1. LOW POWER OF COMPUTED TOMOGRAPHY WITH IODINE CONTRAST IN DETECTION OF LYMPH NODE METASTASES BEFORE RADICAL CYSTECTOMY, OUR EXPERIENCE
F.Catanzariti, U.Cantoro, A.Conti, G.Muzzonigro
Clinica Urologica-Università Politecnica delle Marche
-Ancona-

2. INTRODUCTION
Lymph nodes metastases in patients with bladder cancer influence negatively survival.
Correct detection before surgery could guide surgeon in choosing between pelvic (external iliac vessels, the obturator fossa, the lateral and medial aspects of the internal iliac vessels) or extended lymphadenectomy (at least the distal half of the common iliac vessels together with its bifurcation) with the result of improved survival [1].
Computed tomoghraphy (CT) with iodine contrast is the most used imaging for nodal involvement because of its low cost and its widespread
[1] The Impact of Lymphadenectomy and Lymph Node Metastasis on the Outcomes of Radical Cystectomy for Bladder Cancer
Alexander Karl, Peter R. Carroll, Jurgen E. Gschwend, Ruth Knuchel, Francesco Montorsi, Christian G. Stief, Urs E. Studer
European urology 55 ( ) 826–835

3. OBJECTIVES
To determine the sensibility (SE), the specificity (SP), the positive predictive value (PPV), the negative predictive value (NPV) and the accuracy (AC) of the CT with iodine contrast in detecting lymph node metastases in our experience.

4. MATERIALS From March 2009 to July 2012
110 consecutive patients with a diagnosis of muscle invasive bladder cancer or carcinoma in situ of the bladder who underwent staging with CT with iodine contrast.
Comparing these reports with pathological results of the lymph nodes to evaluate SE, SP, PPV, NPV and AC of this imaging technique.

5. METHODS
Before cystectomy all patients underwent to CT with iodine contrast
Lymph nodes examination in the same institute of pathology using the same technique for histological exam
Presence of lymph nodes larger than 1 cm reported by the radiologist, as suspicious for lymph node metastases

6. RESULTS suspicious lymph node involvement at the CT: 28/110 (25,45 %)
normal lymph node at CT: 82/110 (74,54 %)
lymph node metastases at histologic examination: 34/110 (30,9%)
lymph nodes free of metastases: 76/110 (69,09%).
Understaging: 19/110 cases (17,27%)
Overstaging: 13/110 cases (11,82%).
Correct correlation CT-histological results: 78/110 cases,
AC of the CT: 70,91% (95% CI: 62,42 to 79,39).

7. RESULTS
SE: 44,12% (95% CI :34,84-53, 40)
SP: 82, 89% (95% CI :75,86-89, 93).
PPV:53,57%
NPV: 76,83%.

8. DISCUSSION This study has some limits:
different radiologists had examined the images
different pathologists had analyzed the specimens.
However, the results show a clear
failure of the CT in staging
this disease.

9. CONCLUSION
Other studies in literature showed this lack of ability of the CT in staging [2,3]
Correct stadiation before surgery is very important to guide surgeon to a more extended lymphadenectomy in order to have better survival as it described by other authors. [1]
[2] STAGING AND STAGING ERORS IN BLADDER CANCER
Peter J. Bostrom , Bas W.G. van Rhijn, Neil Fleshner, Antonio Finelli, Michael Jewett
,John Thoms, Sally Hanna, Cynthia Kuk, Alexandre R. Zlotta
EUROP E AN UROLOGY SUPP L EMENT S 9 ( ) 2 –9
[3] LIMITATIONS OF COMPUTERIZED TOMOGRAPHY IN STAGING INVASIVE
BLADDER CANCER BEFORE RADICAL CYSTECTOMY
Michael L. Paik, Michael J. Scolieri, Scott L. Brown, J. Patrick Spirnak
and Martin I. Resnik
THE JOURNAL OF UROLOGY Vol. 163, 1693–1696, June 2000

10. CONCLUSION
Some scientific works had shown that PET in combination with CT could be better in staging, even if more studies and with more numerous cases are needed. [3]
Other studies showed the utility of lymphoscintigraphy combined with computed tomography (CT) for preoperative detection of sentinel lymph nodes [4]
Other authors had shown better results in lymphnode detection thanks to diffusion weighted MR [5]
[3] FDG-PET/CT for the Preoperative Lymph Node Staging of Invasive Bladder Cancer
Greet Swinnen, Alex Maes, Hans Pottel, Alain Vanneste, Ignace Billiet,Karl Lesage, Patrick Werbrouck
EUROPEAN UROLOGY 5 7 ( ) – 6 4 7
[4] Hybrid SPECT-CT: An Additional Technique for Sentinel Node Detection of Patients with Invasive Bladder Cancer
Amir Sherif et all
European urology 50 ( ) 83–91
[5] Diffusion-weighted magnetic resonance imaging in patients selected for radical cystectomy: detection rate of pelvic lymph node metastases
Rocco Papalia, et al
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