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Positronenemissionstomographie (PET) zur Diagnostik und zum Therapiemonitoring bei urologischen Tumoren

Positron emission tomography (PET) for diagnosis and monitoring of treatment for urological tumors

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Zusammenfassung

Die Positronenemissionstomographie (PET) unter Einsatz der (18F)2-Fluoro-D-2-desoxyglukose (FDG) hat sich bei zahlreichen nichturologischen Tumoren als eine Untersuchungsform mit hoher Sensitivität und Spezifität in der Primärdiagnostik, zum Rezidivnachweis und zur Therapiekontrolle gezeigt. Aufgabe dieses Reviews war eine Untersuchung der Bedeutung der PET als bildgebendes Verfahren bei malignen Tumoren des Urogenitaltrakts.

Die Rolle der PET wurde für maligne Tumoren der Niere, des Hodens, der Prostata und der Harnblase durch Sichtung und Auswertung der vorhandenen Literatur untersucht. Die Rolle der FDG-PET beim Nierenzellkarzinom ist in der Detektion von Lokalrezidiven nach definitiver lokaler Therapie und von Metastasen zu sehen. Die höhere Spezifität der PET im Vergleich zu anderen diagnostischen Methoden (CT, Sono, MRT) beim rezidivierenden oder metastasierten Nierenzellkarzinom positioniert dieses diagnostische Werkzeug als Ergänzung zu anderen bildgebenden Verfahren bei dieser Tumorentität.

Die klinische Bedeutung der PET ist gesichert für die Identifikation von vitalem Residualtumorgewebe nach Chemotherapie des seminomatösen Keimzelltumors. Die Bedeutung dieser diagnostischen Methode beim primären Tumorstaging und in der Diagnostik von nichtseminomatösen Keimzelltumoren bleibt aufgrund der häufig falsch-negativen Reaktion des Teratomanteils gering.

Die FDG-PET ist weder für die Primär- noch in der Lokalrezidivdiagnostik beim Prostata- und Harnblasenkarzinom ausreichend sensitiv. Auch beim Nachweis zumeist osteoblastischer Knochenmetastasen des Prostatakarzinoms zeigt sich die PET dem konventionellen Knochenszintigramm nicht überlegen.

Der jüngste Einsatz alternativer z. T. nicht renal eliminierter Tracer (Acetat, Cholin) hat die Sensitivität und Spezifität der PET auch bei dieser Tumorentität erhöht, sodass weitere klinische Studien die Bedeutung dieser technischen Modifikation für die Validität der Untersuchung zeigen müssen.

Nur beim diagnostischen Follow-up von Patienten mit seminomatösen Keimzelltumoren nach Chemotherapie erscheint die PET ausreichend klinisch evaluiert, um sie als etabliertes bildgebendes Verfahren zu werten. Bei allen anderen Malignomen des Urogenitaltrakts steht dieser Beweis noch aus.

Abstract

Positron emission tomography (PET) using (18F)2-fluoro-D-2-desoxyglucose (FDG) has been shown to be a highly sensitive and specific imaging modality in the diagnosis of primary and recurrent tumors and in the control of therapies in numerous non-urologic cancers. It was the aim of this review to validate the significance of PET as a diagnostic tool in malignant tumors of the urogenital tract.

A systematic review of the current literature concerning the role of PET for malignant tumors of the kidney, testicles, prostate, and bladder was carried out. The role of FDG PET for renal cell cancer can be seen in the detection of recurrences after definitive local therapy and metastases. The higher sensitivity of PET in comparison to other therapeutic modalities (CT, ultrasound, MRI) in recurrent and metastatic renal cell cancer suggests a supplemental role of this diagnostic procedure to complement other imaging modalities.

The clinical value of PET is established for the identification of vital tumor tissue after chemotherapy of seminomatous germ cell tumors. This diagnostic method has little significance for primary tumor staging and diagnosis of non-seminomatous germ cell tumor because of the high probability of false-negative results in adult teratomas.

FDG PET is not sensitive enough in the diagnosis of primary or recurrent tumors in prostate or bladder cancer. Also PET did not prove to be superior to conventional bone scintigram in the detection of mostly osteoblastic metastases in prostate cancer. The recent use of alternative tracers, which are partly not eliminated by urinary secretion (acetate, choline) has increased the sensitivity and specificity of PET also in this tumor entity so that further clinical investigations are needed to validate these technical modifications in their significance for this imaging modality.

PET appears to be sufficiently evaluated only for the diagnostic follow-up of patients with seminomatous germ cell tumors after chemotherapy to regard it is the diagnostic tool of first choice. For all other tumors of the urogenital tract this proof is still awaited.

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  1. Klinik für Urologie und Kinderurologie, Medizinische Hochschule, Hannover

    S. Machtens & U. Jonas

  2. Klinik für Nuklearmedizin, Medizinische Hochschule, Hannover

    A. R. Boerner & W. H. Knapp

  3. Klinik für Nuklearmedizin, Inselspital, Bern

    M. Hofmann

  4. Klinik für Urologie und Kinderurologie, Medizinische Hochschule, Carl-Neuberg-Straße 1, 30625, Hannover

    S. Machtens

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Machtens, S., Boerner, A.R., Hofmann, M. et al. Positronenemissionstomographie (PET) zur Diagnostik und zum Therapiemonitoring bei urologischen Tumoren. Urologe [A] 43, 1397–1409 (2004). https://doi.org/10.1007/s00120-004-0714-3

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