Is Ultrasound of the Retroperitoneum a Valuable Staging Method in Selecting Testicular Cancer Patients for Primary Retroperitoneal Lymph Node Dissection?

Abstract

Objective: In nonseminomatous testicular cancer patients with normal serum tumor markers and no distant metastasis, postorchiectomy surgery is a valid treatment option if the disease extension into the retroperitoneum is not advanced. We assessed the ability of ultrasound (US) to exclude the presence of bulky retroperitoneal disease. Materials and Methods: One hundred and forty testicular cancer patients underwent US and computed tomography (CT) of the retroperitoneum. US results were analyzed using three cutoffs: 5 cm (conventional staging), 3 cm (based on the minimal sonographical dimension of actual bulky disease) and 0 cm (‘clean retroperitoneum’ or any detectable nodes), and were compared with CT data using the 5-cm cutoff (‘gold standard’). Results: The sensitivity, specificity, overall accuracy, positive and negative predictive values of US in detecting of bulky retroperitoneum for the 5-cm cutoff were 83, 96, 93, 88 and 94%, for the 3-cm cutoff 100, 91, 94, 80 and 100%, and for the 0-cm cutoff 100, 66, 74, 49 and 100%, respectively. Conclusions: In stage I and IIA/B marker-negative nonseminomas if the treatment strategy is surgery, US may facilitate the selection process; the report of a clean retroperitoneum safely excludes the presence of bulky disease and may be an indication for lymphadenectomy, although in case of positive findings a CT should be performed.

Interdisciplinary Evidence-Based Recommendations for the Follow-Up of Testicular Germ Cell Cancer Patients

“…Certainly, abdominal ultrasound is highly dependent on the experience of the examiner and the anatomy and preparation of the patient. Ultrasound appears to have similar sensitivity and specificity for the detection of retroperitoneal metastases in patients with testicular cancer as compared to a CT of the abdomen [26,27] (level III, B).…”

Diagnostic value of multislice computed tomography and magnetic resonance imaging in the diagnosis of retroperitoneal spread of testicular cancer: a literature review

“…One publication concerned evaluation of ultrasonography (US) of the retroperitoneum with regard to bulky metastasis (52), where CT was regarded as the gold standard.…”

Interdisciplinary Evidence-Based Recommendations for the Follow-Up of Early Stage Seminomatous Testicular Germ Cell Cancer Patients

“…Certainly, abdominal ultrasound is highly dependent on not only the experience of the examiner and the anatomy but also the preparation of the patient. Ultrasound appears to have similar sensitivity and specificity for detection of retroperitoneal metastases in patients with testicular cancer as CT of the abdomen (Level III, B) [13,27]. However, we recommend a CT scan in all cases with a need to detect even a small retroperitoneal mass or to assess possible growth of a known larger mass, e.g., growing teratoma.…”