Staging and Surveillance of Testicular Cancer 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]. For nonseminoma testicular cancer, a slight advantage for chest CT has been noted compared with chest radiography [48,51], and chest CT is recommended during the initial staging of nonseminoma testicular cancer by the NCCN and European Association of Urology guidelines [8,9]. Detection of mediastinal and hilar lymph nodes may be aided by the use of iodinated IV contrast media [33]. 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], 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 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 DWI. DWI can substantially improve identification of lymph nodes; however, it is still limited by significant overlap between benign and malignant 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].
Staging and Surveillance of Testicular Cancer. Staging and Surveillance of Testicular Cancer 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]. For nonseminoma testicular cancer, a slight advantage for chest CT has been noted compared with chest radiography [48,51], and chest CT is recommended during the initial staging of nonseminoma testicular cancer by the NCCN and European Association of Urology guidelines [8,9]. Detection of mediastinal and hilar lymph nodes may be aided by the use of iodinated IV contrast media [33]. 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], 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 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 DWI. DWI can substantially improve identification of lymph nodes; however, it is still limited by significant overlap between benign and malignant 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].