The role of ¹⁸fluoro‐2‐deoxyglucose positron emission tomography in initial staging and re‐staging after chemotherapy for testicular germ cell tumours

Abstract

Objective To investigate the role of 18 fluoro-2-deoxyglucose positron emission tomography (FDG-PET) tumorous residual mass the FDG-PET scan was clearly positive; in four of 12 with mature teratoma and inflammation components retroperitoneally, the FDG-PET was also positive. In contrast, eight patients with solitary mature teratoma had a negative PET result. In four of five patients with necrosis after chemotherapy the PET result was correctly negative. All eight patients on surveillance had a negative PET scan and were free of disease at median (range) of 14 (8-18) months. Interestingly, of the 12 patients with a correct negative PET result, 11 had no mature teratoma in their primary tumour. Nine of 10 patients with SGCT were correctly staged. Two FDG-PET studies showed increased uptake; in one, a viable seminomatous mass was found and in the other there was inflammation in the residual mass. In all other patients the FDG-PET scan correctly predicted absence of viability in the residual mass. Conclusions In primary staging, FDG-PET has no benefit over CT. In re-staging, a negative FDG-PET result predicts fibrotic residual mass in seminomatous GCT. Moreover, it could be useful to predict fibrotic residual mass in NSGCT in those patients with no teratoma component in their primary tumour.

Management of residual mass in nonseminomatous germ cell tumors following chemotherapy

“…A postchemotherapy residual mass is the most common indication for FDG-PET [Karapetis et al 2003]. In NSGCTs, PET scans cannot differentiate teratoma from necrosis/fibrosis, but has been used to predict fibrotic residual mass in patients with no teratoma in their primary tumor [Spermon et al 2002]. Although a positive PET scan is highly suggestive of residual viable cancer, false-negative rates of up to 40% have been reported in a prospective trial [Pfannenberg et al 2004].…”

Diagnostic Accuracy of 18F-FDG-PET in Patients with Testicular Cancer: a Meta-analysis

“…False-negative and the unsatisfactory sensitivity may be given in following conditions. Micro-tumor and micrometastases have lower uptake values which might be masked by the higher uptake of the primary tumor, which can infect the false-negative results (Hoekstra et al, 1993;Cremerius et al, 1998;Hofer et al, 2001;Spermon et al, 2002;Antoch et al, 2004). In addition, timing of the PET scan is important, for patients examined within 10-14 days of chemotherapy may result in false-negative (Cremerius et al, 1998, Hain, 2005.…”

“…Ultimately, 21 studies were excluded for undesirable article types (n=21), not written in English (n=6), and insufficient data (n=4), letter (n=2), case report (n=1), and review (n=8). Thus, 16 studies were included in our final dataset for the meta-analysis (Cremerius et al, 1998;Albers et al, 1999;Cremerius et al, 1999;Hain et al, 2000;Bokemeyer et al, 2002;Spermon et al, 2002;Tsatalpas et al, 2002;Lassen et al, 2003;De Santis et al, 2004;Becherer et al, 2005;de Wit et al, 2008;Hinz et al, 2008;Oechsle et al, 2008;Akbulut et al, 2011;Bachner et al, 2012;Siekiera et al, 2012). The flowchart of study selection was shown in Figure 1.…”

Positron Emission Tomography/Computed Tomography in Mediastinal Masses

“…Matür teratomun F-18 FDG ile görüntülenmesi normal/normale yakın glikoz metabolizması olan, düşük proliferasyon oranı gösteren benign bir oluşum olduğundan zordur (41,42,43,44). Tedavi genel olarak total cerrahi yapılmasıdır.…”