Staging is by:
- Imaging
- Histology of orchidectomy
- Tumour markers
CT chest/abdo/pelvis the most sensitive way to stage for nodal and distant metastases prior to orchidectomy. It can be done before or after orchidectomy
- Trade off between sensitivity and specificity for nodes depending on size criteria used – consider the expected drainage patterns
Imaging of the head/brain is not routine – only recommended in NSGCT with widespread pulmonary mets or poor prognosis group (bHCG > 5000), or in symptomatic patients.
MRI is uncommonly used in my practice:
- MRI of the scrotum can be accurate for local assessment, but cost is prohibitive
- MRI abdomen has similar sensitivity and accuracy as contrast enhanced abdominal CT
- MRI of the brain is probably more sensitive than CT brain
FDG PET is not recommended for use in initial staging.
- Its main role is to assess residual masses > 3 cm post chemo for seminoma, to assess FDG activity
- However, even in that setting false positives can occur with post-chemo desmoplastic reaction, and inflammation from fibrosis and necrosis
*S staging should be tumour markers at nadir post orchidectomy (6 weeks or so)
