Evaluation of Computed Tomography for Lymph Node Staging in Bladder Cancer Prior to Radical Cystectomy.

OBJECTIVES: To retrospectively evaluate the value of CT for lymph node (LN) staging in bladder cancer. METHODS: Two uroradiologists reviewed CT scans of 231 patients who underwent radical cystectomy and pelvic lymphadenectomy according to a predefined 12-field template. A 5-step model was used to grade the radiological likelihood of a LN to represent malignant spread based on size, configuration and structure as well as regional clustering. Statistical analyses were performed both on patient- and field-based levels. RESULTS: LN metastases were found in 59 of 231 patients (25.5%). On a patient-based level, sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy were 52.6, 93.6, 73.2, 85.6 and 83.4%, respectively. Using the field-based approach, a total of 1,649 anatomical fields were evaluable, of which 114 fields showed malignancy (6.9%). On a field basis, sensitivity, specificity, PPV, NPV and accuracy were 30.2, 98, 51.5, 94.5 and 93.3%, respectively. Concerning local staging (pT category), the overall accuracy was 78%; overstaging occurred in 6% and understaging in 16%. CONCLUSIONS: In line with prior studies, the sensitivity of CT imaging for the detection of LN metastases was low, while high values for specificity were achieved. This was further underlined by analyzing standardized anatomical fields. Concerning local staging, postoperative changes after TURB-T rarely led to overstaging.

Presurgical treatment with sunitinib for renal cell carcinoma with a level III/IV vena cava tumour thrombus.

AIM: The feasibility and safety of a presurgical treatment approach with sunitinib for renal cell carcinoma (RCC) with level III/IV tumour thrombus in the inferior vena cava (IVC) were to be evaluated and its potential ability to reduce the surgical morbidity explored. PATIENTS AND METHODS: In our institution, we treated five consecutive patients with suspected RCC and a level III/IV IVC tumour thrombus with preoperative sunitinib (50 mg, 4 weeks on, 2 weeks off). Side dose effects were assessed and the effect on the tumour size and the dependent surgical approach documented with a computed tomographic scan before and after the treatment. The data were analyzed retrospectively. RESULTS: The overall tolerability to presurgical sunitinib was good. All procedures were carried out without perioperative complications. In four patients, a reduction in tumour size was observed, which resulted in avoidance of a bicavital surgical approach with cardiopulmonary bypass in one patient. This patient was diagnosed with papillary renal cancer; the other four patients had clear cell carcinomas. CONCLUSION: Presurgical treatment with sunitinib is able to ease surgery for RCC tumour thrombi regardless of the histological subtype in selected patients. In our series, surgery was possible without additional morbidity. Two courses of a presurgical therapy with sunitinib seems to be an appropriate duration. In accordance with previously published data, presurgical sunitinib treatment may become more widely used in RCC with level III/IV IVC tumour thrombi but administered with restraint in cases of level I/II thrombi. The effects on the risk of recurrence and survival remain to be evaluated prospectively.