FDG PET is superior to CT in the prediction of viable tumour in post-chemotherapy seminoma residuals
Standard
FDG PET is superior to CT in the prediction of viable tumour in post-chemotherapy seminoma residuals. / Becherer, Alexander; De Santis, Maria; Karanikas, Georgios; Szabó, Monica; Bokemeyer, Carsten; Dohmen, Bernhard M; Pont, Jörg; Dudczak, Robert; Dittrich, Christian; Kletter, Kurt.
in: EUR J RADIOL, Jahrgang 54, Nr. 2, 05.2005, S. 284-8.Publikationen: SCORING: Beitrag in Fachzeitschrift/Zeitung › SCORING: Zeitschriftenaufsatz › Forschung › Begutachtung
Harvard
APA
Vancouver
Bibtex
}
RIS
TY - JOUR
T1 - FDG PET is superior to CT in the prediction of viable tumour in post-chemotherapy seminoma residuals
AU - Becherer, Alexander
AU - De Santis, Maria
AU - Karanikas, Georgios
AU - Szabó, Monica
AU - Bokemeyer, Carsten
AU - Dohmen, Bernhard M
AU - Pont, Jörg
AU - Dudczak, Robert
AU - Dittrich, Christian
AU - Kletter, Kurt
PY - 2005/5
Y1 - 2005/5
N2 - AIM: In advanced seminoma the management of residuals after completion of chemotherapy is controversial. Some centres routinely perform surgery for lesions > or =3 cm diameter, others recommend surgery solely if the residual fail to shrink or show even growth. This study prospectively investigates whether FDG PET can improve the prediction of viable tumour in post-chemotherapy seminoma residuals.MATERIALS AND METHODS: After an expansion of a previous study population, 54 patients from eight centres with metastatic seminoma and a CT-documented mass after chemotherapy were included in the study. Six patients were excluded from evaluation because of protocol violations. After PET, the patients underwent either surgery or were followed clinically. On follow-up the lesions were considered to be non-viable when there was unequivocal shrinking, or when the lesion remained morphologically stable for at least 24 months. Any lesion growth was assumed to be malignant. PET results were compared to CT discrimination (< or > or =3 cm) of the residual masses.RESULTS: Fifty-two PET scans were evaluable. After adequate chemotherapy, there were 74 CT-documented residual masses ranging in size from 1 to 11 cm (median, 2.2 cm). Their dignities were confirmed histologically in 13 lesions, or by follow-up CT in 61 lesions. Four of forty-seven lesions <3 cm and 11/27 lesions > or =3 cm were viable. PET was true positive in one lesion <3 cm and in 11 lesions > or =3 cm, false negative in three lesions <3 cm, and true negative in 59 lesions (43 lesions <3 cm). No PET scan was false positive. In detecting viability the sensitivity and specificity was 73% (95% CI, 44-88), and 73% (59-83), respectively, for CT (< or > or =3 cm); and 80% (51-95), and 100% (93-100), respectively, for PET (specificity, P < 0.001).CONCLUSION: In post-chemotherapy seminoma residuals, a positive PET is highly predictive for the presence of viable tumour. The specificity of PET is significantly higher than that of CT when using a > or =3 cm cut-off. A negative PET scan is excellent for the exclusion of disease in lesions > or =3 cm, with a somewhat higher sensitivity than CT (n.s.). PET can contribute to the management of residual seminoma lesions, especially in terms of avoiding unnecessary additional treatment for patients with lesions > or =3 cm.
AB - AIM: In advanced seminoma the management of residuals after completion of chemotherapy is controversial. Some centres routinely perform surgery for lesions > or =3 cm diameter, others recommend surgery solely if the residual fail to shrink or show even growth. This study prospectively investigates whether FDG PET can improve the prediction of viable tumour in post-chemotherapy seminoma residuals.MATERIALS AND METHODS: After an expansion of a previous study population, 54 patients from eight centres with metastatic seminoma and a CT-documented mass after chemotherapy were included in the study. Six patients were excluded from evaluation because of protocol violations. After PET, the patients underwent either surgery or were followed clinically. On follow-up the lesions were considered to be non-viable when there was unequivocal shrinking, or when the lesion remained morphologically stable for at least 24 months. Any lesion growth was assumed to be malignant. PET results were compared to CT discrimination (< or > or =3 cm) of the residual masses.RESULTS: Fifty-two PET scans were evaluable. After adequate chemotherapy, there were 74 CT-documented residual masses ranging in size from 1 to 11 cm (median, 2.2 cm). Their dignities were confirmed histologically in 13 lesions, or by follow-up CT in 61 lesions. Four of forty-seven lesions <3 cm and 11/27 lesions > or =3 cm were viable. PET was true positive in one lesion <3 cm and in 11 lesions > or =3 cm, false negative in three lesions <3 cm, and true negative in 59 lesions (43 lesions <3 cm). No PET scan was false positive. In detecting viability the sensitivity and specificity was 73% (95% CI, 44-88), and 73% (59-83), respectively, for CT (< or > or =3 cm); and 80% (51-95), and 100% (93-100), respectively, for PET (specificity, P < 0.001).CONCLUSION: In post-chemotherapy seminoma residuals, a positive PET is highly predictive for the presence of viable tumour. The specificity of PET is significantly higher than that of CT when using a > or =3 cm cut-off. A negative PET scan is excellent for the exclusion of disease in lesions > or =3 cm, with a somewhat higher sensitivity than CT (n.s.). PET can contribute to the management of residual seminoma lesions, especially in terms of avoiding unnecessary additional treatment for patients with lesions > or =3 cm.
KW - Abdomen
KW - Adult
KW - Fluorodeoxyglucose F18
KW - Follow-Up Studies
KW - Humans
KW - Male
KW - Middle Aged
KW - Neoplasm, Residual
KW - Positron-Emission Tomography
KW - Predictive Value of Tests
KW - Prospective Studies
KW - Radiographic Image Enhancement
KW - Radiography, Abdominal
KW - Radiography, Thoracic
KW - Radiopharmaceuticals
KW - Seminoma
KW - Sensitivity and Specificity
KW - Testicular Neoplasms
KW - Thorax
KW - Tomography, Spiral Computed
U2 - 10.1016/j.ejrad.2004.07.012
DO - 10.1016/j.ejrad.2004.07.012
M3 - SCORING: Journal article
C2 - 15837411
VL - 54
SP - 284
EP - 288
JO - EUR J RADIOL
JF - EUR J RADIOL
SN - 0720-048X
IS - 2
ER -