Positron emission tomography and histology of residual postchemotherapy masses in patients with nonseminomatous germ cell tumours


Authors: Jana Grimová 1*;  Tomáš Büchler 1*;  Pavel Fencl 2;  Kateřina Šimonová 2;  Zuzana Donátová 1;  Ludmila Boublíková 1;  Martin Kupec 1;  Jaroslav Jarabák 3;  Roman Zachoval 3;  Jitka Abrahámová 1
Authors‘ workplace: Onkologická klinika Thomayerovy nemocnice a 1. lékařské fakulty Univerzity Karlovy, Praha 1;  Oddělení nukleární medicíny a PET centrum, Nemocnice Na Homolce, Praha 2;  Urologické oddělení Thomayerovy nemocnice, Praha 3
Published in: Ces Urol 2012; 16(1): 43-49
Category: Original article

*přispěli stejným dílem

Overview

Aim:
The value of using fluorodeoxyglucose positron emission tomography (FDG-PET) before residual mass resection was studied in patients with nonseminomatous germ cell tumours (NSGCTs) after orchiectomy and platinumbased chemotherapy.

Methods:
Thirty patients with NSGCTs who had been investigated with FDG-PET in the preoperative period were evaluated retrospectively. We have calculated specificity, sensitivity, positive predictive value (PPV) and negative predictive value (NPV) of FDG-PET to correctly predictt he presence of viable carcinoma, mature teratoma,and necrotic/ scar tissue in postchemotherapy residual masses.

Results:
FDG-PET was evaluated as negative, positive, or inconclusive in 11 (37%), 17 (57%) and 2 (7%) patients, respectively. Histological examination of the resected residual masses showed immature tumour elements, mature teratoma, and no tumour structures in 12 (40%), 11 (37%), and 7(23%) patients, respectively. FDG-PET correctly identified only 50% of lesions with immature tumour elements. FDG-PET was negative in 13/21 (62%) patients with immature elements and/or mature teratoma – histologies that require surgical resection because of high risk of relapse.

Conclusions:
Sensitivity, specificity, PPV, and NPV of FDGPET were insufficient for characterisation of postchemotherapy residual lesions in NSGCT patients. These residual masses should be resected if technically possible regardless of the FDG-PET result.

Key words:
positron emission tomography, testicular cancer, therapy.


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Paediatric urologist Nephrology Urology
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