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Radiological Assessment of Different Retroperitoneal Lymph Node Measurements in Stage 1 Testicular Cancer Patients: Impact on Clinical Stage and Treatment - Beyond the Abstract

This study was conducted at the Federal Armed Forces Hospital in Koblenz, Germany, following our survey from last year (published by UroToday on June 6, 2023). In that survey, we highlighted considerable discrepancies between international and national guidelines regarding the radiological measurement (plane and diameter) of retroperitoneal lymph node metastases in testicular cancer patients.

RECIST (Response Evaluation Criteria In Solid Tumors) 1.1 uses the maximum axial SAD (short-axis diameter), the S3-guideline of the German Society of Urology, like SWENOTECA (Swedish and Norwegian Testicular Cancer Group), uses the maximum LAD (long-axis diameter) in the axial plane, while other guidelines such as EAU (European Association of Urology), ESMO (European Society for Medical Oncology), and AJCC (American Joint Committee on Cancer) use the maximum LAD in any plane according to the TNM (Tumor-Node-Metastasis) classification.

Our prior survey revealed significant inconsistency among German urologists and oncologists in measuring retroperitoneal lymph node metastases in testicular cancer patients. We have now investigated the potential consequences of this inconsistency, such as different clinical staging and treatment decisions, in clinical stage I testicular cancer patients from the last 20 years at the Federal Armed Forces Hospital in Koblenz, who received no adjuvant therapy and had at least 24 months of follow-up.

Our findings indicate that the variability in measurement guidelines resulted in significant differences in clinical staging and treatment decisions. Our findings revealed significant variability in clinical staging and derived treatments based on the different guideline recommendations. We conclude, that testicular cancer guidelines should be standardized to ensure uniform staging and treatment. In our study, using RECIST 1.1 with axial SAD resulted in 100% overall survival, no increased recurrence rate, and the best ratio of overtreatment to undertreatment. This suggests that axial SAD could be a suitable parameter for guideline standardization. Larger prospective studies are urgently needed for further validation.

Written by: Angelina Strauch,1 Kai Nestler,2 Justine Schoch,1 Laura Kubitscheck,2 Stephan Waldeck,2 Hans Schmelz1 and Tim Nestler1


  1. Department of Urology, Federal Armed Forces Hospital Koblenz, 56072 Koblenz, Germany
  2. Institute of Diagnostic and Interventional Radiology, Federal Armed Forces Hospital Koblenz, Germany
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