Primary radical retroperitoneal lymphadenectomy currently is used for pathologic staging of nonseminomatous germ cell testis tumors unless advanced disease is present initially. Many attempts have been made with serum markers, lymphangiograms, excretory urograms, gallium and ultrasound scans, and computerized tomography for accurate staging of these tumors preoperatively. We reviewed the accuracy of alpha-fetoprotein and beta-human chorionic gonadotropin serum markers, and abdominal ultrasound and computerized tomography scans in preoperatively staging 64 patients with stage A or B nonseminomatous germ cell testis tumors seen at our university between 1977 and 1980. The results of the preoperative staging studies were correlated with the pathologic stages obtained by retroperitoneal lymphadenectomy. The combined results of serum markers, ultrasound and computerized tomography staged correctly 24 of 32 cases of pathologic stage A disease (75 per cent) and 21 of 32 of pathologic stage B disease (66 per cent). In patients with stage B disease the accuracy improved as the amount of tumor increased: 6 of 13 cases of stage B1 disease (46 per cent), 8 of 12 of B2 (67 per cent) and 7 of 7 of B3 (100 per cent) were staged correctly preoperatively. Over-all, the correct results were obtained in 61 per cent of the patients with alpha-fetoprotein, 64 per cent with beta-human chorionic gonadotropin, 53 per cent with ultrasound and 67 per cent with computerized with beta-human chorionic gonadotropin, 53 per cent with ultrasound and 67 per cent with computerized tomography. Occasionally, alpha-fetoprotein or beta-human chorionic gonadotropin, or computerized tomography alone would be positive in a patient with stage B disease but ultrasound was never positive unless the computerized tomography scan also was positive. Based upon these results ultrasound scanning has been eliminated from the preoperative staging routine. Also, since the over-all accuracy in preoperatively evaluating patients with stages A and B nonseminomatous germ cell testis tumors is 70 per cent retroperitoneal lymphadenectomy still is needed for accurate staging as well as for providing therapeutic benefit in the majority of patients with stage B disease.
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