RETROPERITONEAL NODAL DISTRIBUTION OF METASTATIC SEMINOMA: A CLINICAL MAPPING STUDY

You have accessJournal of UrologyPenile & Testicular Cancer I (MP01)1 May 2024MP01-14 RETROPERITONEAL NODAL DISTRIBUTION OF METASTATIC SEMINOMA: A CLINICAL MAPPING STUDY Jiping Zeng, Jacob McFadden, Timothy A. Masterson, and Clint Cary Jiping ZengJiping Zeng , Jacob McFaddenJacob McFadden , Timothy A. MastersonTimothy A. Masterson , and Clint CaryClint Cary View All Author Informationhttps://doi.org/10.1097/01.JU.0001008660.87408.90.14AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Retroperitoneal lymph node dissection (RPLND) has emerged as another curative option in early-stage metastatic seminoma in an effort to mitigate long-term treatment related morbidities. In this study, we aimed to characterize the metastatic deposition pattern of seminoma in the retroperitoneum. METHODS: We queried the Indiana University Testicular Cancer database to identify patients who had metastatic Stage II seminoma and underwent primary RPLND with a full bilateral template from 2013 to 2023. Patients who had bilateral testicular seminoma or had mixed germ cell tumor on final pathology were excluded. The nodal distribution based on preoperative CT and the pathology report was reviewed. RESULTS: The cohort consists 27 left and 38 right testis tumors. For left sided primary tumor, the para-aortic (96.3%) is the most common landing zone, followed by left gonadal (18.5%) and interaortocaval (14.8%) regions. Four (14.8%) patients had crossover to the interaortocaval zone; however, 1 of these 4 was detected on preoperative CT. Thus, based on preoperative imaging 3 (11%) of the 27 left sided primaries had microscopic disease outside the unilateral template. For right sided primary tumor, the interaortocaval (89.5%) is the most common landing zone, followed by para-caval (26.3%) and para-aortic (18.4%) regions. Seven (18.4%) patients had cross over to the para-aortic zone; however, 5 of these 7 was detected on preoperative CT. Thus, based on preoperative imaging, 2 (5%) of the 38 right sided primaries had microscopic disease outside of a unilateral template. Overall, the sensitivity, specificity, PPV and NPV of CT zonal detection are 78.9%, 99.5%, 97.3%, and 95.7%, respectively. CONCLUSIONS: The spread of seminoma in the retroperitoneum follows a similar but subtly different pattern compared to non-seminomatous germ cell tumors. Crossover occurs in 14.8-18.6% of patients. With negative CT imaging, the incidence of microscopic disease in the contralateral zone ranges from 5-11%. While CT is highly specific, it may miss up to 21.1% of anatomical zones. Source of Funding: None © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e7 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Jiping Zeng More articles by this author Jacob McFadden More articles by this author Timothy A. Masterson More articles by this author Clint Cary More articles by this author Expand All Advertisement PDF downloadLoading ...