Incidental testicular masses and the role of organ-sparing approach

Abstract

Objectives: The widespread use of ultrasonography for the investigation of common urological conditions, such as infertility or pain, has resulted in an increased incidence of incidental non-palpable testicular masses. The majority of these are expected to be benign therefore a conservative approach, either active monitoring or organsparing approach, is recommended. However, there are no clinical or radiological parameters which define the exact nature of such lesions and optimal patient selection criteria are lacking. In this comprehensive review we discuss the significance of incidental, small testicular masses (STMs) and the role of organ-sparing approach in the management of these lesions. Materials and methods: A non-systematic search was performed using PubMed to identify articles that covered the following topics; clinical implications at diagnosis, role of imaging in identifying the malignant capabilities of a lesion, role of surgery and the final pathology. Results: Incidental STMs are routinely identified following ultrasound examination of infertile men. STMs usually measure a few millimeters in size and the majority of these are benign. Therefore, strict follow up or an organ-sparing approach, with utilisation of frozen section analysis (FSA), is favored for STMs. FSA has a high correlation with final pathology and prevents unnecessary orchidectomies. Advances in imaging, namely ultrasound and magnetic resonance imaging may provide enhanced assessment of STMs and guidance intraoperatively. Conclusions: The optimal approach is not well defined and there is no specific clinical parameter that can predict the nature of STMs. The increasing incidence of small, benign testicular masses has resulted in the development of organ-sparing surgery to investigate and manage these lesions. Organ-sparing surgery has been shown to be practical and carries excellent oncological outcomes.

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

“…More than 50% of all testicular tumours in the size category ≤10 mm consist of benign tumours, and we also noted a significant trend towards higher proportions of benign tumours with decreasing tumour size. Thus, small size of a testicular lesion appears to be a strong indicator of benign histology, and this result is in line with several previous reports [ 7 , 16 , 36 , 37 , 38 , 39 , 40 , 41 , 42 ]. The very high proportion of benign tumours among incidentally found small testicular masses had already been noted some decades ago [ 43 ], but this knowledge became clinically relevant only with the ever-growing number of small testicular neoplasms incidentally detected by improved ultrasonography technology.…”

Multiparametric ultrasound for the diagnosis of Leydig cell tumours in non‐palpable testicular lesions

“…This study had some limitations which need to be addressed. First, according to the predefined criteria, this study included only non‐palpable tumours, the cut‐off size of which differed among authors 3,56 and could have been influenced by clinical experience. Moreover, the study took place in a referral centre for testicular imaging; thus, a selection bias may have altered the results as demonstrated by the higher prevalence of LCTs in the present cohort than in the general population 17 .…”