostic information in preoperative nodal staging of patients with BCa and be considered a useful tool to restage patients with BCa suspected of relapse. Further studies are needed to assess if C-choline-PET/CT could have an influence on survival of patients with BCa.
authors.affiliation: From the *Service of Nuclear Medicine, and †Department of Urology, Policlinico S. Orsola-Malpighi, University of Bologna, Bologna, Italy; ‡Department of Radiology, University of Southern California, Los Angeles, CA; and §Department of Nuclear Medicine and PET/CT Centre, 'Santa Maria della Misericordia' Hospital, Rovigo, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Ceci
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Bianchi
authors.forename: Tiziano
authors.initials: T
authors.lastname: Graziani
authors.forename: Paolo
authors.initials: P
authors.lastname: Castellucci
authors.forename: Christian
authors.initials: C
authors.lastname: Pultrone
authors.forename: Brunocilla
authors.initials: B
authors.lastname: Eugenio
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Martorana
authors.forename: Patrick M
authors.initials: PM
authors.lastname: Colletti
authors.forename: Domenico
authors.initials: D
authors.lastname: Rubello
authors.forename: Stefano
authors.initials: S
authors.lastname: Fanti
authors.forename: Riccardo
authors.initials: R
authors.lastname: Schiavina
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002250:Carbon Radioisotopes; D002277:Carcinoma / Q000000981:diagnostic imaging* / Q000473:pathology; D002794:Choline; D005260:Female; D006801:Humans; D008207:Lymphatic Metastasis / Q000000981:diagnostic imaging / Q000473:pathology; D008297:Male; D008875:Middle Aged; D064847:Multimodal Imaging / Q000592:standards*; D049268:Positron-Emission Tomography / Q000592:standards*; D019275:Radiopharmaceuticals; D012015:Reference Standards; D014057:Tomography, X-Ray Computed / Q000592:standards*; D001749:Urinary Bladder Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology
chemical_list: D002250:Carbon Radioisotopes; D019275:Radiopharmaceuticals; D002794:Choline