Two decades of FDG-PET/CT in seminoma: exploring its role in diagnosis, surveillance and follow-up
- Author(s)
- Conduit, C; Koh, TT; Hofman, MS; Toner, GC; Goad, J; Lawrentschuk, N; Tai, KH; Lewin, JH; Tran, B;
- Journal Title
- Cancer Imaging
- Publication Type
- Research article
- Abstract
- BACKGROUND: Survivors of testicular cancer may experience long-term morbidity following treatment. There is an unmet need to investigate techniques that can differentiate individuals who need additional therapy from those who do not. 2-(18)fluoro-deoxy-D-glucose (FDG) positron emission tomography (PET) with computerised tomography (CT) may be helpful in select settings and may be used outside of current evidence-based recommendations in real-world practice. METHODS: A institutional FDG-PET/CT database of scans performed between 2000 and 2020 for adults with testicular seminoma was interrogated. Endpoints of interest included the positive (PPV) and negative (NPV) predictive value of FDG-PET/CT for identifying active seminoma (defined by progressive radiology, response to treatment or biopsy); or no active seminoma within 24-months for patients with stage 1 and advanced seminoma. An exploratory analysis examining predictive role of SUV(max) was also performed. RESULTS: 249 patients met eligibility criteria for the analysis, including 184 patients with stage 1 and 77 patients with advanced testicular seminoma. Of 193 FDG-PET/CT performed in stage 1 seminoma with available follow-up data, 79 were performed during active surveillance. 18 (23%) of these were positive, all of which had confirmed recurrent seminoma (PPV 100%). Of 45 negative FDG-PET/CT during active surveillance, 4 recurrences developed corresponding to a NPV 91%. When clinical suspicion precipitated FDG-PET/CT (n = 36): PPV 100%, NPV 86%. Of 145 FDG-PET/CT in advanced seminoma with available follow-up data, 25 (17%) were performed at baseline (within 2 months of diagnosis), 70 (48%) post-treatment for evaluation of treatment response and 50 (34%) during follow-up following prior curative treatment. 10 (14%) post-treatment FDG-PET/CT were positive corresponding to a PPV 60%. Of 46 negative FDG-PET/CT, 5 recurrences occurred (NPV 89%). During follow-up after prior curative treatment, 24 (50%) FDG-PET/CT were positive corresponding to a PPV 83%; of 20 negative FDG-PET/CT, 1 recurrence occurred, NPV 95%. When clinical suspicion indicated FDG-PET/CT (n = 36): PPV 100%, NPV 94%. CONCLUSION: FDG-PET/CT offers high PPV for identifying seminoma and accurately predicts non-recurrence across a clinically relevant 24-months. Notably, FDG-PET/CT may prevent unnecessary treatment in 45% of patients undergoing investigation for clinical suspicion of recurrence during follow-up of advanced seminoma. The use of FDG-PET/CT in selected patients now, may help prevent unnecessary treatment of people with testicular seminoma.
- Keywords
- Adult; Fluorodeoxyglucose F18/therapeutic use; Follow-Up Studies; Glucose/therapeutic use; Humans; Male; Positron Emission Tomography Computed Tomography; Positron-Emission Tomography/methods; Radiopharmaceuticals/therapeutic use; Retrospective Studies; *Seminoma/diagnostic imaging/therapy; *Testicular Neoplasms/diagnostic imaging/therapy; Tomography, X-Ray Computed; Biomarkers; PET-CT scan; Seminomas; Testicular neoplasm; cancer survivors
- Department(s)
- Medical Oncology; Cancer Imaging; Surgical Oncology; Radiation Oncology; AYA Cancer Service
- PubMed ID
- 36209121
- Publisher's Version
- https://doi.org/10.1186/s40644-022-00496-w
- Open Access at Publisher's Site
https://doi.org/10.1186/s40644-022-00496-w- Terms of Use/Rights Notice
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Creation Date: 2024-10-17 03:12:11
Last Modified: 2024-10-17 03:12:37