Open AccessPerformance characteristics of 18F-fluciclovine positron emission tomography/computed tomography prior to retroperitoneal lymph node dissection
Author(s) -
Solomon L. Woldu,
Xiaosong Meng,
Daniel Wong,
Fady Baky,
Vitaly Margulis,
Yin Xi,
Rathan M. Subramaniam,
Aditya Bagrodia
Publication year - 2021
Publication title -
canadian urological association journal
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.477
H-Index - 38
eISSN - 1920-1214
pISSN - 1911-6470
DOI - 10.5489/cuaj.7317
Subject(s) - medicine , retroperitoneal lymph node dissection , positron emission tomography , radiology , pet ct , nuclear medicine , chemotherapy , surgery , testicular cancer
We aimed to determine whether anti-1-amino-3-18F-fluorocyclobutane-1-carboxylic acid (18F-fluciclovine) positron emission tomography/computed tomography (PET/CT) can accurately detect residual non-seminomatous germ cell tumor (NSGCT) prior to retroperitoneal lymph node dissection (RPLND). There is no reliable way to differentiate between fibrosis/necrosis, teratoma, and viable germ cell tumor in patients receiving post-chemotherapy RPLND. Functional imaging, including 18F-fludeoxyglucose (18F-FDG) PET/CT, has been disappointing. Due to the need for better imaging modalities, our prospective, pilot study aims to investigate the accuracy of 18F-fluciclovine PET/CT in detecting residual tumor prior to RPLND.Methods: From March 2018 to May 2019, 10 eligible patients underwent preoperative 18F-fluciclovine PET/CT prior to undergoing bilateral, full-template RPLND or excision of mass (for one re-do RPLND) in a prospective, phase 2 study. Correlation between 18F-fluciclovine PET/CT and RPLND pathology were evaluated on a per-patient level.Results: A total of 10 patients (mean age 29±7.6 years) underwent 18F-fluciclovine PET/CT prior to surgery. Nine of 10 patients received chemotherapy prior to RPLND. Correlation between 18F-fluciclovine PET/CT and RPLND pathology was seen in 3/10 (30%) patients. Five of 10 patients (50%) with negative 18F-fluciclovine PET/CT were found to have residual disease/teratoma on RPLND. Compared to the reference standard of RPLND, 18F-fluciclovine PET/CT demonstrated 29% sensitivity and 33% specificity. No patients experienced any adverse events due to 18F-fluciclovine PET/CT.Conclusions: Despite a different mechanism of action from 18F-FDG, 18F-fluciclovine has low sensitivity and specificity for residual teratoma in the retroperitoneum.