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

Ager, Michael; Donegan, Sarah; Boeri, Luca; Castro, J. Mayor de; Donaldson, James F.; Omar, Muhammad Imran; Dimitropoulos, Konstantinos; Tharakan, Tharu; Janisch, Florian; Muilwijk, Tim; Yuan, Yuhong; Tudur-Smith, Catrin; Nijman, Rien J.M.; Radmayr, Christian; Salonia, Andrea; Pes, M. Pilar Laguna

doi:10.1111/bju.15869

Cited by 6 publications

(6 citation statements)

References 45 publications

(171 reference statements)

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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%

“…In practical terms, conservative surgery using intraoperative frozen section examination appears to be appropriate in small testicular masses, since malignancy can principally be encountered among the incidentally detected lesions. Surveillance could be a solution in the very small masses (<5 mm) [ 9 , 35 , 48 , 49 , 50 ].…”

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: Discussionmentioning

confidence: 99%

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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“…However, as shown in the present patient and several previously published cases, the testicular mass in MGST is usually roundish with clear margins. This finding is usually compatible with a benign tumor, particularly if the mass is small [ 31 , 32 ]. TSS guided by frozen section examination can safely be performed in MGST, although the final diagnosis of this rare neoplasm will certainly be established only upon final immunohistochemical examination.…”

Section: Discussionmentioning

confidence: 99%

Myoid gonadal stromal tumor of the testis—the novel subtype of testicular gonadal stromal tumors: a case report and review of the literature

Dieckmann,

Tharun,

Angerer

et al. 2024

J Med Case Reports

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Background Sex cord gonadal stromal tumors compose less than 10% of all testicular neoplasms and consist of a variety of histological subtypes. In 2016, the World Health Organization introduced a novel subtype, the myoid gonadal stromal tumor, that consists of spindle-shaped cells with immunohistologic features of muscle cells. Only few cases have been reported to date. Due to its rarity and owing to its only recent introduction, the current knowledge about myoid gonadal stromal tumor is limited, and particularly, appropriate clinical management is still ill-defined. Case presentation A 47-year-old man of Caucasian descent presented with nonspecific scrotal discomfort. A roundish and well demarcated hypoechoic mass of 8.5 mm in diameter was detected in the cranial region of the left testis. Serum tumor marker levels were within normal ranges. Testis-sparing surgery revealed a 9-mm whitish, hard mass with sharp surgical margin. Histologically, the neoplasm consisted of microfibrillar tissue with spindle-shaped cells harboring elongated nuclei. Immunohistochemical work-up disclosed expression of desmin, small muscle actin, and S100 protein giving evidence for the myogenic nature of the neoplastic cells. There was no indication of malignancy, neither histologically nor clinically. Follow-up of 1 year was uneventful. Conclusion A literature survey revealed 22 previous cases of myoid gonadal stromal tumor. The median age was 37 years, the median size of the neoplasm was 20 mm, and there was no side-preponderance. Myoid gonadal stromal tumor is not much different from other subtypes of gonadal stromal tumors nor from testicular gem cell tumors regarding age and laterality; however, tumor size is smaller in myoid gonadal stromal tumors than in germ cell tumors. Although rarely performed so far, testis-sparing surgery probably constitutes an appropriate treatment of this neoplasm. Myoid gonadal stromal tumor represents an emerging novel entity of benign testicular new growths that caregivers of patients with testicular tumors should be aware of.

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“…Thus, a pre-operative diagnostic tool that allows histological subtype classification of testicular masses will be of great importance to precise treatment and clinical prognosis judgement. Although ultrasound examination is the preferred examination for testicular masses, the widespread use of ultrasound has led to more and more impalpable or ambiguous results ( 8 ). As mentioned by the EAU Guidelines 2022( http://uroweb.org/guidelines/compilations-of-all-guidelines/ ) ( 7 ), although magnetic resonance imaging (MRI) provides higher sensitivity and specificity than ultrasound in the diagnosis of testicular tumor, MRI is not superior to contrast enhanced computerized tomography (CECT) in detecting retroperitoneal lymph node metastasis in general and is more expensive, which does not justify its routine use in the diagnosis of testicular tumor ( 8 , 9 ).…”

Section: Introductionmentioning

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

Cited by 6 publications

References 45 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

Myoid gonadal stromal tumor of the testis—the novel subtype of testicular gonadal stromal tumors: a case report and review of the literature

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

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