Adult UrologyDoes positron emission tomography using 18-fluoro-2-deoxyglucose improve clinical staging of testicular cancer?— results of a study in 50 patients
Section snippets
Patients
Fifty patients with germ cell cancer underwent PET imaging in addition to routine staging after the initial diagnosis. The study was approved by the local ethical committee, and the patients were informed in detail about the PET examination. The median age of all patients was 31 years (range 20 to 76). The histopathologic diagnosis after orchiectomy was pure seminoma in 30 patients, embryonal carcinoma in 7, teratocarcinoma in 5, mixed tumor in 5, and teratoma in 2 patients. Unclassified germ
Results
Metastatic spread was finally suspected in 14 (28%) of 50 patients. It was more common in nonseminomatous (10 of 19 patients) than in seminomatous (4 of 30 patients) tumors. In the patient with unclassified retroperitoneal germ cell tumor, no additional lesions were present. Table I shows the performance of all three diagnostic modalities for detection of malignant lesions. The differences were not statistically significant using Fisher’s exact test.
In comparison to the final clinical staging,
Comment
The use of FDG PET in patients with testicular cancer has been reported by several investigators.9, 11, 12, 13, 14, 15 Although the clinical usefulness of FDG PET was demonstrated in re-evaluation after chemotherapy,9, 12 its value for initial staging has only recently been studied in detail.15 In contrast to the study by Müller-Mattheis et al.,15 in the present study, “whole-body” PET was performed that encompassed the abdomen and chest in most of the patients. Comparison with CT may be
Conclusions
FDG PET has the potential to improve clinical staging of testicular cancer. However, PET, as well as CT, is limited in the detection of small retroperitoneal lymph node metastases. Larger trials are needed to draw a final conclusion about the usefulness of FDG PET imaging as a routine method for staging testicular cancer. Such a trial is now being performed in Germany.23
Acknowledgements
To the technicians of our PET group for their skilled work and to A. Rodón for editorial assistance.
References (23)
- et al.
Staging of testis cancer. Combining serum markers, histologic parameters, and radiographic imaging
Urol Clin North Am
(1998) - et al.
Retroperitoneal imaging with third and fourth generation computed axial tomography in clinical stage I nonseminomatous germ cell tumors
Urology
(1994) - et al.
Retroperitoneal lymphadenectomy in staging and treatment. The development of nerve-sparing techniques
Urol Clin North Am
(1998) - et al.
Positron emission tomography in urological oncology
J Urol
(1998) - et al.
Detection of residual tumours in postchemotherapy testicular cancer by FDG-PET
Eur J Cancer
(1997) - Warburg O: The Metabolism of Tumours. London, England, Constable,...
- et al.
Positron emission tomography as a diagnostic tool in oncology
Eur Radiol
(1998) - Sobin LH, and Wittekind C (Eds): TNM Classification of Malignant Tumours, 5th ed. New York, John Wiley & Sons, 1997, pp...
- et al.
Normal pelvic lymph nodesevaluation with CT after bipedal lymphangiography
Radiology
(1995) - et al.
FDG PET for detection and therapy control of metastatic germ cell tumor
J Nucl Med
(1998)
The applications of PET in clinical oncology
J Nucl Med
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