Ultrasonography of the scrotum: Revisiting a classic technique

Tsili, Athina C.; Bougia, Christina K.; Pappa, Ourania; Argyropoulou, Maria I.

doi:10.1016/j.ejrad.2021.110000

Cited by 11 publications

(6 citation statements)

References 177 publications

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“…So, the true frequency of subcentimeter testicular tumours in that population was probably much higher. In light of the ever-growing clinical use of scrotal sonography in urologic practice and its ongoing technical refinements [ 8 , 9 , 34 , 35 ], the relative frequency of subcentimeter testicular tumours is probably in the range of 10% or more in contemporary series. This figure clearly underscores the clinical relevance of managing incidentally detected small testicular lesions.…”

Section: Discussionmentioning

confidence: 99%

“…The size of a testicular new growth is considered to have a bearing on histology found upon surgery [ 7 ]. This knowledge is of high clinical relevance, because in light of the continuously growing use of scrotal ultrasound in everyday urological practice and ongoing technical refinements of this technology [ 8 , 9 , 10 ], the incidence of small testicular neoplasms has been increasing in recent years. Tumour size also has a bearing on metastatic spread, at least in the subgroup of seminoma [ 11 ].…”

Section: Introductionmentioning

confidence: 99%

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Testicular Neoplasms: Primary Tumour Size Is Closely Interrelated with Histology, Clinical Staging, and Tumour Marker Expression Rates—A Comprehensive Statistical Analysis

Dieckmann

Isbarn

Grobelny

et al. 2022

Cancers

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The role of primary tumour size (TS) in the clinical course of testicular tumours is incompletely understood. We retrospectively evaluated 641 consecutive patients with testicular neoplasms with regard to TS, histology, clinical stage (CS), serum tumour marker (STM) expression and patient age using descriptive statistical methods. TS ≤ 10 mm was encountered in 13.6% of cases. Median TS of 10 mm, 30 mm, 35 mm, and 53 mm were found in benign tumours, seminomas, nonseminomas, and other malignant tumours, respectively. In cases with TS ≤ 10 mm, 50.6% had benign tumours. Upon receiver operating characteristics analysis, TS of > 16 mm revealed 81.5% sensitivity and 81.0% specificity for detecting malignancy. In subcentimeter germ cell tumours (GCTs), 97.7% of cases had CS1, and CS1 frequency dropped with increasing TS. Expression rates of all STMs significantly increased with TS. MicroRNA-371a-3p (M371) serum levels had higher expression rates than classical STMs, with a rate of 44.1% in subcentimeter GCTs. In all, TS is a biologically relevant factor owing to its significant associations with CS, STM expression rates and histology. Importantly, 50% of subcentimeter testicular neoplasms are of benign nature, and M371 outperforms the classical markers even in subcentimeter tumours.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Testicular Neoplasms: Primary Tumour Size Is Closely Interrelated with Histology, Clinical Staging, and Tumour Marker Expression Rates—A Comprehensive Statistical Analysis

Dieckmann

Isbarn

Grobelny

et al. 2022

Cancers

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“…Conventionally, ultrasound examination is the preferred choice for testicular masses. Despite its high sensitivity in the mass detection, it shows low specificity in distinguishing between benign and malignant masses, let alone other pathological subtypes ( 23 , 24 ). Furthermore, testicular biopsy is used in some centers but has not gained widespread acceptance because of narrow indications and concerns for tumor seeding along the biopsy tract.…”

Section: Discussionmentioning

confidence: 99%

Machine learning-based CT texture analysis in the differentiation of testicular masses

Hu,

Qiao,

et al. 2024

Front. Oncol.

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PurposeTo evaluate the ability of texture features for distinguishing between benign and malignant testicular masses, and furthermore, for identifying primary testicular lymphoma in malignant tumors and identifying seminoma in testicular germ cell tumors, respectively.MethodsWe retrospectively collected 77 patients with an abdominal and pelvic enhanced computed tomography (CT) examination and a histopathologically confirmed testicular mass from a single center. The ROI of each mass was split into two parts by the largest cross-sectional slice and deemed to be two samples. After all processing steps, three-dimensional texture features were extracted from unenhanced and contrast-enhanced CT images. Excellent reproducibility of texture features was defined as intra-class correlation coefficient ≥0.8 (ICC ≥0.8). All the groups were balanced via the synthetic minority over-sampling technique (SMOTE) method. Dimension reduction was based on pearson correlation coefficient (PCC). Before model building, minimum-redundancy maximum-relevance (mRMR) selection and recursive feature elimination (RFE) were used for further feature selection. At last, three ML classifiers with the highest cross validation with 5-fold were selected: autoencoder (AE), support vector machine(SVM), linear discriminant analysis (LAD). Logistics regression (LR) and LR-LASSO were also constructed to compare with the ML classifiers.Results985 texture features with ICC ≥0.8 were extracted for further feature selection process. With the highest AUC of 0.946 (P <0.01), logistics regression was proved to be the best model for the identification of benign or malignant testicular masses. Besides, LR also had the best performance in identifying primary testicular lymphoma in malignant testicular tumors and in identifying seminoma in testicular germ cell tumors, with the AUC of 0.982 (P <0.01) and 0.928 (P <0.01), respectively.ConclusionUntil now, this is the first study that applied CT texture analysis (CTTA) to assess the heterogeneity of testicular tumors. LR model based on CTTA might be a promising non-invasive tool for the diagnosis and differentiation of testicular masses. The accurate diagnosis of testicular masses would assist urologists in correct preoperative and perioperative decision making.

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“…Scrotal ultrasonography (US), with a combination of grayscale and color Doppler US, is the first-line imaging technique for the evaluation of testicular pathology, due to its low cost, wide availability, convenience, short examination time, lack of radiation exposure, and high diagnostic accuracy [ 1 , 2 , 3 , 4 , 5 , 6 , 7 ]. This technique represents the initial imaging diagnostic tool for the confirmation of the presence of a testicular mass and for the evaluation of the contralateral testis, and is strongly recommended, even in the presence of a clinically evident testicular tumor [ 8 ].…”

Section: Introductionmentioning

confidence: 99%

“…However, US has limitations related to the operator’s practice and clinical experience, along with its relatively small field of view and lack of adequate tissue characterization. Occasionally, scrotal US findings are equivocal or nonspecific, including indeterminate nature of a testicular mass, difficulties in delineating lesions’ location and/or extension, and discrepancies between US findings and clinical history [ 1 , 2 , 3 , 4 , 5 , 6 , 7 , 9 ]. Multiparametric US—including conventional US, contrast-enhanced US, and elastography—has significantly improved the diagnostic efficacy of the technique in the assessment of scrotal diseases [ 10 , 11 , 12 , 13 ].…”

Section: Introductionmentioning

confidence: 99%

An Overview of the Role of Multiparametric MRI in the Investigation of Testicular Tumors

Tsili

Sofikitis

Pappa

et al. 2022

Cancers

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Conventional ultrasonography represents the mainstay of testis imaging. In cases in which ultrasonography is inconclusive, scrotal MRI using a multiparametric protocol may be used as a useful problem-solving tool. MRI of the scrotum is primarily recommended for differentiating between benign and malignant testicular masses when sonographic findings are ambiguous. This technique is also accurate in the preoperative local staging of testicular tumors and, therefore, is recommended in patients scheduled for testis-sparing surgery. In addition, MRI may provide valuable information regarding the histological characterization of testicular germ-cell tumors, in selected cases. Scrotal MRI may also help in the differentiation between testicular germ-cell neoplasms and non-germ-cell neoplasms. Axial T1-weighted imaging, axial and coronal T2-weighted imaging, axial diffusion-weighted imaging, and coronal subtracted dynamic contrast-enhanced imaging are the minimum requirements for scrotal MRI. A variety of MRI techniques—including diffusion tensor imaging, magnetization transfer imaging, proton MR spectroscopy, volumetric apparent diffusion coefficient histogram analysis, and MRI-based radiomics—are being investigated for testicular mass characterization, providing valuable supplementary diagnostic information. In the present review, we aim to discuss clinical indications for scrotal MRI in cases of testicular tumors, along with MRI findings of common testicular malignancies.

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Ultrasonography of the scrotum: Revisiting a classic technique

Cited by 11 publications

References 177 publications

Testicular Neoplasms: Primary Tumour Size Is Closely Interrelated with Histology, Clinical Staging, and Tumour Marker Expression Rates—A Comprehensive Statistical Analysis

Testicular Neoplasms: Primary Tumour Size Is Closely Interrelated with Histology, Clinical Staging, and Tumour Marker Expression Rates—A Comprehensive Statistical Analysis

Machine learning-based CT texture analysis in the differentiation of testicular masses

An Overview of the Role of Multiparametric MRI in the Investigation of Testicular Tumors

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