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Gallium-67-Citrate Imaging in Extragonadal and Gonadal Seminomas: Relationship to Radiologic Findings

Division of Nuclear Medicine, Department of Radiology and Department of Medicine, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts

Correspondence: For correspondence or reprints contact: Philip W. Kantoff, MD, Department of Medicine, Dana-Farber Cancer Institute, 44 Binney Street, Boston, MA 02115.

ABSTRACT

Methods: The results and analysis of baseline and follow-up ⁶⁷Ga imaging in three patients with extragonadal seminoma were compared to those of nine patients with primary and metastatic gonadal seminomas. Gallium-67 tumor avidity was scored (0–6) relative to accumulation in the stemum and the liver. Response time to systemic therapy for ⁶⁷Ga imaging compared to other radiological examinations was also measured. Results: Prior to therapy, ⁶⁷Ga scan sensitivity was 100%, (3/3) in patients with extragonadal seminomas and 90%, (9/10) for primary and radiologically evident metastatic sites in patients with gonadal seminomas. The combined sensitivity was 92%, (12/13) with the smallest ⁶⁷Ga scan detecting a mass 1.5 cm in diameter. There was no significant difference in ⁶⁷Ga avidity or sensitivity between extragonadal and gonadal sites. Following chemotherapy, CT scanning demonstrated residual radiologic abnormalities in all three extragonadal seminoma tumor sites and 5/8 metastatic gonadal seminoma tumor sites. However, the ⁶⁷Ga scan was normal in 10/11 sites at the first radionuclide examination after systemic therapy, indicating no active tumor, an observation supported by clinical follow-up from 6 to 72 mo. Conclusion: Gallium-67 scanning appears useful in the management of patients with both extragonadal and gonadal seminoma and may be useful in differentiating active disease from fibrosis in the treated patient with a post-therapy residual radiologic mass.

Key Words: gallium-67-citrate imaging • CT scan • seminoma • extragonadal seminoma