Imaging of the thorax in the management of germ cell testicular tumours

AIM: To evaluate role of chest computed tomography (CTC) and chest radiogra phy (CXR) in management of patients with testicular germ cell tumours (GCT) , PATIENTS AND METHODS: An analysis was undertaken of staging and re-assessme nt CTC and CXR examinations performed on patients with GCT over a 4.5-year period, Data were obtained on clinical presentation, tumour histology, tumo ur marker levels and clinical course. Consensus review interpretation was c ombined with these data to obtain a 'standard of reference'. Sensitivity, s pecificity and predictive values were derived by comparison of original ima ging reports to 'standard of reference'. RESULTS: Six hundred and twenty-three CTC examinations on 207 patients with GCT were included. Intrathoracic metastases were identified in 1% of semin oma patients compared with 20% of non-seminoma (NSGCT) patients. CTC was mo re accurate than CXR in the detection of intrathoracic metastases at 0.97, 0.96-0.98 (95% CI) compared with 0.91, 0.89-0.93. The agreement between ima ging techniques and the standard of reference (determined by Kappa statisti c) was respectively 0.96 for CTC and 0.65 for CXR, In GCT patients undergoi ng re-assessment with both CXR and CTC, CXR never detected unknown intratho racic metastatic disease. Abdominopelvic lymphadenopathy was associated wit h intrathoracic metastases (P < 0.001), however re-assessment CTC did ident ify intrathoracic metastases in 27 cases without concurrent abdominopelvic disease. CXR was negative in 19 of these, CONCLUSION: Routine interval CXRs are unnecessary in NSGCT patients undergo ing regular re-assessment CTC due to the low additional yield and limited e ffect on management. Re-assessment should still include CTC, In low risk, p ure seminoma patients (abdominal CT and marker negative) re-assessment CTC can be safely avoided, Baseline CTC is advocated with CXR alone for re-asse ssment.