Staging and Surveillance of Testicular Cancer The use of iodinated IV contrast media, as well as oral contrast media, may aid in detection of retroperitoneal lymph nodes, clarifying the adjacent normal anatomic structures including blood vessels and the duodenum [29]. Surveillance protocols no longer include chest CT [30] and may eliminate pelvic CT, except in cases in which the pelvis is deemed high risk [53-55]. The number and frequency schedule of follow-up CT examinations of the abdomen and pelvis is variable [56]. Most recently, the 2021 NCCN guidelines recommends different intensity of follow-up for stage I pure seminoma testicular cancer and nonseminoma testicular cancer, which also depends on the presence or absence of risk factors for metastatic disease [8]. CT Chest Although CT is more sensitive than radiography for detecting recurrent disease in the chest [30,31], this added sensitivity is offset by lower specificity and a higher false positive detection rate for abnormalities that are not metastatic [32]. Detection of mediastinal and hilar lymph nodes may be aided by the use of iodinated IV contrast media [33]. In patients with thoracic symptoms, the NCCN advises the use of CT chest for follow-up of patients with nonseminoma undergoing surveillance [8]. FDG-PET/CT Whole Body FDG-PET has been used for staging and restaging patients with testicular cancer, but its incremental value in staging patients compared with CT or MRI has yet to be defined. For initial staging, PET may be slightly more sensitive than CT [34-39]. MRI Abdomen and Pelvis MRI has also been studied for staging and surveillance of testicular cancer to identify metastatic retroperitoneal lymphadenopathy [41-46]. Limited evidence from single-institution studies indicates comparable efficacy to CT for detection of retroperitoneal lymphadenopathy, notably without the need for GBCAs [41,43].
Staging and Surveillance of Testicular Cancer. Staging and Surveillance of Testicular Cancer The use of iodinated IV contrast media, as well as oral contrast media, may aid in detection of retroperitoneal lymph nodes, clarifying the adjacent normal anatomic structures including blood vessels and the duodenum [29]. Surveillance protocols no longer include chest CT [30] and may eliminate pelvic CT, except in cases in which the pelvis is deemed high risk [53-55]. The number and frequency schedule of follow-up CT examinations of the abdomen and pelvis is variable [56]. Most recently, the 2021 NCCN guidelines recommends different intensity of follow-up for stage I pure seminoma testicular cancer and nonseminoma testicular cancer, which also depends on the presence or absence of risk factors for metastatic disease [8]. CT Chest Although CT is more sensitive than radiography for detecting recurrent disease in the chest [30,31], this added sensitivity is offset by lower specificity and a higher false positive detection rate for abnormalities that are not metastatic [32]. Detection of mediastinal and hilar lymph nodes may be aided by the use of iodinated IV contrast media [33]. In patients with thoracic symptoms, the NCCN advises the use of CT chest for follow-up of patients with nonseminoma undergoing surveillance [8]. FDG-PET/CT Whole Body FDG-PET has been used for staging and restaging patients with testicular cancer, but its incremental value in staging patients compared with CT or MRI has yet to be defined. For initial staging, PET may be slightly more sensitive than CT [34-39]. MRI Abdomen and Pelvis MRI has also been studied for staging and surveillance of testicular cancer to identify metastatic retroperitoneal lymphadenopathy [41-46]. Limited evidence from single-institution studies indicates comparable efficacy to CT for detection of retroperitoneal lymphadenopathy, notably without the need for GBCAs [41,43].