背景:睾丸生殖细胞肿瘤(GCT)是侵袭性但高度可治愈的肿瘤。为了避免过度/不充分的治疗,腹膜后淋巴结转移的可靠临床分期是必要的。目前的临床指南,在他们不同的版本中,缺乏关于如何测量淋巴结转移的具体建议。
目的:我们旨在评估经常治疗睾丸癌的德国机构测量腹膜后淋巴结大小的实践模式。
方法:在德国大学医院和德国睾丸癌研究小组成员中进行了一项8项调查。
结果:在泌尿科医师组中,54.7%根据短轴直径(SAD)评估腹膜后淋巴结(33.3%在任何平面,轴向平面中为21.4%),而45.3%的人使用长轴直径(LAD)进行评估(任何平面的42.9%,轴向平面内的2.4%)。此外,肿瘤学家主要根据SAD评估淋巴结大小(71.4%).具体来说,42.9%的肿瘤学家在任何飞机上评估SAD,而28.5%的人在轴向平面上测量了这个尺寸。只有28.6%的肿瘤学家认为LAD(在任何平面上都有14.3%,轴向平面内14.3%)。没有一个肿瘤学家和11.9%的泌尿科医师(n=5)总是进行MRI进行初步评估,而对于后续成像,使用增加到36.5%的肿瘤科医师和31%的泌尿科医师。此外,只有17%的泌尿科医生,也没有肿瘤学家,在他们的评估中计算淋巴结体积(p=0.224)。
结论:在涉及睾丸癌管理的不同专业领域的所有指南中,迫切需要明确和一致的测量说明。
BACKGROUND: Testicular germ cell tumors (GCTs) are aggressive but highly curable tumors. To avoid over/undertreatment, reliable clinical staging of retroperitoneal lymph-node metastasis is necessary. Current clinical
guidelines, in their different versions, lack specific recommendations on how to measure lymph-node metastasis.
OBJECTIVE: We aimed to assess the practice patterns of German institutions frequently treating testicular cancer for measuring retroperitoneal lymph-node size.
METHODS: An 8-item survey was distributed among German university hospitals and members of the German Testicular Cancer Study Group.
RESULTS: In the group of urologists, 54.7% assessed retroperitoneal lymph nodes depending on their short-axis diameter (SAD) (33.3% in any plane, 21.4% in the axial plane), while 45.3% used long-axis diameter (LAD) for the assessment (42.9% in any plane, 2.4% in the axial plane). Moreover, the oncologists mainly assessed lymph-node size based on the SAD (71.4%). Specifically, 42.9% of oncologists assessed the SAD in any plane, while 28.5% measured this dimension in the axial plane. Only 28.6% of oncologists considered the LAD (14.3% in any plane, 14.3% in the axial plane). None of the oncologists and 11.9% of the urologists (n = 5) always performed an MRI for the initial assessment, while for follow-up imaging, the use increased to 36.5% of oncologists and 31% of urologists. Furthermore, only 17% of the urologists, and no oncologists, calculated lymph-node volume in their assessment (p = 0.224).
CONCLUSIONS: Clear and consistent measurement instructions are urgently needed to be present in all
guidelines across different specialistic fields involved in testicular cancer management.