Declining Use of Imaging Modalities Preoperatively in Management of Cryptorchidism in Children

Abstract

Abstract:Cryptorchidism is characterised by the absence of one or both testes from the scrotum. It is recorded in 30% of preterm compared to 3% in term infants. Different radiological modalities have been adopted preoperatively to localise cryptorchid testes. Ultrasound Scan (USS) is the most widely used imaging modality because of availability and non-invasiveness. However, the role of Magnetic Resonance Imaging (MRI) & Computed Tomography (CT) preoperatively is still unclear. Several studies advocated comparisons between imaging modalities and operative findings. Aim of the study is to perform 35-year literature survey to elucidate trends of imaging studies in investigating cryptorchidism in children. A PubMed search was performed for publications relevant to the pediatric age group, between January 1980 and January 2015. The 35-year search identified a total of 259 articles. Of these, 45 articles that matched the inclusion criteria were retrospective (n = 11), prospective (n = 5) and other related studies (n = 29). Addressed end-points out come: (1) Imaging modality; USS (n = 16), MRI (n = 6) & CT (n = 3); (2) Sensitivity; USS (45%-96%), MRI (55%-86%) & CT (94%); (3) Specificity; USS (25%-100%), MRI (79%-100%) & CT (100%); (4) Accuracy; USS (15%-91%), MRI (52%) & CT (33%-96%); (5) Population size; (n = 838); (6) Patients' age; range (6m-17y). USS has low sensitivity, specificity and accuracy relatively in determining the presence of testes and localisation of their position. Comparatively, MRI has superior role. However, in the presence of examination under anaesthesia and laparoscopic technique, all these modalities are not recommended in investigations preoperatively. Based on the literature review, there is a universal decline trend in performing imaging studies prior to surgery in children with cryptorchidism despite technology improvement.