Skip to main content
British Journal of Cancer logoLink to British Journal of Cancer
. 2000 Sep 4;83(7):863–869. doi: 10.1054/bjoc.2000.1389

Fluorodeoxyglucose positron emission tomography in the evaluation of germ cell tumours at relapse

S F Hain 1, M J O’Doherty 1, A R Timothy 2, M D Leslie 2, P G Harper 2, R A Huddart 3
PMCID: PMC2374687  PMID: 10970686

Abstract

Differentiation of active disease from fibrosis/mature teratoma in patients with residual masses or identifying of sites of recurrence in patients with raised markers following treatment of their testicular cancer remains a problem.18F-fluorodeoxyglucose positron emission tomography (FDG-PET) has the potential to identify active disease and thereby influence further management in these patients. We performed a retrospective study of the use of FDG-PET in detecting residual/recurrent testicular carcinoma in 55 patients (seventy FDG-PET scans). Forty-seven scans were for the assessment of residual masses (18 had raised markers) and 23 scans were for the investigation of raised markers in the presence of normal CT scans. True positive results were based on positive histology or clinical follow-up. FDG-PET had a positive predictive value (PPV) of 96% and a negative predictive value (NPV) of 90% in patients with residual masses. This PPV was equivalent to that of markers (94%) but FDG-PET had the advantage of identifying the site of that recurrence. The NPV was higher than that of markers. In patients with raised markers alone the PPV of FDG-PET was 92% but the NPV was only 50%. However, subsequent FDG-PET imaging was frequently the first imaging modality to identify the site of disease. FDG-PET effected a management change in 57% of cases. FDG-PET scanning detected viable tumour in residual masses and identified sites of disease in suspected recurrence. © 2000 Cancer Research Campaign

Keywords: fluorodeoxyglucose, positron emission tomography, testicular cancer

Full Text

The Full Text of this article is available as a PDF (981.5 KB).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Coogan C. L., Foster R. S., Rowland R. G., Bihrle R., Smith E. R., Jr, Einhorn L. H., Roth B. J., Donohue J. P. Postchemotherapy retroperitoneal lymph node dissection is effective therapy in selected patients with elevated tumor markers after primary chemotherapy alone. Urology. 1997 Dec;50(6):957–962. doi: 10.1016/S0090-4295(97)00458-5. [DOI] [PubMed] [Google Scholar]
  2. Cremerius U., Effert P. J., Adam G., Sabri O., Zimmy M., Wagenknecht G., Jakse G., Buell U. FDG PET for detection and therapy control of metastatic germ cell tumor. J Nucl Med. 1998 May;39(5):815–822. [PubMed] [Google Scholar]
  3. Ganjoo K. N., Chan R. J., Sharma M., Einhorn L. H. Positron emission tomography scans in the evaluation of postchemotherapy residual masses in patients with seminoma. J Clin Oncol. 1999 Nov;17(11):3457–3460. doi: 10.1200/JCO.1999.17.11.3457. [DOI] [PubMed] [Google Scholar]
  4. Javadpour N. Current status of tumor markers in testicular cancer. A practical review. Eur Urol. 1992;21 (Suppl 1):34–36. doi: 10.1159/000474885. [DOI] [PubMed] [Google Scholar]
  5. Kalofonos H. P., Kosmas C., Pawlikowska T. R., Bamias A., Snook D., Dhokia B., Sivolapenko G. B., Courtenay-Luck N. S., Epenetos A. A. Immunolocalisation of testicular tumours using radiolabelled monoclonal antibody to placental alkaline phosphatase. J Nucl Med Allied Sci. 1990 Oct-Dec;34(4):294–298. [PubMed] [Google Scholar]
  6. Lodge M. A., Lucas J. D., Marsden P. K., Cronin B. F., O'Doherty M. J., Smith M. A. A PET study of 18FDG uptake in soft tissue masses. Eur J Nucl Med. 1999 Jan;26(1):22–30. doi: 10.1007/s002590050355. [DOI] [PubMed] [Google Scholar]
  7. Müller-Mattheis V., Reinhardt M., Gerharz C. D., Fürst G., Vosberg H., Müller-Gärtner H. W., Ackermann R. Die Positronenemissionstomographie mit [18 F]-2-fluoro-2-deoxy-D-glukose (18FDG-PET) bei der Diagnostik retroperitonealer Lymphknotenmetastasen von Hodentumoren. Urologe A. 1998 Nov;37(6):609–620. doi: 10.1007/s001200050223. [DOI] [PubMed] [Google Scholar]
  8. O'Doherty M. J., Barrington S. F., Campbell M., Lowe J., Bradbeer C. S. PET scanning and the human immunodeficiency virus-positive patient. J Nucl Med. 1997 Oct;38(10):1575–1583. [PubMed] [Google Scholar]
  9. Rathmell A. J., Brand I. R., Carey B. M., Jones W. G. Early detection of relapse after treatment for metastatic germ cell tumour of the testis: an exercise in medical audit. Clin Oncol (R Coll Radiol) 1993;5(1):34–38. doi: 10.1016/s0936-6555(05)80694-6. [DOI] [PubMed] [Google Scholar]
  10. Saunders C. A., Dussek J. E., O'Doherty M. J., Maisey M. N. Evaluation of fluorine-18-fluorodeoxyglucose whole body positron emission tomography imaging in the staging of lung cancer. Ann Thorac Surg. 1999 Mar;67(3):790–797. doi: 10.1016/s0003-4975(98)01257-0. [DOI] [PubMed] [Google Scholar]
  11. Stephens A. W., Gonin R., Hutchins G. D., Einhorn L. H. Positron emission tomography evaluation of residual radiographic abnormalities in postchemotherapy germ cell tumor patients. J Clin Oncol. 1996 May;14(5):1637–1641. doi: 10.1200/JCO.1996.14.5.1637. [DOI] [PubMed] [Google Scholar]
  12. Sugawara Y., Zasadny K. R., Grossman H. B., Francis I. R., Clarke M. F., Wahl R. L. Germ cell tumor: differentiation of viable tumor, mature teratoma, and necrotic tissue with FDG PET and kinetic modeling. Radiology. 1999 Apr;211(1):249–256. doi: 10.1148/radiology.211.1.r99ap16249. [DOI] [PubMed] [Google Scholar]
  13. Uchiyama M., Kantoff P. W., Kaplan W. D. Gallium-67-citrate imaging in extragonadal and gonadal seminomas: relationship to radiologic findings. J Nucl Med. 1994 Oct;35(10):1624–1630. [PubMed] [Google Scholar]
  14. Warren G. P., Einhorn L. H. Gallium scans in the evaluation of residual masses after chemotherapy for seminoma. J Clin Oncol. 1995 Nov;13(11):2784–2788. doi: 10.1200/JCO.1995.13.11.2784. [DOI] [PubMed] [Google Scholar]
  15. de Wit M., Bumann D., Beyer W., Herbst K., Clausen M., Hossfeld D. K. Whole-body positron emission tomography (PET) for diagnosis of residual mass in patients with lymphoma. Ann Oncol. 1997;8 (Suppl 1):57–60. [PubMed] [Google Scholar]

Articles from British Journal of Cancer are provided here courtesy of Cancer Research UK

RESOURCES