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Diagnostic Applications of Nuclear Medicine: Testicular Cancer

Nuclear Oncology

Abstract

Testicular cancer is the most common solid-non hematological cancer diagnosed in young adult men. Personal history of testicular cancer is a major risk factor for developing testicular cancer. Testicular germ cell tumors are the most common tumors, these are further divided into seminomas and non seminomatous germ cell tumors. Tumors generally present as painless testicular mass, the first investigation is testicular ultrasound followed by serum biomarkers. MRI can be used as a problem solver only in equivocal cases. Radical orchiectomy provides therapy as well as pathological T staging. CT scan is the primary investigation for assessing lymph node status and for evaluation of distant metastasis. [18F]FDG PET/CT is not recommended for diagnosis of primary testicular cancer with reported unsatisfactory negative predictive value, nevertheless PET/CT offers several advantages over CT particularly for patients with equivocal CT findings and in patients who exhibit elevated tumor markers and negative CT scan. In addition, [18F]FDG PET/CT is especially useful for evaluation of post chemotherapy residual masses in metastatic seminoma. [18F]FDG PET/CT is, however; not routinely indicated for post chemotherapy evaluation of non seminomatous germ cell tumors because of high false negative rate in Teratomas.

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Abbreviations

[18F]FDG:

2-Deoxy-2-[18F]fluoro-d-glucose

AFP:

α-Fetoprotein

AJCC:

American Joint Committee on Cancer

Beta-hCG:

Beta-human chorionic gonadotropin

BRAF:

Gene encoding for the B-Raf protein, a serine/threonine-protein kinase (also known as the proto-oncogene B-Raf and v-Raf murine sarcoma viral oncogene homolog B)

C-KIT:

Proto-oncogene encoding for tyrosine-protein kinase Kit (or CD117), also known as mast/stem cell growth factor receptor (SCFR)

CT:

X-ray computed tomography

CXCR4:

Gene encoding for C-X-C chemokine receptor type 4 (CXCR-4), also known as fusin or CD184 (cluster of differentiation 184)

EGFR:

Epidermal growth factor receptor; the mutated form EGFRvIII plays a prominent role in tumorigenesis and proangiogenic signaling

GCT:

Germ cell tumor

IGD:

In greatest dimension

IGF:

Insulin-like factor

LDH:

Lactate dehydrogenase

M:

Metastasis status according to the AJCC/UICC TNM staging system

MRI:

Magnetic resonance imaging

N:

Lymph node status according to the AJCC/UICC TNM staging system

NCCN:

National Comprehensive Cancer Network

NSGCT:

Nonseminomatous germ cell tumor

p53:

Tumor protein p53, also known as cellular tumor antigen p53, phosphoprotein p53, tumor suppressor p53, antigen NY-CO-13, or transformation-related protein 53 (TRP53)

PET:

Positron emission tomography

PET/CT:

Positron emission tomography/Computed tomography

RAS:

Oncogene regulating signaling cascades

SDF-1:

Gene encoding for the stromal cell-derived factor 1, also known as C-X-C motif chemokine 12 (CXCL12)

SNP:

Single nucleotide polymorphism

SPECT:

Single-photon emission tomography

SPECT/CT:

Single-photon emission tomography/Computed tomography

T:

Tumor status according to the AJCC/UICC TNM staging system

TGCT:

Testicular germ cell tumor

TNM:

AJCC/UICC staging system based on parameters “T” (tumor status), “N” (lymph node status), and “M” (distant metastasis status)

UICC:

Union Internationale Contre le Cancer (International Union Against Cancer)

ULN:

Upper limit of normal range

US:

Ultrasonography

WHO:

World Health Organization

References

  1. Gonzalez-Exposito R, Merino M, Aguayo C. Molecular biology of testicular germ cell tumors. Clin Transl Oncol. 2016;18:550–6.

    Google Scholar 

  2. Fosså SD, Chen J, Schonfeld SJ, et al. Risk of contralateral testicular cancer: a population-based study of 29,515 U.S. men. J Natl Cancer Inst. 2005;97:1056–66.

    Article  PubMed  Google Scholar 

  3. Heller HT, Oliff MC, Doubilet PM, O’Leary MP, Benson CB. Testicular microlithiasis: prevalence and association with primary testicular neoplasm. J Clin Ultrasound. 2014;42:423–6.

    Article  PubMed  Google Scholar 

  4. Crockford GP, Linger R, Hockley S, et al. Genome-wide linkage screen for testicular germ cell tumour susceptibility loci. Hum Mol Genet. 2006;15:443–5.

    Article  CAS  PubMed  Google Scholar 

  5. Gonzalez-Exposito R, Merino M, Aguayo C. Molecular biology of testicular germ cell tumors. Clin Transl Oncol. 2016;18:550–6.

    Google Scholar 

  6. Madani A, Kemmer K, Sweeney C, et al. Expression of kit and epidermal growth factor receptor in chemotherapy refractory non-seminomatous germ cell tumors. Ann Oncol. 2003;14:873–80.

    Article  CAS  PubMed  Google Scholar 

  7. Howitt BE, Berney DM. Tumors of the testis: morphologic features and molecular alterations. Surg Pathol Clin. 2015;8:687–716.

    Article  PubMed  Google Scholar 

  8. Skakkebaek NE, Rajpert-De Meyts E, et al. Germ cell cancer and disorders of spermatogenesis: an environmental connection? APMIS. 1998;106:3–11.

    Article  CAS  PubMed  Google Scholar 

  9. Chaganti RS, Houldsworth J. The cytogenetic theory of the pathogenesis of human adult male germ cell tumors. APMIS. 1998;106:80–3.

    Article  CAS  PubMed  Google Scholar 

  10. Ulbright TM, Tickoo SK, Berney DM, Srigley JR. Members of the IIiDUPG. Best practices recommendations in the application of immunohistochemistry in testicular tumors: report from the International Society of Urological Pathology consensus conference. Am J Surg Pathol. 2014;38:e50–9.

    PubMed  Google Scholar 

  11. Leite KR, Garicochea B, Srougi M, et al. Monoclonality of asynchronous bilateral lymphoma of the testis. Eur Urol. 2000;38:774–7.

    Article  CAS  PubMed  Google Scholar 

  12. Nazeer T, Ro JY, Amato RJ, Park YW, Ordonez NG, Ayala AG. Histologically pure seminoma with elevated alpha-fetoprotein: a clinicopathologic study of ten cases. Oncol Rep. 1998;5:1425–9.

    CAS  PubMed  Google Scholar 

  13. Weissbach L1, Bussar-Maatz R, Mann K. The value of tumor markers in testicular seminomas. Results of a prospective multicenter study. Eur Urol. 1997;32:16–22.

    CAS  PubMed  Google Scholar 

  14. Motzer RJ, Jonasch E, Agarwal N, et al. Testicular cancer, version 2.2015. J Natl Compr Canc Netw. 2015;13:772–99.

    PubMed  Google Scholar 

  15. Albers P, Albrecht W, Algaba F, et al. Guidelines on testicular cancer: 2015 update. Eur Urol. 2015;68:1054–68.

    Article  PubMed  Google Scholar 

  16. Sobin LH, Gospodarowicz MK, Wittekind C, editors. TNM classification of malignant tumors. 7th ed. Oxford: Wiley-Blackwell; 2009. p. 249–54.

    Google Scholar 

  17. Ray B, Hajdu SI, Whitmore Jr WF. Proceedings: distribution of retroperitoneal lymph node metastases in testicular germinal tumors. Cancer. 1974;33:340–8.

    Article  CAS  PubMed  Google Scholar 

  18. Donohue JP, Zachary JM, Maynard BR. Distribution of nodal metastases in nonseminomatous testis cancer. J Urol. 1982;128:315–20.

    CAS  PubMed  Google Scholar 

  19. Weissbach L, Boedefeld EA. Localization of solitary and multiple metastases in stage II nonseminomatous testis tumor as basis for a modified staging lymph node dissection in stage I. J Urol. 1987;138:77–82.

    CAS  PubMed  Google Scholar 

  20. Brouwer OR, Valdés Olmos RA, Vermeeren L, Hoefnagel CA, Nieweg OE, Horenblas S. SPECT/CT and a portable gamma-camera for image-guided laparoscopic sentinel node biopsy in testicular cancer. J Nucl Med. 2011;52:551–4.

    Article  PubMed  Google Scholar 

  21. Mead GM, Stenning SP. The International Germ Cell Consensus Classification: a new prognostic factor-based staging classification for metastatic germ cell tumours. Clin Oncol. 1997;9:207–9.

    Article  CAS  Google Scholar 

  22. Guthrie JA, Fowler RC. Ultrasound diagnosis of testicular tumours presenting as epididymal disease. Clin Radiol. 1992;46:397–400.

    Article  CAS  PubMed  Google Scholar 

  23. Schwerk WB, Schwerk WN, Rodeck G. Testicular tumors: prospective analysis of real-time US patterns and abdominal staging. Radiology. 1987;164:369–74.

    Article  CAS  PubMed  Google Scholar 

  24. Meyts ER, McGlynn KA, Okamoto K, Jewett MA, Bokemeyer C. Testicular germ cell tumours. Lancet. 2016;387(10029):1762–74.

    Google Scholar 

  25. Coursey Moreno C, Small WC, Camacho JC, et al. Testicular tumors: what radiologists need to know – differential diagnosis, staging, and management. Radiographics. 2015;35:400–15.

    Article  PubMed  Google Scholar 

  26. Höbarth K, Szabo N, Klingler HC, Kratzik C. Sonographic appearance of testicular microlithiasis. Eur Urol. 1993;24:251–5.

    PubMed  Google Scholar 

  27. Richenberg J, Belfield J, Ramchandani P, et al. Testicular microlithiasis imaging and follow-up: guidelines of the ESUR scrotal imaging subcommittee. Eur Radiol. 2015;25:323–30.

    Article  PubMed  Google Scholar 

  28. Secil M, Altay C, Basara I. State of the art in germ cell tumor imaging. Urol Oncol. 2016;34:156–64.

    Article  PubMed  Google Scholar 

  29. Kreydin EI, Barrisford GW, Feldman AS, Preston MA. Testicular cancer: what the radiologist needs to know. AJR Am J Roentgenol. 2013;200:1215–25.

    Article  PubMed  Google Scholar 

  30. Correas JM, Drakonakis E, Isidori AM, et al. Update on ultrasound elastography: miscellanea. Prostate, testicle, musculo-skeletal. Eur J Radiol. 2013;82:1904–12.

    Article  CAS  PubMed  Google Scholar 

  31. Tsili AC, Argyropoulou MI, Giannakis D, Sofikitis N, Tsampoulas K. MRI in the characterization and local staging of testicular neoplasms. AJR Am J Roentgenol. 2010;194:682–9.

    Article  PubMed  Google Scholar 

  32. Algebally AM, Tantawy HI, Yousef RR, Szmigielski W, Darweesh A. Advantage of adding diffusion weighted imaging to routine MRI examinations in the diagnostics of scrotal lesions. Pol J Radiol. 2015;80:442–9.

    Article  PubMed  PubMed Central  Google Scholar 

  33. Hilton S, Herr HW, Teitcher JB, Begg CB, Castéllino RA. CT detection of retroperitoneal lymph node metastases in patients with clinical stage I testicular nonseminomatous germ cell cancer: assessment of size and distribution criteria. AJR Am J Roentgenol. 1997;169:521–5.

    Article  CAS  PubMed  Google Scholar 

  34. Rajpert-De Meyts E, McGlynn KA, Okamoto K, Jewett MA, Bokemeyer C. Testicular germ cell tumours. Lancet. 2016;387(10029):1762–74.

    Google Scholar 

  35. Sohaib SA, Koh DM, Barbachano Y, et al. Prospective assessment of MRI for imaging retroperitoneal metastases from testicular germ cell tumours. Clin Radiol. 2009;64:362–7.

    Article  CAS  PubMed  Google Scholar 

  36. Zhao JY, Ma XL, Li YY, et al. Diagnostic accuracy of 18F-FDG-PET in patients with testicular cancer: a meta-analysis. Asian Pac J Cancer Prev. 2014;15:3525–31.

    Article  PubMed  Google Scholar 

  37. Mansberg R, Ho B, Bui C. Positive FDG PET/CT of recurrent testicular tumour due to orchitis. Mol Imaging Radionucl Ther. 2014;23:28–30.

    Article  PubMed  PubMed Central  Google Scholar 

  38. Lassen U, Daugaard G, Eigtved A, Højgaard L, Damgaard K, Rørth M. Whole-body FDG-PET in patients with stage I non-seminomatous germ cell tumours. Eur J Nucl Med Mol Imaging. 2003;30:396–402.

    Article  CAS  PubMed  Google Scholar 

  39. Tsatalpas P, Beuthien-Baumann B, Kropp J, et al. Diagnostic value of 18F-FDG positron emission tomography for detection and treatment control of malignant germ cell tumors. Urol Int. 2002;68:157–63.

    Article  PubMed  Google Scholar 

  40. De Wit M, Brenner W, Hartmann M, et al. [18F]-FDG-PET in clinical stage I/II non-seminomatous germ cell tumours: results of the German multicentre trial. Ann Oncol. 2008;19:1619–23.

    Article  PubMed  Google Scholar 

  41. Cook GJ, Sohaib A, Huddart RA, Dearnaley DP, Horwich A, Chua S. The role of 18F-FDG PET/CT in the management of testicular cancers. Nucl Med Commun. 2015;36:702–8.

    Article  CAS  PubMed  Google Scholar 

  42. Huddart RA, O’Doherty MJ, Padhani A, NCRI Testis Tumour Clinical Study Group, et al. 18Fluorodeoxyglucose positron emission tomography in the prediction of relapse in patients with high-risk, clinical stage I nonseminomatous germ cell tumors: preliminary report of MRC Trial TE22 – the NCRI Testis Tumour Clinical Study Group. J Clin Oncol. 2007;25:3090–5.

    Article  PubMed  Google Scholar 

  43. Tandstad T, Smaaland R, Solberg A, et al. Management of seminomatous testicular cancer: a binational prospective population-based study from the Swedish Norwegian Testicular Cancer Study Group. J Clin Oncol. 2011;29:719–25.

    Article  PubMed  Google Scholar 

  44. De Santis M, Becherer A, Bokemeyer C, et al. 2-18fluoro-deoxy-D-glucose positron emission tomography is a reliable predictor for viable tumor in postchemotherapy seminoma: an update of the prospective multicentric SEMPET trial. J Clin Oncol. 2004;22:1034–9.

    Article  PubMed  Google Scholar 

  45. Becherer A, De Santis M, Karanikas G, et al. FDG PET is superior to CT in the prediction of viable tumour in post-chemotherapy seminoma residuals. Eur J Radiol. 2005;54:284–8.

    Article  PubMed  Google Scholar 

  46. Stattaus J, Bockisch A, Forsting M, Müller SP. Value of imaging for lymph node metastases from renal cell, bladder, prostate, penile, and testicular cancers. Urologe A. 2005;44:614–24.

    Article  CAS  PubMed  Google Scholar 

  47. Bachner M, Loriot Y, Gross-Goupil M, et al. 2-18Fluoro-deoxy-D-glucose positron emission tomography (FDG-PET) for postchemotherapy seminoma residual lesions: a retrospective validation of the SEMPET trial. Ann Oncol. 2012;23:59–64.

    Article  CAS  PubMed  Google Scholar 

  48. Hinz S, Schrader M, Kempkensteffen C, et al. The role of positron emission tomography in the evaluation of residual masses after chemotherapy for advanced stage seminoma. J Urol. 2008;179:936–40.

    Article  PubMed  Google Scholar 

  49. Gerl A, Clemm C, Schmeller N, et al. Sequential resection of residual abdominal and thoracic masses after chemotherapy for metastatic nonseminomatous germ cell tumours. Br J Cancer. 1994;70:960–5.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  50. Hartmann JT, Schmoll HJ, Kuczyk MA, et al. Postchemotherapy resections of residual masses from metastatic non-seminomatous testicular germ cell tumors. Ann Oncol. 1997;8:531–8.

    Article  CAS  PubMed  Google Scholar 

  51. Oechsle K, Hartmann M, Brenner W, et al. [18F]Fluorodeoxyglucose positron emission tomography in nonseminomatous germ cell tumors after chemotherapy: the German multicenter positron emission tomography study group. J Clin Oncol. 2008;26:5930–5.

    Article  PubMed  Google Scholar 

  52. Quak E, Kovacs I, Oyen WJ, van der Graaf WT. FDG-PET/CT in a patient with poor-risk non-seminoma testis with mature teratoma and secondary gliosarcoma: multimodality imaging for guiding multimodality treatment. Nucl Med Mol Imaging. 2015;49:237–40.

    Article  PubMed  PubMed Central  Google Scholar 

  53. Brouwer OR, Meinhart W, Horenblas S, Valdés Olmos RA. Preoperative and intraoperative lymphatic mapping for radioguided sentinel node biopsy in cancers of the male reproductive system. In: Mariani G, Manca G, Orsini F, Vidal-Sicart S, Valdés Olmos RA, editors. Atlas of lymphoscintigraphy and sentinel node mapping – a pictorial case-based approach. Milan: Springer-Verlag Italia; 2013. p. 269–83.

    Chapter  Google Scholar 

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AlSharif, A., Chiacchio, S., Giovacchini, G. (2016). Diagnostic Applications of Nuclear Medicine: Testicular Cancer. In: Strauss, H., Mariani, G., Volterrani, D., Larson, S. (eds) Nuclear Oncology. Springer, Cham. https://doi.org/10.1007/978-3-319-26067-9_21-1

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  • DOI: https://doi.org/10.1007/978-3-319-26067-9_21-1

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Chapter history

  1. Latest

    Diagnostic Applications of Nuclear Medicine: Testicular Cancer
    Published:
    22 April 2022

    DOI: https://doi.org/10.1007/978-3-319-26067-9_21-2

  2. Original

    Diagnostic Applications of Nuclear Medicine: Testicular Cancer
    Published:
    27 September 2016

    DOI: https://doi.org/10.1007/978-3-319-26067-9_21-1