Scrotal Explorations Negative for Malignancy

Altaffer, Lawrence F.; Steele, Samuel M.

doi:10.1016/s0022-5347(17)55584-6

Cited by 22 publications

(6 citation statements)

References 3 publications

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“…B ecause of the availability, ease of use, and high resolution of ultrasonography (US), it is the imaging modality of choice for testicular pathologies and characterization of intratesticular lesions (1). Gray-scale US is widely used and shows high sensitivity regarding the detection, localization, and sizing of testicular lesions, but it shows low specificity in differentiating benign from malignant intratesticular lesions (2,3). This can lead to unnecessary orchiectomy in the case of benign intratesticular lesions.…”

Section: Patientsmentioning

confidence: 99%

Value of Multiparametric US in the Assessment of Intratesticular Lesions

et al. 2017

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Purpose To evaluate the diagnostic accuracy of multiparametric ultrasonography (US) consisting of gray-scale US, color Doppler US, strain elastography, and contrast agent-enhanced US in the assessment of intratesticular lesions. Materials and Methods Institutional review board approval was obtained for this retrospective study. From January 2012 to December 2015, 55 focal testicular lesions that were indeterminate on gray-scale US scans were further characterized with color Doppler US, strain elastography, and contrast-enhanced US. Strain elastography was performed to assess tissue elasticity, and hard lesions were defined as malignant. Color Doppler US and contrast-enhanced US were performed to determine the absence or presence of vascularization. Avascular lesions were defined as benign. Histopathologic results or follow-up examinations served as reference standards. Correct classification rate, sensitivity, specificity, and likelihood ratio were calculated. Results Of 55 testicular lesions, 43 (78.2%) were benign and 12 (21.8%) were malignant. Single-modality sensitivities and specificities were 66.7% and 88.4% for color Doppler US, 100% and 76.7% for contrast-enhanced US, and 100% and 72.1% for strain elastography, respectively. Among 12 malignant lesions, color Doppler US failed to demonstrate vascularization in four (33.3%) lesions, which were positive for cancer at contrast-enhanced US. By combining strain elastography and contrast-enhanced US, a sensitivity of 100% and specificity of 93.0% were achieved in differentiating benign and malignant focal testicular lesions. Positive likelihood ratio was 5.7 for color Doppler US, 4.3 for contrast-enhanced US, 3.6 for strain elastography, 14.3 for strain elastography combined with color Doppler US, and 14.3 for strain elastography combined with contrast-enhanced US. Conclusion Multiparametric US allows for a reliable differentiation of benign and malignant intratesticular lesions and can potentially be useful in deciding whether orchiectomy can be replaced with follow-up or less invasive organ-sparing strategies. RSNA, 2017.

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Section: Patientsmentioning

confidence: 99%

Value of Multiparametric US in the Assessment of Intratesticular Lesions

et al. 2017

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“…1 Yet, even at that time, some urologists noted an unnecessary loss of 51% of testicles. 2 Fortunately, the methods of assessing testicular masses have changed fundamentally in the past 40 years. This Review highlights modern aspects of clinical examination, the modalities for scrotal imaging, and the surgical techniques used for exploring the testis.…”

Section: Introductionmentioning

confidence: 99%

Contemporary diagnostic work-up of testicular germ cell tumours

Dieckmann

Frey

Lock³

2013

Nat Rev Urol

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Diagnostic work-up of testicular masses should begin with a complete patient history and palpation of the testes with both hands. First-line imaging of the scrotum should be performed using multiparametric ultrasonography, that is the sequential use of grey-scale ultrasonography, colour Doppler ultrasonography (CDUS), and, if available, contrast-enhanced ultrasonography (CEUS) and real-time elastography (RTE). Increased vascularization--a characteristic of malignancy and inflammation--is visualized on CDUS and CEUS. RTE provides additional information for distinguishing between benign and malignant tissue by measuring tissue elasticity of lesions. MRI is another powerful modality, typically used for second-line imaging of intrascrotal disorders. MRI can provide images with a broad field of view of the scrotal contents. Cancerous lesions are identified on MRI by their signal enhancement after injection of contrast agent. Testicular germ cell tumours require treatment by inguinal orchiectomy. Testis-sparing surgery is advocated for benign tumours and in solitary testicles provided the tumour is <3 cm and the preoperative serum testosterone level is normal. For intraoperative decision-making with regard to testis-sparing surgery, frozen section histological examination can be used, which has a false-negative rate of <10%.

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“…The diagnosis spontaneous intratesticular haemorrhage was established after orchidectomy and histological examination. Altaffer and Steele [2] who reported 74 cases of scrotal exploration, all revealing benign diseases, found 2 cases with intratesticular haematoma in whom the diagnosis was made after orchidec tomy. No suggestions concerning the pathogenesis were described.…”

Section: Discussionmentioning

confidence: 99%