Abstract
PurposeOne of the main issues in testicular germ cell tumors (TGCTs) management is to reduce the necessary amount of treatment to achieve cure. Excess treatment burden may arise from late diagnosis of the primary as well as from false positive or negative staging results. Correct imaging is of paramount importance for successful management of TGCT. The aim of this review is to point out the current state of the art as well as innovative developments in TGCT imaging on the basis of three common challenging clinical situations.MethodsA selective literature search was performed in PubMed, Medline as well as in recent conference proceedings.ResultsRegarding small testicular lesions, recent studies using elastography, contrast-enhanced ultrasound or magnetic resonance imaging (MRI) showed promising data for differentiation between benign and malignant histology. For borderline enlarged lymph nodes FDG-PET-CT performance is unsatisfactory, promising new techniques as lymphotropic nanoparticle-enhanced MRI is the subject of research in this field. Regarding the assessment of postchemotherapeutic residual masses, the use of conventional computerized tomography (CT) together with serum tumor markers is still the standard of care. To avoid overtreatment in this setting, new imaging modalities like diffusion-weighted MRI and radiomics are currently under investigation. For follow-up of clinical stage I TGCTs, the use of MRI is non-inferior to CT while omitting radiation exposure.ConclusionFurther efforts should be made to refine imaging for TGCT patients, which is of high relevance for the guidance of treatment decisions as well as the associated treatment burdens and oncological outcomes.
Highlights
Testicular germ cell tumors (TGCTs) represent the most common malignancy among young men aged 15–40 years [1, 2].Clinically, TGCTs are categorized into seminomas and non-seminomas with relatively equal proportions of 50%–60% for seminomas and 40%–50% for non-seminomas [2, 3]
Most non-seminomas are rather inhomogeneous and show sometimes cystic structures and/or calcifications, which can be explained by more common tumor necrosis, mixed histologies and teratoma components [15, 16]
From the perspective of the current guidelines, magnetic resonance imaging (MRI) is already recommended in the follow-up of TGCT by the ESMO guideline as well as the German TGCT guideline [10, 11]
Summary
Testicular germ cell tumors (TGCTs) represent the most common malignancy among young men aged 15–40 years [1, 2]. TGCTs are categorized into seminomas and non-seminomas with relatively equal proportions of 50%–60% for seminomas and 40%–50% for non-seminomas [2, 3]. Among the entire histologic spectrum of testicular neoplasms, TGCTs comprise of 90%–95% of the cases [4, 5] and the remainder comprise of a great variety non-germ. Clinical diagnosis of TGCTs relies on physical examination, testicular ultrasound and determination of specific tumor markers such as alpha feto protein (AFP), beta-hCG (β-hCG) and lactate dehydrogenase (LDH) [4, 6]. The tumor is confined to the testis in 68%–75% of the cases (clinical Stage I), regional lymph nodes metastasis in 15%–20% of the cases (clinical Stage II) and distant metastasis in 5%–12% of the cases (clinical Stage III) [6,7,8,9].
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