FDG-PET/CT Whole Body Fluorine-18-2-fluoro-2-deoxy-D-glucose (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], but it is not recommended by the NCCN [40]. 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 gadolinium-based contrast agents (GBCAs) [41,43]. A limitation of the literature regarding MRI for detection of metastatic retroperitoneal lymphadenopathy is that the studies are older and do not incorporate diffusion-weighted imaging (DWI). DWI can substantially improve identification of lymph nodes; however, it is still limited by significant overlap between benign and malignant Staging and Surveillance of Testicular Cancer lymph nodes [6]. A study published in 2020 showed comparable accuracy between MRI, which included DWI and omitted GBCAs, and CT for detection of metastatic retroperitoneal lymph nodes in testicular germ-cell tumors [47]. MRI Head MRI of the head, without and with GBCAs, is recommended during the initial staging of testicular cancer if the patient is symptomatic or has high-risk features (eg, human chorionic gonadotropin [hCG] >5000 IU/L or extensive lung metastases) [8-11]. Radiography Chest Studies have shown that chest radiography is beneficial in pure seminoma testicular cancer during the initial staging of testicular cancer to assess for the presence of pulmonary metastases [48,49]. Chest CT is recommended during initial staging if chest radiograph or abdominal CT is abnormal [8].
Staging and Surveillance of Testicular Cancer. FDG-PET/CT Whole Body Fluorine-18-2-fluoro-2-deoxy-D-glucose (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], but it is not recommended by the NCCN [40]. 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 gadolinium-based contrast agents (GBCAs) [41,43]. A limitation of the literature regarding MRI for detection of metastatic retroperitoneal lymphadenopathy is that the studies are older and do not incorporate diffusion-weighted imaging (DWI). DWI can substantially improve identification of lymph nodes; however, it is still limited by significant overlap between benign and malignant Staging and Surveillance of Testicular Cancer lymph nodes [6]. A study published in 2020 showed comparable accuracy between MRI, which included DWI and omitted GBCAs, and CT for detection of metastatic retroperitoneal lymph nodes in testicular germ-cell tumors [47]. MRI Head MRI of the head, without and with GBCAs, is recommended during the initial staging of testicular cancer if the patient is symptomatic or has high-risk features (eg, human chorionic gonadotropin [hCG] >5000 IU/L or extensive lung metastases) [8-11]. Radiography Chest Studies have shown that chest radiography is beneficial in pure seminoma testicular cancer during the initial staging of testicular cancer to assess for the presence of pulmonary metastases [48,49]. Chest CT is recommended during initial staging if chest radiograph or abdominal CT is abnormal [8].