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Positronenemissionstomographie bei Keimzelltumoren des Mannes

Einsatzmöglichkeiten und Grenzen

Positron emission tomography in germ cell tumors in men

Possibilities and limitations

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Zusammenfassung

Hintergrund

Problemfelder konventioneller Bildgebung bei Keimzelltumoren sind die sichere Differenzierung der klinischen Stadien I und IIA, die Lokalisation okkulter Markerrezidive und die Beurteilung der Vitalität postchemotherapeutischer Residualtumoren.

Ziel der Arbeit

Diese Übersichtsarbeit gibt einen Überblick über die diagnostische Aussagekraft und Limitationen der FDG-PET-CT bei seminomatösen und nichtseminomatösen Keimzelltumoren.

Material und Methoden

Diese Übersichtsarbeit basiert auf einer Literaturrecherche von Pubmed/MEDLINE aus den Jahren 1990–2018 sowie Kongressbeiträgen der ASCO- und EAU-Jahrestagungen 2014–2017.

Ergebnisse

In der primären Ausbreitungsdiagnostik testikulärer Keimzelltumoren im klinischen Stadium I hat die PET-CT keinen Vorteil gegenüber der klassischen CT. Bei der Beurteilung der Vitalität postchemotherapeutischer Seminomresiduen >3 cm hilft eine PET-Negativität bei der Entscheidung für oder gegen zusätzliche Lokalmaßnahmen oder eine erneute Chemotherapie. Auch PET-positive Residualtumoren führen nicht zwangsläufig zum Rezidiv. Beim Nichtseminom ist die Aussagekraft der PET-Diagnostik aufgrund möglicher reifer Teratomanteile limitiert, da diese regelhaft PET-negativ sind.

Schlussfolgerungen

Die FDG-PET wird in aktuellen Leitlinien zur Vitalitätsbeurteilung seminomatöser Residualtumoren >3 cm empfohlen. Individuelle Ausnahmesituationen, in denen eine PET-Diagnostik beim Nichtseminom sinnvoll sein kann, sind: (i) weiterführende Ausbreitungsdiagnostik im klinischen Stadium IS, (ii) Vitalitätsbeurteilung von Residualtumoren ohne Teratomanteile im Primärtumor bei Unmöglichkeit der vollständigen Residualtumorresektion, (iii) Tumorsuche bei CT-graphisch okkultem Markerrezidiv, (iv) frühe Beurteilung des Ansprechens während einer Chemotherapie.

Abstract

Background

Conventional radiographic imaging may fail to safely distinguish clinical stage I from stage IIA germ cell cancer, to localize isolated tumor marker relapses, and to equivocally identify the viability of postchemotherapy residual masses.

Objectives

To provide an overview of the diagnostic value and limitations of functional imaging by positron emission tomography with 2‑deoxy-2-[fluorine-18]fluoro-D-glucose with computed tomography (18F-FDG-PET-CT) in male germ cell cancer.

Materials and methods

A narrative review based on a literature search of PubMed/MEDLINE for original articles published from 1990–2018 and conference proceedings of ASCO (American Society of Clinical Oncology) and EAU (European Association of Urology) annual meetings 2014–2017 is presented.

Results

18F-FDG-PET-CT does not improve diagnostic accuracy compared to conventional CT imaging clinical stage (CS) I disease. Particularly PET-negativity of postchemotherapy residual masses of seminomas >3 cm in size guide decision-making against further additional treatment. Even PET-positive residues must not result in relapse. For nonseminoma, the value of PET imaging is reduced by potential mature teratoma components, which are commonly PET negative.

Conclusions

Current guidelines recommend 18F-FDG-PET-CT 6–8 weeks postchemotherapy for viability assessment of seminoma residues >3 cm in size. Exceptional circumstances, in which 18F-FDG-PET-CT may be helpful, include: (1) detection of active disease in CS IS, (2) viability assessment of residual masses >1 cm where complete secondary resection is impossible, (3) staging at marker relapse with unconspicuous conventional CT scan, (4) early response assessment during chemotherapy.

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Authors and Affiliations

  1. Klinik und Poliklinik für Urologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland

    P. Schriefer,  M. Hartmann,  C. P. Meyer &  M. Fisch

  2. Klinik für Onkologie, Hämatologie und Knochenmarktransplantation mit Abteilung für Pneumologie, Universitätsklinikum Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Deutschland

    K. Oechsle,  C. Bokemeyer &  C. Oing

  3. Klinik und Poliklinik für Diagnostische und Interventionelle Radiologie und Nuklearmedizin, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland

    S. Klutmann

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  1. P. Schriefer
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Correspondence to C. Oing.

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Interessenkonflikt

P. Schriefer, M. Hartmann, K. Oechsle, C.P. Meyer, S. Klutmann, M. Fisch, C. Bokemeyer und C. Oing geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

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Schriefer, P., Hartmann, M., Oechsle, K. et al. Positronenemissionstomographie bei Keimzelltumoren des Mannes. Urologe 58, 418–423 (2019). https://doi.org/10.1007/s00120-018-0797-x

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