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Evaluation of lymph node status in patients with urothelial carcinoma—still in search of the perfect imaging modality: a systematic review

While accurate lymph node status evaluation in urothelial carcinoma patients is essential for the correct disease staging and, hence, establishing the most beneficial treatment strategy, the diagnostic performance of routine imaging in regards to this issue is not satisfactory. For the purpose of th...

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Autores principales: Frączek, Michał, Kamecki, Hubert, Kamecka, Anna, Sosnowski, Roman, Sklinda, Katarzyna, Czarniecki, Marcin, Królicki, Leszek, Walecki, Jerzy
Formato: Online Artículo Texto
Lenguaje:English
Publicado: AME Publishing Company 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6212628/
https://www.ncbi.nlm.nih.gov/pubmed/30456182
http://dx.doi.org/10.21037/tau.2018.08.28
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author Frączek, Michał
Kamecki, Hubert
Kamecka, Anna
Sosnowski, Roman
Sklinda, Katarzyna
Czarniecki, Marcin
Królicki, Leszek
Walecki, Jerzy
author_facet Frączek, Michał
Kamecki, Hubert
Kamecka, Anna
Sosnowski, Roman
Sklinda, Katarzyna
Czarniecki, Marcin
Królicki, Leszek
Walecki, Jerzy
author_sort Frączek, Michał
collection PubMed
description While accurate lymph node status evaluation in urothelial carcinoma patients is essential for the correct disease staging and, hence, establishing the most beneficial treatment strategy, the diagnostic performance of routine imaging in regards to this issue is not satisfactory. For the purpose of this article, we systematically reviewed the contemporary literature on the sensitivity and specificity of particular imaging modalities which have been studied for detecting lymph node metastases in patients diagnosed with urothelial carcinoma. The evidence reviewed shows that computed tomography (CT), although recognized as the imaging modality of choice, is associated with marked limitations, resulting in its low sensitivity for lymph node involvement detection in urothelial carcinoma patients, with no study reporting a value higher than 46% using standard cut-off values. Markedly higher sensitivity rates may be achieved with magnetic resonance imaging (MRI), especially when using ultrasmall superparamagnetic iron oxide as the contrast agent, however, no uniform protocol has been systematically studied up to date. The vast majority of recent evidence concerns positron emission tomography (PET), which is being reported to improve the diagnostic performance of CT alone, as has been demonstrated in multiple articles, which investigated the accuracy of PET/CT at primary or post-treatment staging of urothelial carcinoma patients. However, there has been substantial heterogeneity in terms of methodology and results between those studies, making it premature to draw any definitive conclusions. The results of this review lead to a conclusion, that while CT, despite being not fully satisfactory, still remains the gold-standard method of imaging for staging purposes in urothelial carcinoma, other imaging modalities are under investigation, with promising results.
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spelling pubmed-62126282018-11-19 Evaluation of lymph node status in patients with urothelial carcinoma—still in search of the perfect imaging modality: a systematic review Frączek, Michał Kamecki, Hubert Kamecka, Anna Sosnowski, Roman Sklinda, Katarzyna Czarniecki, Marcin Królicki, Leszek Walecki, Jerzy Transl Androl Urol Review Article While accurate lymph node status evaluation in urothelial carcinoma patients is essential for the correct disease staging and, hence, establishing the most beneficial treatment strategy, the diagnostic performance of routine imaging in regards to this issue is not satisfactory. For the purpose of this article, we systematically reviewed the contemporary literature on the sensitivity and specificity of particular imaging modalities which have been studied for detecting lymph node metastases in patients diagnosed with urothelial carcinoma. The evidence reviewed shows that computed tomography (CT), although recognized as the imaging modality of choice, is associated with marked limitations, resulting in its low sensitivity for lymph node involvement detection in urothelial carcinoma patients, with no study reporting a value higher than 46% using standard cut-off values. Markedly higher sensitivity rates may be achieved with magnetic resonance imaging (MRI), especially when using ultrasmall superparamagnetic iron oxide as the contrast agent, however, no uniform protocol has been systematically studied up to date. The vast majority of recent evidence concerns positron emission tomography (PET), which is being reported to improve the diagnostic performance of CT alone, as has been demonstrated in multiple articles, which investigated the accuracy of PET/CT at primary or post-treatment staging of urothelial carcinoma patients. However, there has been substantial heterogeneity in terms of methodology and results between those studies, making it premature to draw any definitive conclusions. The results of this review lead to a conclusion, that while CT, despite being not fully satisfactory, still remains the gold-standard method of imaging for staging purposes in urothelial carcinoma, other imaging modalities are under investigation, with promising results. AME Publishing Company 2018-10 /pmc/articles/PMC6212628/ /pubmed/30456182 http://dx.doi.org/10.21037/tau.2018.08.28 Text en 2018 Translational Andrology and Urology. All rights reserved.
spellingShingle Review Article
Frączek, Michał
Kamecki, Hubert
Kamecka, Anna
Sosnowski, Roman
Sklinda, Katarzyna
Czarniecki, Marcin
Królicki, Leszek
Walecki, Jerzy
Evaluation of lymph node status in patients with urothelial carcinoma—still in search of the perfect imaging modality: a systematic review
title Evaluation of lymph node status in patients with urothelial carcinoma—still in search of the perfect imaging modality: a systematic review
title_full Evaluation of lymph node status in patients with urothelial carcinoma—still in search of the perfect imaging modality: a systematic review
title_fullStr Evaluation of lymph node status in patients with urothelial carcinoma—still in search of the perfect imaging modality: a systematic review
title_full_unstemmed Evaluation of lymph node status in patients with urothelial carcinoma—still in search of the perfect imaging modality: a systematic review
title_short Evaluation of lymph node status in patients with urothelial carcinoma—still in search of the perfect imaging modality: a systematic review
title_sort evaluation of lymph node status in patients with urothelial carcinoma—still in search of the perfect imaging modality: a systematic review
topic Review Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6212628/
https://www.ncbi.nlm.nih.gov/pubmed/30456182
http://dx.doi.org/10.21037/tau.2018.08.28
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