Annals of Oncology Advance Access published online on May 2, 2008
Annals of Oncology, doi:10.1093/annonc/mdn170
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
[18F]-FDG–PET in clinical stage I/II non-seminomatous germ cell tumours: results of the German multicentre trial
1 Internal Medicine, Hematology and Oncology, Vivantes Klinikum Neukölln, Berlin
2 Department of Nuclear Medicine, University Clinic Eppendorf, Eppendorf
3 Department of Urology, Military Hospital Hamburg, Hamburg
4 Department of Nuclear Medicine, University of Dresden, Dresden
5 Department of Nuclear Medicine, Saarland University Medical Center, Homburg
6 Department of Urology, Saarland University, Saarland
7 Department of Nuclear Medicine
8 Department of Urology, University Hospital Münster, Münster
9 Department of Medicine
10 Department of Nuclear Medicine, Ludwig-Maximilian University, München
11 Department of Urology, Clinic Uckermark, Schwedt/Oder
12 Department of Nuclear Medicine, Clinic for Nuclear Medicine, Campus Mitte, Charité, Berlin
13 Department of Radiology, Clinic for Radiology, Campus Virchow, Charité, Berlin
14 Department of Nuclear Medicine, Diakonie Hospital Rotenburg (W), Rotenburg
15 Department of Nuclear Medicine, University Schleswig-Holstein, Kiel
16 Department of Nuclear Medicine, Klinikum Ingolstadt, Ingolstadt
17 Department of Nuclear Medicine, University Hospital Tübingen, Tübingen, Germany
* Correspondence to: Dr M. de Wit, Department of Internal Medicine–Hematology and Oncology, Vivantes Klinikum Neukölln, Rudower Strasse 48, 12351 Berlin, Germany. Tel: +49-30-130 14 2250; Fax: + 49-30-130 14 2494; E-mail: maike.dewit{at}vivantes.de
Purpose: The aim of this study was to determine the predictive values of 2-[fluorine-18]fluoro-2-deoxy-D-glucose–positron emission tomography (FDG–PET) in primary staging in patients with newly diagnosed non-seminomatous germ cell tumour (NSGCT) clinical stage I/II.
Patients and methods: The hypothesis was that FDG–PET would improve the negative predictive value (NPV) from 70% to 90%, thus requiring a total of 169 patients. All scans underwent visual analysis by a reference team of nuclear medicine physicians. Results were validated by histology following retroperitoneal lymph node dissection.
Results: Only 72 of the planned 169 patients were included, due to poor accrual. The prevalence of nodal involvement was 26%. Correct nodal staging by FDG–PET was achieved in 83% compared with correct computed tomography (CT) staging in 71%. CT had a sensitivity and specificity of 41% and 95%, respectively. Positive predictive value (PPV) and NPV were 87% and 67%, respectively. FDG–PET had a sensitivity and specificity of 66% and 98%, respectively. PPV was 95%. The primary end point was not reached, with an NPV of 78%.
Conclusion: FDG–PET as a primary staging tool for NSGCT yielded only slightly better results than CT. Both methods had a high specificity while false-negative findings were more frequent with CT. FDG–PET is mostly useful as a diagnostic tool in case of questionable CT scan.
FDG–PET, germ cell tumour, NSGCT, staging
Received for publication September 28, 2007. Revision received February 17, 2008. Accepted for publication March 20, 2008.