Department of Urology, Federal Armed Forces Hospital Koblenz, Ruebenacherstrasse 170, 56072, Koblenz, Germany.
Department of Urology, Faculty of Medicine, University Hospital Cologne, University Cologne, Cologne, Germany.
World J Urol. 2023 May;41(5):1353-1358. doi: 10.1007/s00345-023-04364-5. Epub 2023 Apr 4.
Testicular germ cell tumors (GCTs) are aggressive but highly curable tumors. To avoid over/undertreatment, reliable clinical staging of retroperitoneal lymph-node metastasis is necessary. Current clinical guidelines, in their different versions, lack specific recommendations on how to measure lymph-node metastasis.
We aimed to assess the practice patterns of German institutions frequently treating testicular cancer for measuring retroperitoneal lymph-node size.
An 8-item survey was distributed among German university hospitals and members of the German Testicular Cancer Study Group.
In the group of urologists, 54.7% assessed retroperitoneal lymph nodes depending on their short-axis diameter (SAD) (33.3% in any plane, 21.4% in the axial plane), while 45.3% used long-axis diameter (LAD) for the assessment (42.9% in any plane, 2.4% in the axial plane). Moreover, the oncologists mainly assessed lymph-node size based on the SAD (71.4%). Specifically, 42.9% of oncologists assessed the SAD in any plane, while 28.5% measured this dimension in the axial plane. Only 28.6% of oncologists considered the LAD (14.3% in any plane, 14.3% in the axial plane). None of the oncologists and 11.9% of the urologists (n = 5) always performed an MRI for the initial assessment, while for follow-up imaging, the use increased to 36.5% of oncologists and 31% of urologists. Furthermore, only 17% of the urologists, and no oncologists, calculated lymph-node volume in their assessment (p = 0.224).
Clear and consistent measurement instructions are urgently needed to be present in all guidelines across different specialistic fields involved in testicular cancer management.
睾丸生殖细胞肿瘤（GCT）是一种侵袭性但高度可治愈的肿瘤。为了避免过度/治疗不足，有必要对腹膜后淋巴结转移进行可靠的临床分期。目前的临床指南在不同版本中缺乏关于如何测量淋巴结转移的具体建议。
我们旨在评估经常治疗睾丸癌的德国机构测量腹膜后淋巴结大小的实践模式。
向德国大学医院和德国睾丸癌研究组的成员分发了一份包含 8 个项目的调查。
在泌尿科医生组中，54.7%根据短轴直径（SAD）评估腹膜后淋巴结（任何平面 33.3%，轴向平面 21.4%），而 45.3%使用长轴直径（LAD）进行评估（任何平面 42.9%，轴向平面 2.4%）。此外，肿瘤学家主要根据 SAD 评估淋巴结大小（71.4%）。具体而言，42.9%的肿瘤学家在任何平面评估 SAD，而 28.5%在轴向平面测量此维度。只有 28.6%的肿瘤学家考虑 LAD（任何平面 14.3%，轴向平面 14.3%）。没有肿瘤学家，而有 11.9%的泌尿科医生（n=5）总是在初始评估时进行 MRI，而对于随访成像，36.5%的肿瘤学家和 31%的泌尿科医生增加了使用。此外，只有 17%的泌尿科医生，而没有肿瘤学家，在他们的评估中计算淋巴结体积（p=0.224）。
所有涉及睾丸癌管理的不同专业领域的指南都迫切需要明确和一致的测量说明。
