CT of the chest can hinder the management of seminoma of the testis; it detects irrelevant abnormalities

Abstract

To evaluate the role of chest CT in the initial staging of testicular seminomatous germ cell tumours. All patients referred to Addenbrooke's Hospital with testicular seminoma from 1 January 2000 to 31 December 2005 were included and case notes retrospectively reviewed. One hundred and eighty-two patients with testicular seminoma were identified, with a median age of 37 years (range 19–74). Most patients had stage I disease (86%). Twenty-four patients had abnormal abdominal CT findings. One hundred and fifty-eight had normal abdominal CT findings but, on initial staging, chest CT reported abnormalities in 13 patients, which, on further follow-up CT were deemed to be irrelevant to the diagnosis of seminoma. There was a further patient with a normal CT abdomen in whom chest CT detected obvious metastatic disease, which was seen on chest x -ray. Overall 18 cases required additional investigations and follow-up for abnormalities subsequently found to be benign. There was a false-positive rate of 10% for initial staging with chest CT. This is the largest reported series of staging CT chest in testicular seminoma. In all patients with normal abdominal CT, normal chest x -ray and abnormal chest CT, subsequent follow-up investigations demonstrated that the lung lesions were incidental findings.

Cryptorchidism With Bilateral Synchronous Testicular Germ Cell Tumour

“…In seminoma, the thoracic metastasis in the absence of retroperitoneal disease or elevated serum tumour markers is uncommon. According to Horan et al 8 , the routine chest CT may be associated with a high rate of false-positive findings, which may complicate subsequent therapy. CT of the thorax should be performed in patients with elevated post-orchiectomy levels of serum tumour markers, evidence of metastatic disease by physical examination or abdominopelvic CT or abnormal or equivocal findings on chest radiography.…”

Bilateral cryptorchidism with bilateral synchronous abdominal testicular germ cell tumour

“…In seminoma, the thoracic metastasis in the absence of retroperitoneal disease or elevated serum tumour markers is uncommon. According to Horan et al 8, the routine chest CT may be associated with a high rate of false-positive findings, which may complicate subsequent therapy. CT of the thorax should be performed in patients with elevated postorchiectomy levels of serum tumour markers, evidence of metastatic disease by physical examination or abdominopelvic CT or abnormal or equivocal findings on chest radiography.…”

Performance Characteristics of Clinical Staging Modalities for Early Stage Testicular Germ Cell Tumors: A Systematic Review

“…The 21 studies included 1,702 patients with a mean population age of 33.1 years (range of means 27 to 38 years). Of the 21 studies 1 focused on stages I and IIa seminoma, 17 6 examined nonseminomatous TGCT, 10,13,19,20,22,25 3 included seminoma and nonseminomatous TGCT, 16,18,21 and the remaining 11 did not specify tumor histology. 4,11,12,14,15,23,25e29 Two studies were on clinical stage I TGCT, 13,20 9 focused on stages I and II disease, 4,10,17,19,21e24,29 and clinical stage was not specified in the remaining 10 (supplementary table 3, https://www.jurology.com).…”

“…In 3 studies chest CT had a median sensitivity and specificity of 100% (mean 98%, range 95% to 100%) and 92.7% (mean 93%, 89% to 97%), and median PPV, NPV and accuracy of 67.7% (mean 60%, range 25% to 84%), 100% (mean 99.7%, 99% to 100%) and 92.9% (mean 94%, 91% to 97%), respectively. 12,17,21 CT of the chest, abdomen and pelvis was used in 3 studies without individual assessment of the abdominal and thoracic components of imaging. 4,23,28 Chest, abdomen and pelvic CT had a median sensitivity and specificity of 60% (mean 58%, range 40% to 73%) and 94% (mean 91%, 78% to 100%), and median PPV, NPV and accuracy of 85% (mean 75%, range 40% to 100%), 78% (mean 80%, 73% to 89%) and 81% (mean 79%, 68% to 88%), respectively.…”

“…18 The other 2 studies on seminoma focused on evaluation by chest imaging. 17,21 Fernandez et al accurately detected chest metastases with CXR and demonstrated no incremental benefit to CT chest, as sensitivity (100%) and NPV (100%) were identical for each modality. 21 Horan et al reported only incidental findings on chest CT in men with normal CT of the abdomen and normal CXR.…”