Fernandez E B, Moul J W, Foley J P, Colon E, McLeod D G
Urology Service, Walter Reed Army Medical Center, Washington, DC.
Urology. 1994 Oct;44(4):548-52. doi: 10.1016/s0090-4295(94)80056-1.
To examine the accuracy rate of abdominal staging using third and fourth generation computed tomography (CT) scanning in clinical Stage I testicular nonseminoma patients.
Between January 1985 and August 1993, 57 patients presented to our center with clinical Stage I testicular nonseminoma. Retroperitoneal computed tomographic staging studies were interpreted to be normal preoperatively in the entire group. In addition, tumor marker values were normal or returned to normal postorchiectomy within the appropriate half-life intervals. All patients were subjected to radical or modified retroperitoneal lymph node dissection (19% and 72%, respectively). Original abdominal CT scans (preretroperitoneal lymph node dissection) were available for blinded retrospective re-review in 16 cases (7 pathologic Stage II, 9 pathologic Stage I).
Nineteen of 57 (33%) patients were upstaged at surgery including 6 patients (11%) who demonstrated II B volume disease. Third and fourth generation CT scanning of the retroperitoneum yielded a 66% accuracy rate in this population. Six out of 7 pathologic Stage II pre-lymph node dissection abdominal CT scans that were available for blinded re-review revealed nonpathologic nodes by size criteria in the primary landing zone for the corresponding original tumor.
Our data suggests that for clinical Stage I nonseminoma in the 1985 to 1993 era, undue reliance was placed on a less than ideal staging test. The 33% false-negative rate reported showed no improvement over earlier reports and reaffirms concern for relying solely on third or fourth generation CT imaging of the retroperitoneum in the staging of clinical Stage I nonseminomatous germ cell tumor (NSGCT) patients. The presence of any number of lymph nodes in the expected primary landing zone, regardless of size, should raise serious suspicion for occult nodal disease.
探讨第三代和第四代计算机断层扫描（CT）对临床I期睾丸非精原细胞瘤患者进行腹部分期的准确率。
1985年1月至1993年8月期间，57例临床I期睾丸非精原细胞瘤患者就诊于本中心。术前对全组患者进行的腹膜后计算机断层扫描分期检查结果均为正常。此外，肿瘤标志物值正常或在睾丸切除术后在适当的半衰期内恢复正常。所有患者均接受了根治性或改良腹膜后淋巴结清扫术（分别为19%和72%）。16例患者（7例病理II期，9例病理I期）可获得原始腹部CT扫描（腹膜后淋巴结清扫术前）用于盲法回顾性重新评估。
57例患者中有19例（33%）在手术中分期上调，其中6例（11%）表现为II B期体积性疾病。对该人群进行的腹膜后第三代和第四代CT扫描准确率为66%。在可用于盲法重新评估的7例病理II期术前淋巴结清扫腹部CT扫描中，有6例根据大小标准在相应原发肿瘤的主要着陆区显示为非病理性淋巴结。
我们的数据表明，在1985年至1993年期间，对于临床I期非精原细胞瘤，人们过度依赖了一项不太理想的分期检查。报告的33%假阴性率与早期报告相比没有改善，这再次表明仅依靠腹膜后第三代或第四代CT成像对临床I期非精原性生殖细胞肿瘤（NSGCT）患者进行分期存在问题。在预期的主要着陆区出现任何数量的淋巴结，无论大小，都应引起对隐匿性淋巴结疾病的严重怀疑。
