Contralateral testicular biopsy in testis cancer: current concepts and controversies

Abstract

Of all patients with unilateral testis cancer, ≈5% harbour testicular intraepithelial neoplasia (TIN) in their contralateral testicle that will progress into an invasive germ cell tumour over time. The accurate diagnosis of TIN by a random two‐site surgical testis biopsy and effective therapy by local radiation has led to the concept of a contralateral screening biopsy in all patients with testis cancer. However, screening and preventive treatment are only indicated if the therapeutic outcome of the screened population is improved, and the physiological function of the affected organ is not impaired. Based on a critical review of previous reports, some drawbacks of this policy have to be considered and question the routine indication for contralateral testis biopsy: (i) all TIN‐negative patients still have to undergo meticulous follow‐up for metachronous testis cancer due to a false negative biopsy rate of 0.5–1.0%; (ii) local radiation of TIN results in irreversible infertility due to eradication of spermatogenesis; (iii) local radiation of TIN results in an impairment of endocrine Leydig cell function in 25% of the patients; (iv) therapeutic outcome and prognosis will not be improved in irradiated patients as compared to patients on surveillance; (v) local tumour resection for the management of metachronous testicular cancer represents an effective and viable option. Current reports do not support the strategy of contralateral testis biopsy in all patients with unilateral testicular germ cell tumours. According to the recommendations of the European Germ Cell Cancer Consensus Group, a testis biopsy might be offered to high‐risk patients for contralateral TIN (testicular volume <12 mL, history of cryptorchidism, age <30 years).

Predictors of spermatogenesis in radical orchiectomy specimen and potential implications for patients with testicular cancer

“…They suggested that a concomitant ''pre-therapeutic'' TESE procedure is a viable and useful technique for the cryopreservation of sperm in these patients. However, it should be noted that the patients in that study underwent routine contralateral testicular biopsies to exclude intratubular germ cell neoplasia, a controversial practice that is not universally implemented (26). According to the National Comprehensive Cancer Network (NCCN) guidelines, contralateral testicular biopsy should be considered in the presence of suspicious ultrasonographic findings, cryptorchid testis, or marked atrophy (1).…”

Organ-sparing approaches for testicular masses

“…29 Contralateral testicular biopsy to determine the presence of CIS (present in around 9% of men with GCT) 13 is outside the scope of this Review and has been recently discussed elsewhere. 30 In summary, biopsy is rarely undertaken owing to the disadvantages of sampling error, the threat of seeding that remains entrenched, missing CIS, and the option of partial orchiectomy.…”

“…36 The detection of CIS is also plagued by the presence of skip lesions, which are islands of CIS within normal parenchyma, meaning FSe of the margin or even random parts of the testicular bed are not adequate. 30 Thus, it is important to keep in perspective that only once the permanent sections have been examined for CIS, and the malignancy type determined and staged can adjuvant treatment be decided upon.…”

Intratubular germ cell neoplasia in testicular biopsies of nonobstructive azoospermic patients

“…Steiner et al [28] showed alterations in the normal architecture of the germinal epithelium and disturbances of spermatogenesis in the contralateral testes of patients with ITGCN cases. However, Heidenreich [29] did not support the strategy of contralateral testis biopsy in all patients with unilateral testicular germ cell tumors, except in high-risk patients (testis volume o12 ml, history of cryptorchidism, age o30 years).…”