[18F]Fluorodeoxyglucose positron emission tomography in nonseminomatous germ cell tumors after chemotherapy: the German multicenter positron emission tomography study group.
OBJECTIVE
In patients with metastatic nonseminomatous germ cell cancer (NSGCT), residual masses after chemotherapy (CTX) can consist of vital carcinoma, mature teratoma, or necrosis. This prospective trial has evaluated the accuracy of [(18)F]fluorodeoxyglucose positron emission tomography (FDG-PET) for the prediction of histology compared with computed tomography (CT) and serum tumor markers (STM).


METHODS
A total of 121 patients with stage IIC or III NSGCT scheduled for secondary resection after cisplatin-based CTX were included. FDG-PET was performed after completion of CTX. All results were confirmed by histopathology and correlated to STM and CT.


RESULTS
Prediction of tumor viability with FDG-PET was correct in 56%, which did not reach the expected clinically relevant level of 70%, and was not better than the accuracy of CT (55%) or STM (56%). Sensitivity and specificity of FDG-PET were 70% and 48%. The positive predictive values were not significantly different (55%, 61%, and 59% for CT, STM, and PET, respectively). Judging only vital carcinoma as a true malignant finding, the negative predictive value increased to 83% for FDG-PET.


CONCLUSIONS
The presence of vital carcinoma and mature teratoma is common (55%) in residual masses in patients with NSGCT, and CT and STM cannot reliably predict absence of disease. In contrast to prior studies, this prospective trial, which is the only with histologic confirmation in all patients, demonstrated that FDG-PET is unable to give a clear additional clinical benefit to the standard diagnostic procedures, CT and STM, in the prediction of tumor viability in residual masses.
Oechsle
Karin
K
Department of Oncology/Hematology, Bone marrow transplantation/Pneumology, University Medical Center Eppendorf, Martinistr. 52, 20246 Hamburg, Germany. k.oechsle@uke.uni-hamburg.de
Hartmann
Michael
M
Brenner
Winfried
W
Venz
Stephan
S
Weissbach
Lothar
L
Franzius
Christiane
C
Kliesch
Sabine
S
Mueller
Stephan
S
Krege
Susanne
S
Heicappell
Ruediger
R
Bares
Roland
R
Bokemeyer
Carsten
C
de Wit
Maike
M
D000293:Adolescent; D000328:Adult; D014408:Biomarkers, Tumor / Q000097:blood; D002470:Cell Survival; D002945:Cisplatin / Q000627:therapeutic use; D019788:Fluorodeoxyglucose F18; D006801:Humans; D008297:Male; D008875:Middle Aged; D018365:Neoplasm, Residual / Q000000981:diagnostic imaging*; D009373:Neoplasms, Germ Cell and Embryonal / Q000000981:diagnostic imaging* / Q000188:drug therapy* / Q000601:surgery; D049268:Positron-Emission Tomography; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012186:Retroperitoneal Neoplasms / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000601:surgery; D012680:Sensitivity and Specificity; D013736:Testicular Neoplasms / Q000000981:diagnostic imaging* / Q000188:drug therapy* / Q000601:surgery; D014057:Tomography, X-Ray Computed
D014408:Biomarkers, Tumor; D019788:Fluorodeoxyglucose F18; D002945:Cisplatin