Testicular germ cell tumors are the most common malignancy in young adult males. Patients with metastatic disease receive standard of care chemotherapy followed by retroperitoneal lymph node dissection for residual masses >1cm.
However, there is a need for better preoperative tools to discern which patients will have persistent disease after chemotherapy given low rates of metastatic germ cell tumor after chemotherapy. The purpose of this study was to use radiomics to predict which patients would have viable germ cell tumor or teratoma after chemotherapy at time of retroperitoneal lymph node dissection.
Patients with nonseminomatous germ cell tumor undergoing postchemotherapy retroperitoneal lymph node dissection (PC-RPLND) between 2008 and 2019 were queried from our institutional database. Patients were included if prechemotherapy computed tomography (CT) scan and postchemotherapy imaging were available. Semiqualitative and quantitative features of residual masses and nodal regions of interest and radiomic feature extractions were performed by 2 board certified radiologists. Radiomic feature analysis was used to extract first order, shape, and second order statistics from each region of interest. Post-RPLND pathology was compared to the radiomic analysis using multiple t-tests.
45 patients underwent PC-RPLND at our institution, with the majority (28 patients) having stage III disease. 24 (53%) patients had teratoma on RPLND pathology, while 2 (4%) had viable germ cell tumor. After chemotherapy, 78%, 53%, and 33% of patients had cystic regions, fat stranding, and local infiltration present on imaging. After radiomic analysis, first order statistics mean, median, 90th percentile, and root mean squares were significant. Strong correlations were observed between these 4 features;a lower signal was associated with positive pathology at RPND.
Testicular radiomics is an emerging tool that may help predict persistent disease after chemotherapy.
Clinical genitourinary cancer. 2023 Jul 07 [Epub ahead of print]
Nikit Venishetty, Jacob Taylor, Yin Xi, Jeffrey M Howard, Yee Seng Ng, Daniel Wong, Solomon L Woldu, Alberto Diaz De Leon, Ivan Pedrosa, Vitaly Margulis, Aditya Bagrodia
Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center, El Paso, TX., Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX., Department of Radiology, University of Texas Southwestern Medical Center, Dallas, TX., Department of Urology, Maine Medical Center, Portland, ME., Department of Urology, Washington University School of Medicine, St. Louis, MO., Department of Urology, University of Texas MD Anderson Cancer Center, Houston, TX., Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX; Department of Urology, University of California San Diego Health, San Diego, CA. Electronic address: .
PubMed http://www.ncbi.nlm.nih.gov/pubmed/37468341