Obligatory medical device diagnostics.
- Scrotal sonography/sonography (ultrasonography) of the scrotal contents (testis and epididymis) (minimum 7.5 MHz transducer) [Sensitivity (percentage of diseased patients in whom the disease is detected by use of the procedure, ie, a positive finding occurs): 100 %]
- Contrast-enhanced ultrasound (CEUS) significantly improves diagnosis.[Differentiation of avascular, hypo- and hypervascularized processes/increased density of blood vessels in a tissue; lack of evidence of perfusion (blood flow) of the lesion (change) is usually considered a sign of benignity/goodness; presence of vascularization → evidence of neoplasia (neoplasm), but this is not synonymous with malignancy/malignancy]
- X-ray of the thorax (X-ray thorax/chest), in two planes – for staging (staging).
- Computed tomography of the thorax (thoracic CT) and abdomen (abdominal CT) – for staging or primary staging of germ cell tumors (KZT)Note: In contraindications (contraindications) against the administration of iodine-containing contrast medium, such as allergy, impaired renal function or thyroid dysfunction:
- Magnetic resonance imaging (MRI) of the abdomen and pelvis – for staging.
- Computed tomography of the thorax (thoracic CT) without contrast medium – to clarify pulmonary involvement (lung involvement)
- Magnetic resonance imaging (MRI) of the skull – in patients in the poor prognosis group according to IGCCCG and in patients with excessive beta-hCG levels, multiple pulmonary metastases or neurological symptoms.
Optional medical device diagnostics – depending on the results of the history, physical examination, laboratory diagnostics and obligatory medical device diagnostics for differential diagnosis.
- FDG-PET/CT (procedure should preferably be performed as contrast CT) – Use in seminomatous patients (not in patients with a nonseminomatous CCT/germ cell tumor) who have residual tumors (tumor portions remaining in the patient’s body after treatment (tumor surgery, chemotherapy, radiotherapy) with a diameter > 3 cm after completion of therapy with normal or normalized serum tumor markers.Note: The procedure should be performed no earlier than 6 weeks after the end of the last cycle of chemotherapy.
- Skeletal scintigraphy (nuclear medicine procedure that can show functional changes in the skeletal system, in which regionally (locally) pathologically (pathologically) increased or decreased bone remodeling processes are present) – if bone metastases are suspected.
Testicular tumor screening
- General screening for early detection is not recommended; however, regular self-examination of the testes is useful, especially in young men. Guidance on self-examination is provided by the German Society of Urology in cooperation with the Professional Association of German Urologists on its Internet portal www.hodencheck.de
Aftercare
- Two to three months after radiotherapy, abdominal/pelvic CT should be performed for follow-up. The same procedure should be followed after chemotherapy. The result of this examination is also the starting point for further follow-up [guidelines: S3 guideline].
- Magnetic resonance imaging (MRI) of the abdomen and pelvis – to reduce radiation exposure, CT of the abdomen and pelvis should be used by MRI in contraindications to the administration of iodine-containing contrast medium, such as allergy, impaired renal function or thyroid dysfunction.
