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Testicular Radiomics To Predict Pathology At Time of Postchemotherapy Retroperitoneal Lymph Node Dissection for Nonseminomatous Germ Cell Tumor - Beyond the Abstract

Testicular germ cell tumors (TGCTs) are the most common malignancy in men aged 15 to 44 in the U.S., primarily non-seminomatous germ cell tumors (NSGCTs).1,2 Metastatic TGCT treatment involves chemotherapy and potentially retroperitoneal lymph node dissection (RPLND).3 Post-chemotherapy RPLND is considered when masses exceed 1cm due to the risk of residual disease.

However, this often leads to over-treatment since 40-50% of cases exhibit benign pathology.4 Novel preoperative tools are needed to predict the likelihood of positive pathology at the time of retroperitoneal lymph node dissection (RPLND) to reduce unnecessary treatment and morbidity in men with clinical stage II and III non-seminomatous germ cell tumors. Imaging is crucial for accurately staging testicular germ cell tumors (TGCTs). Radiomics, an emerging technique, extracts detailed data from standard images to aid clinical decisions, showing promise in evaluating genitourinary cancers, including TGCTs.5 Our study found correlations between radiomic first-order statistics and positive pathology at the time of RPLND. Future refinements in data extraction protocols of radiomic data may improve clinical decision-making in patients with metastatic NSGCT after chemotherapy prior to RPLND.

Written by: Nikit Venishetty,1 Jacob Taylor,2 Yin Xi,3 Jeffrey M. Howard,4 Yee Seng Ng,3 Daniel Wong,5 Solomon L. Woldu,2 Alberto Diaz De Leon,6 Ivan Pedrosa,2 Vitaly Margulis,2 Aditya Bagrodia7


  1. Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center, El Paso, TX.
  2. Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX.
  3. Department of Radiology, University of Texas Southwestern Medical Center, Dallas, TX.
  4. Department of Urology, Maine Medical Center, Portland, ME.
  5. Department of Urology, Washington University School of Medicine, St. Louis, MO.
  6. Department of Urology, University of Texas MD Anderson Cancer Center, Houston, TX.
  7. Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX; Department of Urology, University of California San Diego Health, San Diego, CA.
References:

  1. Ghazarian AA, Kelly SP, Altekruse SF, Rosenberg PS, McGlynn KA. Future of testicular germ cell tumor incidence in the United States: Forecast through 2026: Forecast of TGCT Incidence Rates. Cancer. 2017;123(12):2320-2328.
  2. Oldenburg J, Fosså SD, Nuver J, et al. Testicular seminoma and non-seminoma: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2013;24:vi125-vi132.
  3. Batool A, Karimi N, Wu XN, Chen SR, Liu YX. Testicular germ cell tumor: a comprehensive review. Cell Mol Life Sci. 2019;76(9):1713-1727.
  4. Al Othman K, Al Hathal N, Mokhtar A. Predictors of viable germ cell tumor in postchemotherapeutic residual retroperitoneal masses. Urol Ann. 2014;6(1):27-30.
  5. Wu S, Zheng J, Li Y, et al. A Radiomics Nomogram for the Preoperative Prediction of Lymph Node Metastasis in Bladder Cancer. Clin Cancer Res Off J Am Assoc Cancer Res. 2017;23(22):6904-6911.
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