10.6084/M9.FIGSHARE.C.6239016
Ciara Conduit
Ciara
Conduit
University of Melbourne
Walter and Eliza Hall Institute of Medical Research
Peter MacCallum Cancer Centre
Thuan Tzen Koh
Thuan Tzen
Koh
Peter MacCallum Cancer Centre
Flinders Medical Centre
Michael S Hofman
Michael S
Hofman
University of Melbourne
Peter MacCallum Cancer Centre
Guy C Toner
Guy C
Toner
University of Melbourne
Peter MacCallum Cancer Centre
Jeremy Goad
Jeremy
Goad
Peter MacCallum Cancer Centre
Nathan Lawrentschuk
Nathan
Lawrentschuk
Peter MacCallum Cancer Centre
Royal Melbourne Hospital
Keen-Hun Tai
Keen-Hun
Tai
University of Melbourne
Peter MacCallum Cancer Centre
Jeremy H Lewin
Jeremy H
Lewin
University of Melbourne
Peter MacCallum Cancer Centre
Ben Tran
Ben
Tran
University of Melbourne
Walter and Eliza Hall Institute of Medical Research
Peter MacCallum Cancer Centre
Two decades of FDG-PET/CT in seminoma: exploring its role in diagnosis, surveillance and follow-up
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. 2-18fluoro-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 SUVmax 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 (nā=ā36): 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 (nā=ā36): 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.
Space Science
Medicine
Cell Biology
Molecular Biology
Neuroscience
59999 Environmental Sciences not elsewhere classified
Cancer
111714 Mental Health
figshare
2022
2022-10-10
2022-10-10
Collection
10.1186/s40644-022-00496-w
CC BY 4.0