PURPOSE: The aim of this study was to determine the predictive values of 2-[fluorine-18]fluoro-2-deoxy-D-glucose-positron emission tomography (FDG-PET) in primary staging in patients with newly diagnosed non-seminomatous germ cell tumour (NSGCT) clinical stage I/II. PATIENTS AND METHODS: The hypothesis was that FDG-PET would improve the negative predictive value (NPV) from 70% to 90%, thus requiring a total of 169 patients. All scans underwent visual analysis by a reference team of nuclear medicine physicians. Results were validated by histology following retroperitoneal lymph node dissection. RESULTS: Only 72 of the planned 169 patients were included, due to poor accrual. The prevalence of nodal involvement was 26%. Correct nodal staging by FDG-PET was achieved in 83% compared with correct computed tomography (CT) staging in 71%. CT had a sensitivity and specificity of 41% and 95%, respectively. Positive predictive value (PPV) and NPV were 87% and 67%, respectively. FDG-PET had a sensitivity and specificity of 66% and 98%, respectively. PPV was 95%. The primary end point was not reached, with an NPV of 78%. CONCLUSION: FDG-PET as a primary staging tool for NSGCT yielded only slightly better results than CT. Both methods had a high specificity while false-negative findings were more frequent with CT. FDG-PET is mostly useful as a diagnostic tool in case of questionable CT scan.
PURPOSE: The aim of this study was to determine the predictive values of 2-[fluorine-18]fluoro-2-deoxy-D-glucose-positron emission tomography (FDG-PET) in primary staging in patients with newly diagnosed non-seminomatous germ cell tumour (NSGCT) clinical stage I/II. PATIENTS AND METHODS: The hypothesis was that FDG-PET would improve the negative predictive value (NPV) from 70% to 90%, thus requiring a total of 169 patients. All scans underwent visual analysis by a reference team of nuclear medicine physicians. Results were validated by histology following retroperitoneal lymph node dissection. RESULTS: Only 72 of the planned 169 patients were included, due to poor accrual. The prevalence of nodal involvement was 26%. Correct nodal staging by FDG-PET was achieved in 83% compared with correct computed tomography (CT) staging in 71%. CT had a sensitivity and specificity of 41% and 95%, respectively. Positive predictive value (PPV) and NPV were 87% and 67%, respectively. FDG-PET had a sensitivity and specificity of 66% and 98%, respectively. PPV was 95%. The primary end point was not reached, with an NPV of 78%. CONCLUSION: FDG-PET as a primary staging tool for NSGCT yielded only slightly better results than CT. Both methods had a high specificity while false-negative findings were more frequent with CT. FDG-PET is mostly useful as a diagnostic tool in case of questionable CT scan.
Authors: J Beyer; P Albers; R Altena; J Aparicio; C Bokemeyer; J Busch; R Cathomas; E Cavallin-Stahl; N W Clarke; J Claßen; G Cohn-Cedermark; A A Dahl; G Daugaard; U De Giorgi; M De Santis; M De Wit; R De Wit; K P Dieckmann; M Fenner; K Fizazi; A Flechon; S D Fossa; J R Germá Lluch; J A Gietema; S Gillessen; A Giwercman; J T Hartmann; A Heidenreich; M Hentrich; F Honecker; A Horwich; R A Huddart; S Kliesch; C Kollmannsberger; S Krege; M P Laguna; L H J Looijenga; A Lorch; J P Lotz; F Mayer; A Necchi; N Nicolai; J Nuver; K Oechsle; J Oldenburg; J W Oosterhuis; T Powles; E Rajpert-De Meyts; O Rick; G Rosti; R Salvioni; M Schrader; S Schweyer; F Sedlmayer; A Sohaib; R Souchon; T Tandstad; C Winter; C Wittekind Journal: Ann Oncol Date: 2012-11-14 Impact factor: 32.976