Lymph node staging in malignant testicular germ cell tumors.

Imaging procedures are important in the initial staging and subsequent management of testicular germ cell tumors on account of the differing stage-dependent options for therapy. While the diagnosis of advanced tumors gives no cause for controversial discussion the situation in the clinical stage 1 of germ cell tumors is more ambiguous. The lymph node status is only assessed correctly in about 70% of the patients using the currently available methods since metastases in normally large lymph nodes are not detected on slice images. Although most clinical experience has been gained with computed tomography (CT), magnetic resonance imaging (MRI) offers an equally efficient diagnostic procedure. The significance of positron emission tomography with 18-fluorodoxyglucose (FDG-PET) appears to be limited on account of the absence of accumulation in lymph node metastases of the differentiating teratoma. Sonography and lymphography have not proved to be useful for retroperitoneal lymph node diagnosis. The present review presents and discusses the current value of the available imaging procedures for staging and follow-up of malignant testicular germ cell tumors in relation to modern therapy regimens.