Performance characteristics of 18F-fluciclovine positron emission tomography/computed tomography prior to retroperitoneal lymph node dissection

Authors

  • Solomon L. Woldu
  • Xiaosong Meng
  • Daniel Wong
  • Fady Baky University of Texas Southwestern Medical Center
  • Vitaly Margulis
  • Yin Xi
  • Rathan M. Subramaniam
  • Aditya Bagrodia

DOI:

https://doi.org/10.5489/cuaj.7317

Keywords:

Testicular cancer, Axumin PET, Postiron emission topography, retroperitoneal lymph node dissection, germ cell tumor

Abstract

Introduction: 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 (18FFDG) 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 18FFDG, 18F-fluciclovine has low sensitivity and specificity for residual teratoma in the retroperitoneum.

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Published

2021-10-18

How to Cite

Woldu, S. L., Meng, X. ., Wong, D., Baky, F., Margulis, V. ., Xi , Y., Subramaniam, R. M. ., & Bagrodia, A. . (2021). Performance characteristics of 18F-fluciclovine positron emission tomography/computed tomography prior to retroperitoneal lymph node dissection. Canadian Urological Association Journal, 16(3), E167–72. https://doi.org/10.5489/cuaj.7317

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Section

Original Research