However, the 2021 NCCN guidelines advise the use of chest CT in both patients with Stage I pure seminoma or nonseminoma testicular cancer with thoracic symptoms [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]. Staging and Surveillance of Testicular Cancer 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]. MRI Head MRI of the head is not recommended during the surveillance of pure seminoma testicular cancer unless the patient is symptomatic. Radiography Chest In pure seminoma testicular cancer under surveillance, studies have shown that lung relapses are rarely detected by chest radiography alone, with most relapses detected by abnormal serum markers or abdominal and pelvic CT scan [57-59], calling into question the value of chest radiography in surveillance of stage I pure seminoma testicular cancer.
Staging and Surveillance of Testicular Cancer. However, the 2021 NCCN guidelines advise the use of chest CT in both patients with Stage I pure seminoma or nonseminoma testicular cancer with thoracic symptoms [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]. Staging and Surveillance of Testicular Cancer 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]. MRI Head MRI of the head is not recommended during the surveillance of pure seminoma testicular cancer unless the patient is symptomatic. Radiography Chest In pure seminoma testicular cancer under surveillance, studies have shown that lung relapses are rarely detected by chest radiography alone, with most relapses detected by abnormal serum markers or abdominal and pelvic CT scan [57-59], calling into question the value of chest radiography in surveillance of stage I pure seminoma testicular cancer.