Sonography and CT in staging nonseminomatous testicular tumors

The usefulness of sonography and computed tomography (CT) in the clinical staging of nonseminomatous testes tumors was examined by retrospectively reviewing the clinical staging of 57 patients. Twenty-five patients had sonographic examinations; two were considered inadequate and there were no false-positive results. Understaging occurred in 13% (3/23), while the negative predictive value for sonography was 73% (8/11). CT was performed on 29 patients; no patients were overstaged and only one examination was inadequate due to technical reasons. Understaging occurred in 18% (5/28), and CT had a negative predictive value of 67% (8/12). A subgroup of 18 patients having both sonography and CT was examined, and each staging procedure had a 22% false-negative and a 0 false-positive rate. Twenty-seven lymphangiograms, 28 excretory urograms, and 49 tumor marker determinations were also performed on this patient population, and their false-negative rates were 35%, 78%, and 61%, respectively. False-positive rates of 30% for lymphangiograms, 6% for tumor markers, and 0 for excretory urograms were also obtained. On the basis of these results, sonography and CT are equivalent and superior examinations that have a high degree of accuracy (90%) in predicting bulky metastatic disease, either stage B3 or C disease. All patients would have received appropriate therapy if both examinations were carried out. However, this same goal could have been achieved with greater cost efficiency by initial sonographic screening, followed by CT in only those patients with negative or inadequate sonographic examinations.