Differential Diagnosis of Nonpalpable Testicular Lesions: Qualitative and Quantitative Contrast-enhanced US of Benign and Malignant Testicular Tumors

Abstract

).q RSNA, 2014 Purpose:To evaluate the diagnostic accuracy of unenhanced and quantitative contrast-enhanced ultrasonography (US) in the differential diagnosis of small nonpalpable testicular lesions. Materials andMethods:The local review board approved the protocol, and all patients provided written informed consent. One hundred fifteen patients (median age, 34 years; age range, 14-61 years) with nonpalpable testicular lesions were consecutively enrolled between 2006 and 2012 and underwent unenhanced scrotal US, contrast-enhanced US, surgical enucleation, and at least 18 months of follow-up. Clinical and histologic features were recorded, and qualitative and quantitative analysis of contrast-enhanced US time-intensity curves were performed. Logistic regression analysis was performed to explore features of malignancy. Receiver operating characteristic (ROC) curves were developed for cumulative unenhanced and contrast-enhanced US scores. Results:All lesions were 1.5 cm or smaller. Forty-four of the 115 patients (38%) had malignant tumors, 42 had benign tumors (37%), and 29 (25%) had nonneoplastic lesions. Conclusion:Benign testicular tumors are frequent incidental findings. Quantitative scrotal contrast-enhanced US is a noninvasive diagnostic tool that could improve the differential diagnosis and individualized management of small testicular lesions.q RSNA, 2014

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

“…The primary outcome of the study was to assess the diagnostic accuracy of qualitative and strain ratio elastography in the differential diagnosis of non‐palpable testicular lesions. Secondary outcomes included the validation of previously identified risk factors for malignancy at baseline US (Isidori et al ., 2014). …”

“…and V.C., both with >5 years of experience). US features were evaluated according to a predefined protocol, taking into account the most widely accepted risk factors for testicular tumors (Isidori et al ., 2014). For each lesion, the size (cm), B‐mode, and color‐Doppler features were recorded and stored; the elastography settings were then applied and SE images and cine‐loops of each lesion were saved for qualitative (color‐coded images) and semi‐quantitative evaluation of dynamic features (strain ratio on cine‐loop).…”

“…In contrast, any multiple and/or non‐vascularized lesions were interpreted as non‐neoplastic (Leydig cell hyperplasia, segmental ischemia, fibrosis, cysts) according to a protocol validated by prior histological, CEUS, and MRI published studies (Isidori et al ., 2014; Manganaro et al ., 2015). Whenever possible, intraoperative frozen section examination (FSE) was performed during surgery (61/64) (Isidori et al ., 2014). …”

“…However, US differentiation between benign and malignant testicular neoplasms and, occasionally, between neoplastic and non‐neoplastic incidental lesions is limited (Lotti & Maggi, 2015). The ability to characterize testicular lesions could enable the use of conservative surgery for selected cases, especially for bilateral/multiple lesions or in monorchid patients (Isidori et al ., 2014). Until recently, all neoplastic lesions were removed because of the assumption that they were mostly malignant (Coret et al ., 1995).…”

“…Until recently, all neoplastic lesions were removed because of the assumption that they were mostly malignant (Coret et al ., 1995). Recent studies suggest that benign tumors are much more frequent than previously thought (Isidori et al ., 2014). Several uro‐andrologists have proposed a conservative approach, with close follow‐up (Giannarini et al ., 2010).…”