Unenhanced MRI of the abdomen and pelvis for surveillance of patients with stage 1 testicular cancer post-radical orchie
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KIDNEYS, URETERS, BLADDER, RETROPERITONEUM
Unenhanced MRI of the abdomen and pelvis for surveillance of patients with stage 1 testicular cancer post‑radical orchiectomy Rishi Narine1 · Heba Osman1 · Sirote Wongwaisayawan1 · Scott Morgan2 · Luke T. Lavallee3 · Nicola Schieda4 Received: 1 June 2020 / Revised: 11 August 2020 / Accepted: 21 August 2020 © Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Objective To evaluate the ability of unenhanced magnetic resonance imaging (MRI) to detect metastatic lymphadenopathy in men with stage 1 testicular cancer on surveillance. Materials and methods With IRB approval, we identified 23 consecutive men with stage 1 testicular cancer (diagnosed after orchiectomy) undergoing surveillance with unenhanced MRI of the abdomen and pelvis. Three blinded radiologists (2 inexperienced R1/R2 and 1 experienced R3) independently assessed MRI for: presence, location and size of abnormal lymph nodes and degree of confidence (5-point Likert scale) in diagnosis. Diagnostic accuracy was tabulated and compared between groups using ROC. Inter-observer agreement was assessed using Cohen’s kappa statistic. Results 17.4% (4/23) men developed 6 metastatic lymph nodes (reference standard: interval development from baseline, size > 1.0 cm short axis). R1 and R2 detected 75% (3/4) patients with abnormal lymph nodes, compared to R3 who detected all four cases. False positive interpretations occurred in: 5.2% (1/19) R1, 10.5% (2/19) R2 and no patients for R3. Sensitivity, specificity and area under the ROC curve (AUC) were: R1: 75% (95% CI 19.4–99.4%), 94.7% (74.0–99.9%) and 0.85 (0.59–1.00), R2: 75% (19.4–99.4%), 89.5% (66.9–98.7%) and 0.82 (0.57–1.00) and, R3: 100% (95% 39.8–100.0%), 100% (82.4–100%) and 1.00 (1.00–1.00) with no difference in AUC between readers (p = 0.383). Comparison in accuracy between readers is limited due to the small sample size. Inter-observer agreement was substantial (K = 0.62). Median (range) degree of confidence scores were rated: R1 5 (5–5), R2 4 (3–5) and, R3 5 (5–5). Conclusion In this study, unenhanced MRI was adequate for surveillance of stage 1 testicular cancer; however, radiologist inexperience may lead to errors. Keywords Testicular cancer · Seminoma · Surveillance · Lymph nodes · MRI
Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00261-020-02715-z) contains supplementary material, which is available to authorized users.
Abbreviations MRI Magnetic resonance imaging CT Computed Tomography R Radiologist
* Nicola Schieda [email protected]
1
Department of Medical Imaging, The Ottawa Hospital, Ottawa, ON, Canada
Rishi Narine [email protected]
2
Division of Radiation Oncology, Department of Medical Imaging, The Ottawa Hospital, Ottawa, ON, Canada
Heba Osman [email protected]
3
Division of Urology, Department of Surgery, The Ottawa Hospital, Ottawa, ON, Canada
Sirote Wongwaisayawan [email protected]
4
Department of Medical Imaging, The Ottawa Hospital, 1053
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