Unenhanced MRI of the abdomen and pelvis for surveillance of patients with stage 1 testicular cancer post-radical orchiectomy

Narine, Rishi; Osman, Hussein Al; Wongwaisayawan, Sirote; Morgan, Scott C.; Lavallée, Luke T.; Schieda, Nicola

doi:10.1007/s00261-020-02715-z

Cited by 5 publications

(4 citation statements)

References 16 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Findings align with observational studies indicating that MRI, with experienced radiologists, is a safe alternative in this setting. [26][27][28] Numbers of advanced relapses on MRI were too small to assess center variation. Independent central scan review (to be reported separately) will provide further insights into impact of radiologist experience.…”

Section: Discussionmentioning

confidence: 99%

Imaging Modality and Frequency in Surveillance of Stage I Seminoma Testicular Cancer: Results From a Randomized, Phase III, Noninferiority Trial (TRISST)

Joffe

Cafferty

Murphy

et al. 2022

JCO

View full text Add to dashboard Cite

PURPOSE Survival in stage I seminoma is almost 100%. Computed tomography (CT) surveillance is an international standard of care, avoiding adjuvant therapy. In this young population, minimizing irradiation is vital. The Trial of Imaging and Surveillance in Seminoma Testis (TRISST) assessed whether magnetic resonance images (MRIs) or a reduced scan schedule could be used without an unacceptable increase in advanced relapses. METHODS A phase III, noninferiority, factorial trial. Eligible participants had undergone orchiectomy for stage I seminoma with no adjuvant therapy planned. Random assignment was to seven CTs (6, 12, 18, 24, 36, 48, and 60 months); seven MRIs (same schedule); three CTs (6, 18, and 36 months); or three MRIs. The primary outcome was 6-year incidence of Royal Marsden Hospital stage ≥ IIC relapse (> 5 cm), aiming to exclude increases ≥ 5.7% (from 5.7% to 11.4%) with MRI ( v CT) or three scans ( v 7); target N = 660, all contributing to both comparisons. Secondary outcomes include relapse ≥ 3 cm, disease-free survival, and overall survival. Intention-to-treat and per-protocol analyses were performed. RESULTS Six hundred sixty-nine patients enrolled (35 UK centers, 2008-2014); mean tumor size was 2.9 cm, and 358 (54%) were low risk (< 4 cm, no rete testis invasion). With a median follow-up of 72 months, 82 (12%) relapsed. Stage ≥ IIC relapse was rare (10 events). Although statistically noninferior, more events occurred with three scans (nine, 2.8%) versus seven scans (one, 0.3%): 2.5% absolute increase, 90% CI (1.0 to 4.1). Only 4/9 could have potentially been detected earlier with seven scans. Noninferiority of MRI versus CT was also shown; fewer events occurred with MRI (two [0.6%] v eight [2.6%]), 1.9% decrease (–3.5 to –0.3). Per-protocol analyses confirmed noninferiority. Five-year survival was 99%, with no tumor-related deaths. CONCLUSION Surveillance is a safe management approach—advanced relapse is rare, salvage treatment successful, and outcomes excellent, regardless of imaging frequency or modality. MRI can be recommended to reduce irradiation; and no adverse impact on long-term outcomes was seen with a reduced schedule.

show abstract

Section: Discussionmentioning

confidence: 99%

Imaging Modality and Frequency in Surveillance of Stage I Seminoma Testicular Cancer: Results From a Randomized, Phase III, Noninferiority Trial (TRISST)

Joffe

Cafferty

Murphy

et al. 2022

JCO

View full text Add to dashboard Cite

show abstract

“…Mosavi et al demonstrated the feasibility of WB-MRI with DWI for the follow-up of patients with testicular cancer and the added value of DWI [22]. A recent study showed that unenhanced MRI of the abdomen and pelvis is an adequate tool for surveillance of stage I testicular cancer [23].…”

Section: Discussionmentioning

confidence: 99%

Whole Body MRI in the Detection of Lymph Node Metastases in Patients with Testicular Germ Cell Cancer

Pasoglou

Nieuwenhove

Damme

et al. 2022

Life

View full text Add to dashboard Cite

Whole-Body Magnetic Resonance Imaging (WB-MRI) is increasingly used for metastatic screening in oncology. This prospective single center study assesses the diagnostic value of WB-MRI including diffusion weighted imaging (DWI) and identifies the sufficient protocol for metastatic lymph node detection in patients with testicular germ cell cancer (TGCC). Forty-three patients underwent contrast enhanced thoraco-abdominopelvic CT (TAP-CT) and WB-MRI with DWI for metastatic lymph node screening. Two independent readers reviewed CTs and WB-MRIs. The diagnostic performance of different imaging protocols (CT, complete WB-MRI, T1W + DWI, T2W + DWI), the agreement between these protocols and the reference standard, the reproducibility of findings and the image quality (Signal and contrast to Noise Ratios, Likert scale) were studied. Reproducibility was very good regardless of both lesion locations (retroperitoneal vs distant lymph nodes, other lesions) and the reader. Diagnostic accuracy of MRI was ≥95% (regardless of the locations and imaging protocol); accuracy of CT was ≥93%. There was a strict overlap of 95% CIs associated with this accuracy between complete WB-MRI, T1W + DWI and T2W + DWI, regardless of the reader. Higher Likert score and SNR were observed for DWI, followed by T2W and T1W sequences. In conclusion, a fast WB-MRI protocol including T2W and DWI is a sufficient, accurate, non-irradiating alternative to TAP-CT for metastatic lymph node screening in TGCC.

show abstract

“…[1][2][3][4][5][6] Experience with MRI in the staging of the retroperitoneal lymph nodes is substantially less than CT and has a sensitivity of 78-98%. [7][8][9][10] There is inadequate evidence to support the use of MRI of the abdomen and pelvis over a CT scan at the time of diagnosis. In general, the smaller the size definition of a positive node, the greater the sensitivity and lesser the specificity.…”

Section: Guideline Statement Updatesmentioning

confidence: 99%

Diagnosis and Treatment of Early-Stage Testicular Cancer: AUA Guideline Amendment 2023

Stephenson,

Bass,

Bixler

et al. 2024

Journal of Urology

View full text Add to dashboard Cite

Purpose:The purpose of this American Urological Association (AUA) guideline amendment is to provide a useful reference on the effective evidence-based treatment strategies for early-stage testicular cancer.Methodology/Methods:The original methodology protocol included searches of PubMed®, Embase®, and the Cochrane Central Register of Controlled Trials (CENTRAL) from January 1980 through August 2018. The search strategy used medical subject heading (MeSH) terms and key words relevant to the diagnosis and treatment of early-stage testicular cancer. The searches conducted for the update presented herein utilized the same methodological protocol to capture literature published through March 2023. When sufficient evidence existed, the body of evidence was assigned a strength rating of A (high), B (moderate), or C (low) for support of Strong, Moderate, or Conditional Recommendations. In the absence of sufficient evidence, additional information is provided as Clinical Principles and Expert Opinions.Results:Updates were made to statements on imaging, seminoma management, non-seminoma management, surveillance for stage I testicular cancer, and additional survivorship. Further revisions were made to the methodology and reference sections as appropriate.Conclusions:This guideline seeks to improve clinicians’ ability to evaluate and treat patients with early-stage testicular cancer based on currently available evidence. Future studies will be essential to further support or refine these statements to improve patient care.

show abstract

Unenhanced MRI of the abdomen and pelvis for surveillance of patients with stage 1 testicular cancer post-radical orchiectomy

Cited by 5 publications

References 16 publications

Imaging Modality and Frequency in Surveillance of Stage I Seminoma Testicular Cancer: Results From a Randomized, Phase III, Noninferiority Trial (TRISST)

Imaging Modality and Frequency in Surveillance of Stage I Seminoma Testicular Cancer: Results From a Randomized, Phase III, Noninferiority Trial (TRISST)

Whole Body MRI in the Detection of Lymph Node Metastases in Patients with Testicular Germ Cell Cancer

Diagnosis and Treatment of Early-Stage Testicular Cancer: AUA Guideline Amendment 2023

Contact Info

Product

Resources

About