title: CT restaging of testicular germ cell tumors: The incidence of isolated pelvic metastases.
abstract: OBJECTIVE
  We determined the incidence of isolated pelvic metastases at restaging computed tomography (CT) in patients with testicular germ cell tumors to consider if imaging the pelvis could be omitted.
  
  
  METHODS
  After receiving IRB approval for this HIPAA-compliant retrospective study, medical records of 560 men (mean age 32.8) with 583 testicular germ cell tumors who underwent 3683 restaging CT scans of the abdomen and pelvis were reviewed to determine the proportion of patients with metastatic disease in the pelvis alone, as verified by histology or by resolution after therapy. Chi-square statistical analysis tested the association between factors currently thought to predispose patients to pelvic metastases. Patients were also categorized by clinical stage, tumor histology, and initial treatment.
  
  
  RESULTS
  Isolated pelvic metastases were detected in nine (1.6%) of 560 men. Neither bulky abdominal disease (p=0.85) nor extratesticular invasion by the primary tumor (p=0.37) were statistically significant in predicting which patients were more likely to have isolated pelvic metastases. Among the nine patients with isolated pelvic recurrence, only three (0.7%) of 408 men with no known pelvic disease at initial staging and no tumor marker elevation at restaging had isolated pelvic metastases. Isolated pelvic recurrence was not statistically different when analyzed by initial stage and treatment.
  
  
  CONCLUSIONS
  The incidence of isolated pelvic metastases in testicular germ cell tumors at restaging CT is low, but no group of patients was found to be without risk. Therefore, given the small, if any, risk of radiation-induced harm, the decision about whether to include routine pelvic CT in surveillance protocols should be individualized.
authors.affiliation: Division of Abdominal Imaging and Intervention, Department of Radiology, Brigham and Women's Hospital, 75 Francis St., Boston, MA 02115, United States. Electronic address: csadow@partners.org.
authors.forename: Cheryl A
authors.initials: CA
authors.lastname: Sadow
authors.affiliation: Division of Abdominal Imaging and Intervention, Department of Radiology, Brigham and Women's Hospital, 75 Francis St., Boston, MA 02115, United States; Current address: Department of Radiology, Medstar Georgetown University Hospital, 3800 Reservoir Rd., Washington DC 20007, United States.
authors.forename: Amma N
authors.initials: AN
authors.lastname: Maurer
authors.affiliation: Department of Radiology and Center for Evidenced-Based Imaging, Brigham and Women's Hospital, 75 Francis St., Boston, MA 02115, United States; Current address: Department of Radiology, The Ohio State Wexner Medical Center, 395 W 12th Ave., Columbus, OH 43210, United States.
authors.forename: Luciano M
authors.initials: LM
authors.lastname: Prevedello
authors.affiliation: Division of Genitourinary Oncology, Department of Oncology, Dana-Farber Cancer Institute, 450 Brookline Ave., Boston, MA 02215, United States.
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Sweeney
authors.affiliation: Division of Abdominal Imaging and Intervention, Department of Radiology, Brigham and Women's Hospital, 75 Francis St., Boston, MA 02115, United States.
authors.forename: Stuart G
authors.initials: SG
authors.lastname: Silverman
mesh_terms: D000328:Adult; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D009367:Neoplasm Staging; D009373:Neoplasms, Germ Cell and Embryonal / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000473:pathology*; D016609:Neoplasms, Second Primary / Q000000981:diagnostic imaging*; D010386:Pelvic Neoplasms / Q000556:secondary*; D010388:Pelvis / Q000000981:diagnostic imaging; D012189:Retrospective Studies; D012307:Risk Factors; D013736:Testicular Neoplasms / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000473:pathology*; D014057:Tomography, X-Ray Computed / Q000379:methods*
keywords: Radiation reduction; Restaging CT; Testicular cancer