Organ-Sparing Surgery in Testicular Tumor: Is This the Right Approach for Lesions ≤ 20 mm?

Abstract

Background: This study was conducted in order to analyze factors predicting malignancy in patients undergoing organ-sparing surgery (OSS) for small testicular lesions. Methods: Patients with small (£20 mm) marker-negative clinical stage I testicular tumors were managed by OSS with tumor enucleation and frozen section examination (FSE) for the past 15 years at our institution. Benign and malignant cases were compared, focusing on preoperative and postoperative lesion sizes. Results: Eighty-nine patients were enrolled in this retrospective study. Ten (11.2%) of them were treated for synchronous bilateral tumors. Sixty-seven (67.7%) of ninety-nine lesions were benign, confirming a high concordance rate (98%) between FSE and final histology. Patients with benign tumors were significantly older than patients with malignant tumors (p = 0.026), and benign tumors were detected more frequently during urologic work-up of hormone disorders (p = 0.001). Preoperative tumor size was a strong predictor of malignancy (area under the curve (AUC) = 0.726; p < 0.001). According to the Youden index, the best cutoff to predict tumor dignity was 13.5 mm, resulting in a sensitivity and specificity of 53% and 85%, respectively. No cases of local recurrence or distant metastasis were confirmed after a median follow-up of 42 months. Conclusion: Our findings are consistent with previous reports, supporting an OSS approach in small testicular tumors whenever possible. Most tumors ≤ 20 mm were benign, and in the case of malignancy, OSS with FSE and consecutive orchiectomy is oncologically safe due to the high concordance rate of FSE and final histology, thus preventing a two-stage procedure.

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

“…Accordingly, the logistic regression curve revealed all tumours sized ≥ 39 mm to represent malignancy, while tumours ≤ 8 mm involved a 50% chance of being benign. Seven previous studies reporting results from ROC analyses are listed in Table 16 ([ 7 , 23 , 31 , 37 , 41 , 44 , 45 ]). Only one study reported on more than 100 patients [ 7 ].…”

Radiological features characterising indeterminate testes masses: a systematic review and meta‐analysis

“…A total of 3380 abstracts were screened and 283 full‐text articles reviewed. In total, 32 studies were eligible for inclusion [9–16,21,24–46]. There were 22 studies reporting SUS outcomes in 1260 masses in post‐pubertal males, three SUS studies with 212 masses in a mixed population of pre‐ and post‐pubertal males, three studies reporting SUS in 78 masses in pre‐pubertal males, and four studies reporting scrotal MRI outcomes in 142 masses in post‐pubertal males.…”

“…Size of the testicular mass was assessed in 10 studies, which included 334 patients [14,15,24,25,27,28,30,37–39]. We divided them into four size groups: ≤0.5, 0.6–1.0, 1.1–1.5, and >1.5 cm.…”

“…We divided them into four size groups: ≤0.5, 0.6–1.0, 1.1–1.5, and >1.5 cm. Masses of ≤0.5 cm demonstrated a lower odds of malignancy compared to those of 0.6–1.0 cm (OR 0.20, 95% CI 0.10–0.40, P < 0.01) [14,15,24,25,27,28,30,37–39] (Fig. 3).…”

“…3). There was no significant difference between masses of 0.6–1.0 and 1.1–1.5 cm [15,25,28,37,39]. Finally, comparison of masses of 0.6–1.0 cm and masses >1.5 cm showed a significantly lower odds of malignancy (OR 0.3, 95% CI 0.09–0.96, P = 0.04).…”