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 The 2021 NCCN guidelines recommend chest radiography for surveillance of Stage I nonseminoma testicular cancer [8]. US Abdomen and Retroperitoneum US of the abdomen and retroperitoneum to detect retroperitoneal lymph node metastases is less accurate and reproducible than CT, MRI, or PET/CT [50]. US Scrotum Scrotal US does not have a role in the restaging of men with testicular cancer diagnosis established by orchiectomy unless there is concern for contralateral tumor or equivocal clinical examination [8]. Scrotal US should always be performed during the initial workup of a scrotal mass before orchiectomy to localize the tumor, plan surgery, and clear the contralateral testicle of disease [40]. After initial triage and orchiectomy, scrotal US does not have a role in the initial staging or restaging of men with testicular cancer diagnosis established by orchiectomy unless there is concern for contralateral tumor or equivocal clinical examination [8]. Staging and Surveillance of Testicular Cancer Variant 5: Surveillance of stage IA and IB pure seminoma and nonseminoma testicular cancer. Diagnosed by orchiectomy. Suspected recurrence. Bone Scan Whole Body Bone metastases from testicular cancer are uncommon.
Staging and Surveillance of Testicular Cancer. 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 The 2021 NCCN guidelines recommend chest radiography for surveillance of Stage I nonseminoma testicular cancer [8]. US Abdomen and Retroperitoneum US of the abdomen and retroperitoneum to detect retroperitoneal lymph node metastases is less accurate and reproducible than CT, MRI, or PET/CT [50]. US Scrotum Scrotal US does not have a role in the restaging of men with testicular cancer diagnosis established by orchiectomy unless there is concern for contralateral tumor or equivocal clinical examination [8]. Scrotal US should always be performed during the initial workup of a scrotal mass before orchiectomy to localize the tumor, plan surgery, and clear the contralateral testicle of disease [40]. After initial triage and orchiectomy, scrotal US does not have a role in the initial staging or restaging of men with testicular cancer diagnosis established by orchiectomy unless there is concern for contralateral tumor or equivocal clinical examination [8]. Staging and Surveillance of Testicular Cancer Variant 5: Surveillance of stage IA and IB pure seminoma and nonseminoma testicular cancer. Diagnosed by orchiectomy. Suspected recurrence. Bone Scan Whole Body Bone metastases from testicular cancer are uncommon.