Performance characteristics of 18F-fluciclovine positron emission tomography/computed tomography prior to retroperitoneal lymph node dissection |
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Authors: | Solomon L. Woldu Xiaosong Meng Daniel Wong Fady Baky Vitaly Margulis Yin Xi Rathan M. Subramaniam Aditya Bagrodia |
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Affiliation: | 1.Department of Urology, UT Southwestern Medical Center, Dallas, TX, United States; 2.School of Medicine, UT Southwestern Medical Center, Dallas, TX, United States; 3.Department of Radiology, UT Southwestern Medical Center, Dallas, TX, United States; 4.Simmons Comprehensive Cancer Center, UT Southwestern Medical Center, Dallas, TX, United States; 5.Department of Urology, University of California-San Diego, San Diego, CA, United States |
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Abstract: | IntroductionWe 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 (18F-FDG) 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.MethodsFrom 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.ResultsA 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.ConclusionsDespite a different mechanism of action from 18F-FDG, 18F-fluciclovine has low sensitivity and specificity for residual teratoma in the retroperitoneum. |
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