Can abdominal ultrasound replace CT scanning in long-term follow-up of male patients with germ cell tumor?

Abstract

4602 Background: To date, there is no international consensus on how best to follow patients (pts) with GCT after their initial management. In the absence of a generally accepted follow-up schedule the possible benefits of regular CT scanning must be weighed against their cost, potential contrast media reactions and the long term risk of cumulative X-ray exposure. The present study focuses on the role of abdominal ultrasound in the follow-up of males with GCT and raises the question whether CT-scanning may be replaced by abdominal ultrasound. Methods: This retrospective single-center cohort study included 887 GCT pts followed between January 2001 and November 2011. The follow-up schedule was predominately based on abdominal ultrasound performed by the same physician (A.G.). Patterns of recurrence and the long-term outcome were analyzed. Results: 462 of 887 pts (52.1%) had stage I, 258 (29.1%) stage II and 130 (14.7%) stage III disease (not evaluable in 37 pts). The median time between baseline and the most recent follow-up examination was 5.0 years. A total of 14.604 abdominal ultrasound examinations (16.5/pt.), 1170 CT scans (1.32/pt.), and 956 chest X-rays (1.08/pt) were performed. A relapse occurred in 58 pts (6.5%) with 11 of 58 pts experiencing multiple relapses. 34 of 58 relapses (58.6%) were detected in pts with stage I GCT. The sites of relapse included the abdomen (n=42), other sites (n=10), and marker elevation only (n=10). 33 of 42 abdominal relapses (78.6%) were detected by abdominal ultrasound. The median size of abdominal lymph nodes was 25 mm (range, 6 - 67 mm). After a median follow-up of 5 years the GCT specific survival of the entire cohort was 98.4%. Regarding the subgroup of pts with relapse the GCT specific survival was 94.7%. Conclusions: Ultrasound appears to be an appropriate method to detect abdominal recurrences in pts with GCT. However, training and cumulative experience is necessary to detect retroperitoneal recurrences at an early stage. The number of expensive and potentially harmful CT scans may be markedly decreased by abdominal ultrasound.