Diagnosis and treatment of pelvic lymph node metastasis in bladder cancer

Background and Methods: Bipedal lymphography and percutaneous fine needle a spiration biopsy (FNAB) of pelvic lymph node was done in 200 patients with bladder cancer. Results: A diagnosis of metastasis to the pelvic lymph node was obtained by this method in 34 patients. Of these 34 patients, only 12 (35%) were posit ive or suspected of having pelvic lymph node metastasis by computed tomogra phy. Sixteen patients (47%) had unequivocally positive or highly suspicious lymphogram and 18 patients (53%) had normal lymphogram. Seventy-eight case s, including eight FNAB-positive cases, were treated by radical cystectomy and regional lymph node dissection. Sensitivity, specificity, positive pred ictive value and negative predictive value of FNAB were 57, 100, 100 and 41 %, respectively. Thirteen FNAB-positive MO patients could be treated by mul timodality therapy and evaluated after neoadjuvant therapy by repeated lymp hography and FNAB. All were changed to NO by FNAB after neoadjuvant therapy . Ln eight patients treated by total cystectomy and lymph node dissection, four had down staged to pN0 but four had one positive node. In five follow- up cases without surgery, one had recurrent pelvic lymph node metastasis 35 months later. Cause-specific survival of these patients was 76% at 5 years and 57% at 8 years. Conclusions: Pretreatment diagnosis of pelvic lymph node metastasis and mul timodality therapy may improve the prognosis of regional lymph node-positiv e bladder cancer. Because it is difficult to diagnose pN1 using FNAB, radic al operation should be performed even if neoadjuvant therapy is effective a nd down staging is obtained.