We aimed to synthesize evidence on the comparative performance characteristics, benefits, and harms of diagnostic imaging modalities used in combination with serum tumor markers in clinical staging of men with testicular germ cell tumors, including computed tomography, magnetic resonance imaging, positron emission tomography, and chest radiographs.
Paired reviewers independently searched PubMed, Embase® and the Cochrane Central Register of Controlled Trials from 1980 to 2018 using title-abstract and full-text screening to identify original studies of the use of computed tomography, magnetic resonance imaging, positron emission tomography, chest radiographs, and serum tumor markers in the clinical staging of men with early-stage testicular germ cell tumors.
We found 21 studies including 1,702 patients. With significant bias and limitations to the data, the performance characteristics of computed tomography, magnetic resonance imaging and positron emission tomography for staging of the retroperitoneum were similar, with median sensitivity ranging from 67% to 80% and median specificity ranging from 95% to 100%. Computed tomography of the chest (median sensitivity 100%) was more sensitive than a chest radiograph (median sensitivity 76%), especially in men with non-seminomatous germ cell tumors. The addition of serum tumor markers to diagnostic imaging improved the sensitivity of the staging of men with early-stage testicular germ cell tumors from 38-41% to 59-60%. No study specifically reported on harms of the imaging modalities.
The combination of axial imaging, with computed tomography or magnetic resonance imaging, and serum tumor markers demonstrates optimal performance characteristics for the staging of men with early-stage testicular germ cell tumors. There is little role for computed tomography scan of the chest in men with seminoma, negative abdominal imaging and negative serum tumor markers.
The Journal of urology. 2019 Oct 14 [Epub ahead of print]
Phillip M Pierorazio, Joseph G Cheaib, Giorgia Tema, Hiten D Patel, Mohit Gupta, Ritu Sharma, Allen Zhang, Eric B Bass
Department of Urology, The James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland., Department of Urology, Sant'Andrea Hospital, La Sapienza University of Rome, Rome, Italy., The Johns Hopkins Evidence-Based Practice Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.