Intricacies of Radiographic Assessment in Testicular Germ Cell Tumors

被引:3
作者
Makovnik, Marek [1 ,2 ,3 ]
Rejlekova, Katarina [2 ,3 ]
Uhrin, Ivan [1 ]
Mego, Michal [2 ,3 ,4 ]
Chovanec, Michal [2 ,3 ]
机构
[1] Natl Canc Inst, Radiol Dept, Bratislava, Slovakia
[2] Comenius Univ, Dept Oncol 2, Fac Med, Bratislava, Slovakia
[3] Natl Canc Inst, Bratislava, Slovakia
[4] Comenius Univ, Translat Res Unit, Fac Med, Bratislava, Slovakia
关键词
follow-up; post-chemotherapy; active surveillance; magnetic resonance; computed tomography; testicular germ cell tumors; testis; positron emission tomography; computer tomography (PET/CT); POSITRON-EMISSION-TOMOGRAPHY; LYMPH-NODE DISSECTION; EUROPEAN CONSENSUS CONFERENCE; CLINICAL-PRACTICE GUIDELINES; STAGE-I; FDG-PET; PELVIC MALIGNANCIES; RESIDUAL MASSES; CANCER; DIAGNOSIS;
D O I
10.3389/fonc.2020.587523
中图分类号
R73 [肿瘤学];
学科分类号
100214 ;
摘要
Testicular germ cell tumors (GCTs) are malignancies with a unique biology, pathology, clinical appearance, and excellent outcomes. A correct radiographic assessment of GCTs is extremely important for the clinical management in several typical scenarios. Advancements in the field of diagnostic medicine bring an increasing number of sophisticated imaging methods to increase the performance of imaging studies. The conventional computed tomography (CT) remains the mainstay of diagnostic imaging in the management of GCTs. While certain improvements in the sensitivity and specificity are suggested with magnetic resonance (MR) imaging with lymphotrophic nanoparticles in evaluating retroperitoneal lymph nodes during the staging procedure, further exploration in larger prospective studies is needed. A common diagnostic dilemma is assessing the post-chemotherapy residual disease in GCTs. Several studies have consistently shown advantages in the utility of positron emission tomography (PET) scanning in post-chemotherapy residual retroperitoneal lymph nodes in patients with seminoma, but not with non-seminoma. Recommendations suggest that seminoma patients with a residual disease in the retroperitoneum larger than 3 cm should be subjected for PET scanning with 18-fluorodeoxyglucose. Relatively high sensitivity, specificity and a negative predictive value (80-95%) may guide clinical decision to spare these patients of high morbidity of an unnecessary surgery. However, a positive predictive value of around 50% renders PET scanning difficult to interpret in the case of positive finding. These patients often require extremely difficult surgical procedures with the high risk of post-operative morbidity. Therefore, seminoma patients with PET positive residual masses larger than 3 cm still remain a serious challenge in the decision making of nuclear medicine specialist, oncologists, and urologic surgeons. In this article, we aim to summarize data on controversial dilemmas in staging procedures, active surveillance, and post-chemotherapy assessment of GCTs based on the available published literature.
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页数:9
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