THE ROLE OF COMPUTED TOMOGRAPHIC EXAMINATION OF THE PELVIS IN THE MANAGEMENT OF TESTICULAR GERM-CELL TUMORS

Aim: To clarify the role of pelvic CT in the imaging of patients with germ cell testicular tumours (GCPT). Patients and methods: A retrospec tive analysis was undertaken of all CT examinations performed on patie nts with GCTT at a regional oncological centre over a 3-year-period, P atient notes were reviewed and data on histology, tumour marker levels , therapy and clinical course obtained. The review interpretation,vas combined with the original radiological report and clinical data to ar rive at a consensus result. Results: Four hundred and forty-three exam inations on 167 patients were included. One hundred and nineteen exami nations (27%) demonstrated abdominal and/or pelvic lymph node enlargem ent. Modal metastasis was entirely or predominantly ipsilateral in 73/ 77 examinations from left-sided primary tumours (95%) and 35/42 examin ations from right-sided tumours (83%). Pelvic nodal enlargement was id entified in 37 examinations from 16 patients, Thirteen of these sixtee n patients possessed an identifiable risk factor for pelvic nodal meta stasis; the remaining three had unequivocal nodal metastases in the ab domen, Combined abdominopelvic CT increased the effective dose equival ent (EDF) by 2.6 mSv (74%) compared with abdominal examination alone. Three hundred pelvic CT examinations were performed on 117 patients wi thout risk factors for pelvic nodal metastasis. For this cohort tile r adiation burden from pelvic CT was 0.78 manSv, giving a risk of induct ion of a single fatal cancer of 3.9%. Conclusion: We advocate pelvic C T only at the time of staging, except in patients with a risk factor f or pelvic nodal metastasis. Any unequivocal abdominal lymph node enlar gement should be regarded as a risk factor, Implementation of this pol icy would safely reduce pelvic CT examinations in patients with testic ular rumours by nearly 50%, with a consequent reduction in patient rad iation exposures and a resource saving.