Imaging of the thorax in the management of germ cell testicular tumours

• Published in: Clinical radiology Vol. 54; no. 4; pp. 207 - 211
• Main Authors: White, P.M., Adamson, D.J.A., Howard, G.C.W., Wright, A.R.
• Format: Journal Article
• Language: English
• Published: Amsterdam Elsevier Ltd 01-04-1999; Elsevier; Elsevier Science Ltd
• Subjects: Biological and medical sciences; computed tomography (CT); False Negative Reactions; False Positive Reactions; Follow-Up Studies; Germinoma - diagnostic imaging; Germinoma - secondary; Gynecology. Andrology. Obstetrics; Humans; Lymphatic Metastasis; Male; Male genital diseases; Medical sciences; Neoplasm Staging; Retrospective Studies; Seminoma - diagnostic imaging; Seminoma - secondary; teratoma; Testicular Neoplasms - pathology; testis; Thoracic Neoplasms - diagnostic imaging; Thoracic Neoplasms - secondary; Tomography, X-Ray Computed; Tumors; utilization; utilization; testis; computed tomography (CT); teratoma; Human; Lung disease; Statistical analysis; Radiodiagnosis; Respiratory disease; Lung; Male; Thorax; Malignant tumor; Metastasis; Testicle; Malignant teratoma; Radiography; Germ cell tumor; Clinical management; Surveillance; Medical imagery; Complication; Computerized axial tomography; Male genital diseases; Testicular diseases
• ISSN: 0009-9260; 1365-229X
• DOI: 10.1016/S0009-9260(99)91152-2

AIM: To evaluate role of chest computed tomography (CTC) and chest radiography (CXR) in management of patients with testicular germ cell tumours (GCT).
PATIENTS AND METHODS: An analysis was undertaken of staging and re-assessment CTC and CXR examinations performed on patients with GCT over a 4.5-year period. Data were obtained on clinical presentation, tumour histology, tumour marker levels and clinical course. Consensus review interpretation was combined with these data to obtain a `standard of reference'. Sensitivity, specificity and predictive values were derived by comparison of original imaging reports to ‘standard of of reference’.
RESULTS: Six hundred and twenty-three CTC examinations on 207 patients with GCT were included. Intrathoracic metastases were identified in 1 % of seminoma patients compared with 20 % of non-seminoma (NSGCT) patients. CTC was more accurate than CXR in the detection of intrathoracic metastases at 0.97, 0.96-0.98 (95% Cl) compared with 0.91, 0.89-0.93. The agreement between imaging techniques and the standard of reference (determined by Kappa statistic) was respectively 0.96 for CTC and 0.65 for CXR. In GCT patients undergoing re-assessment with both CXR and CTC, CXR never detected unknown intrathoracic metastatic disease. Abdominopelvic lymphadenopathy was associated with intrathoracic metastases (P<0.001), however re-assessment CTC did identify intrathoracic metastases in 27 cases without concurrent abdominopelvic disease. CXR was negative in 19 of these.
CONCLUSION: Routine interval CXRs are unnecessary in NSGCT patients undergoing regular re-assessment CTC due to the low additional yield and limited effect on management. Re-assessment should still include CTC. In low risk, pure seminoma patients (abdominal CT and marker negative) re-assessment CTC can be safely avoided. Baseline CTC is advocated with CXR alone for re-assessment.