Originally published as JCO Early Release 10.1200/JCO.2008.17.1157 on November 17 2008

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[¹⁸F]Fluorodeoxyglucose Positron Emission Tomography in Nonseminomatous Germ Cell Tumors After Chemotherapy: The German Multicenter Positron Emission Tomography Study Group

Karin Oechsle, Michael Hartmann, Winfried Brenner, Stephan Venz, Lothar Weissbach, Christiane Franzius, Sabine Kliesch, Stephan Mueller, Susanne Krege, Ruediger Heicappell, Roland Bares, Carsten Bokemeyer, Maike de Wit

From the Department of Oncology/Hematology/Pneumology, University Medical Center Eppendorf; Departments of Urology and Nuclear Medicine, University Hospital Hamburg-Eppendorf, Hamburg; Department of Nuclear Medicine, Munich; Euromed, Urology, Fuerth; Department of Nuclear Medicine; Department of Urology, University Hospital Muenster, Muenster; Department of Nuclear Medicine University Hospital Essen, Essen; Department of Urology, Krankenhaus Maria-Hilf GmbH Krefeld, Krefeld; Department of Urology, ASKLEPIOS Klinikum Uckermark GmbH, Schwedt; Department of Nuclear Medicine, University Hospital Tuebingen, Tuebingen; and Internal medicine-Haematology and Oncology, Vivantes Klinikum Neukölln, Berlin, Germany

Corresponding author: Karin Oechsle, MD, Department of Oncology/Hematology, Bone marrow transplantation/Pneumology, University Medical Center Eppendorf, Martinistr. 52, 20246 Hamburg, Germany; E-Mail: k.oechsle{at}uke.uni-hamburg.de

Purpose In patients with metastatic nonseminomatous germ cell cancer (NSGCT), residual masses after chemotherapy (CTX) can consist of vital carcinoma, mature teratoma, or necrosis. This prospective trial has evaluated the accuracy of [¹⁸F]fluorodeoxyglucose positron emission tomography (FDG-PET) for the prediction of histology compared with computed tomography (CT) and serum tumor markers (STM).

Patients and Methods A total of 121 patients with stage IIC or III NSGCT scheduled for secondary resection after cisplatin-based CTX were included. FDG-PET was performed after completion of CTX. All results were confirmed by histopathology and correlated to STM and CT.

Results Prediction of tumor viability with FDG-PET was correct in 56%, which did not reach the expected clinically relevant level of 70%, and was not better than the accuracy of CT (55%) or STM (56%). Sensitivity and specificity of FDG-PET were 70% and 48%. The positive predictive values were not significantly different (55%, 61%, and 59% for CT, STM, and PET, respectively). Judging only vital carcinoma as a true malignant finding, the negative predictive value increased to 83% for FDG-PET.

Conclusion The presence of vital carcinoma and mature teratoma is common (55%) in residual masses in patients with NSGCT, and CT and STM cannot reliably predict absence of disease. In contrast to prior studies, this prospective trial, which is the only with histologic confirmation in all patients, demonstrated that FDG-PET is unable to give a clear additional clinical benefit to the standard diagnostic procedures, CT and STM, in the prediction of tumor viability in residual masses.

published online ahead of print at www.jco.org on November 17, 2008.

The study was supported by the Deutsche Krebshilfe.

Presented in part at the 41st Annual Meeting of the American Society of Clinical Oncology, May 13-17, 2005, Orlando, FL.

Authors’ disclosures of potential conflicts of interest and author contributions are found at the end of this article.

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