Contemporary diagnostic work-up of testicular germ cell tumours

Abstract

Diagnostic work-up of testicular masses should begin with a complete patient history and palpation of the testes with both hands. First-line imaging of the scrotum should be performed using multiparametric ultrasonography, that is the sequential use of grey-scale ultrasonography, colour Doppler ultrasonography (CDUS), and, if available, contrast-enhanced ultrasonography (CEUS) and real-time elastography (RTE). Increased vascularization--a characteristic of malignancy and inflammation--is visualized on CDUS and CEUS. RTE provides additional information for distinguishing between benign and malignant tissue by measuring tissue elasticity of lesions. MRI is another powerful modality, typically used for second-line imaging of intrascrotal disorders. MRI can provide images with a broad field of view of the scrotal contents. Cancerous lesions are identified on MRI by their signal enhancement after injection of contrast agent. Testicular germ cell tumours require treatment by inguinal orchiectomy. Testis-sparing surgery is advocated for benign tumours and in solitary testicles provided the tumour is <3 cm and the preoperative serum testosterone level is normal. For intraoperative decision-making with regard to testis-sparing surgery, frozen section histological examination can be used, which has a false-negative rate of <10%.

Impalpable Testicular Seminoma Identified on Sonoelastography

“…Classic seminoma usually presents as a painless, hard, palpable testicular mass, making clinical evaluation the initial and most important step in diagnosis [1]. The impetus for more innovative ultrasound techniques comes as a result of the inability of conventional B-mode ultrasound to detect structural and histological characteristics of testicular tumors [2].…”

Diagnostic value of qualitative and strain ratio elastography in the differential diagnosis of non‐palpable testicular lesions

“…Contrast‐enhanced ultrasound (CEUS) has up to 93% diagnostic accuracy in the differential diagnosis of non‐palpable tumors (Isidori et al ., 2014). Magnetic resonance imaging (MRI) has also recently proved accurate in the characterization of incidental testicular lesions (Gianfrilli et al ., 2009; Dieckmann et al ., 2013; Tsili et al ., 2014; Manganaro et al ., 2015). …”

Diffusion‐Weighted and Magnetization Transfer Imaging in Testicular Spermatogenic Function Evaluation: Preliminary Results

“…The advantages of magnetic resonance imaging (MRI) of scrotum include simultaneous imaging of both testicles, paratesticular spaces, and spermatic cords; it can provide adequate anatomic information; satisfactory tissue contrast; and functional information. MRI allows noninvasive assessment of testicular lesions with high soft‐tissue resolution and no ionizing radiation . In diffusion‐weighted MRI (DWI), water molecule diffusion can be reduced in macromolecule‐rich tissues with high cell density and intact cell membrane .…”