Testicular ultrasound score: A new proposal for a scoring system to predict testicular function

Abstract

Background Testicular ultrasound (US) is routinely employed in the evaluation of reproductive and sexual function. However, its use for characteristics other than testicular volume is hampered by a lack of information on the prognostic value of its findings, which to date have only been incorporated in a score proposed by Lenz et al in 1993. Objectives We sought to explore whether testicular US examination can predict the quality of spermatogenesis and provide information on testicular endocrine function. Materials and methods We retrospectively reviewed 6210 testicular US examinations, finally selecting examinations from 2230 unique men. The following variables were considered: bitesticular volume and testicular asymmetry, parenchymal echotexture, echogenicity and presence of microlithiasis, solid lesions and varicocoele. Concurrent fasting hormonal data were available for 1160 men, while 979 had a semen sample available from the same day as the US examination. Results We derived a new US score, termed TU score, that can predict both impaired spermatogenesis (AUC 0.73, sensitivity 72%, specificity 61%, P < .001) and hypogonadism (AUC 0.71, sensitivity 71%, specificity 53%, P < .001) more accurately than the Lenz's score. In a multivariate analysis, a reduced sperm composite index (defined as total spermatozoa × total motility × normal forms) was independently predicted by bitesticular volume and by inhomogeneous echotexture, while hypogonadism was independently predicted also by reduced echogenicity and presence of microlithiasis. Discussion and conclusions We describe the testicular US characteristics that are independently associated with impaired spermatogenesis and hypogonadism and propose the TU score as a simple screening method for use in subjects referred for testicular US.

The European Academy of Andrology (EAA) ultrasound study on healthy, fertile men: Scrotal ultrasound reference ranges and associations with clinical, seminal, and biochemical characteristics

“…In the present study, a mean TV of ~ 17 ml in healthy, fertile men was found. The left TV was smaller than the right one according to some, 6,15,29,46 but not all, 35 the previous studies. In this study, the US‐measured TV lowest reference limit for right and left testis was 12 and 11 ml, respectively.…”

“…We here report that mean US‐TV in fertile men is positively associated with sperm concentration and total sperm count and negatively with FSH and LH levels. Previous studies reported that US‐estimated TV was positively related to total sperm count, 6,29,42,59,60 sperm motility, 6,42 normal sperm morphology, 6,29 and testosterone levels, 6,32,42 and negatively correlated with LH and FSH 6,42,61 . A negative correlation between US‐TV and non‐conventional sperm parameters (sperm DNA fragmentation, 47,62,63 percentage of spermatozoa with low mitochondrial membrane potential, phosphatidylserine externalization, or chromatin compactness 62,63 ) has been also reported.…”

“…In addition, Lenz et al 29 proposed a five‐point “testicular echotexture score,” based on testicular inhomogeneity, ranging from 0 (regular pattern) to 5 (tumor suspected), that correlated negatively with normal sperm morphology, 29 sperm count, 59 US‐TV 29,59,65 and positively with the presence of a carcinoma in situ 65 . Recently, Pozza et al 6 developed, in a cohort of 2230 men, a semi‐quantitative, multiparametric (including bilateral US‐TV, echotexture, echogenicity and microlithiasis) score, ranging from 0 to 7 and named “testicular ultrasound (TU) score,” that has proved significantly more accurate than Lenz's score 23 in predicting impaired spermatogenesis, and able to predict hypogonadism. The EAA US consortium proposes here a new, four‐point scale classification of testicular inhomogeneity, easy to use in clinical practice and avoiding the term “suspected tumors.” In fact, advanced US technology—both in terms of image quality and resolution—leads to a more careful characterization of “suspected tumors,” nowadays described as “nodular lesions” and no more as “echotexture abnormalities” 4,5,7 .…”

“…In fact, scrotal CDUS can detect alterations in size, echotexture, and vascularization of the testis and epididymis that could eventually be associated with sperm abnormalities or inflammation (orchitis, epididymitis) 4,5 . In particular, various testicular US parameters can be combined to predict sperm and testosterone levels impairment 6 . In addition, scrotal CDUS can detect lesions within the testis and epididymis suggesting benign or malignant findings 4,5,7‐11 .…”

Preliminary investigation of the diagnostic value of shear wave elastography in evaluating the testicular spermatogenic function in patients with azoospermia

“…For patients with azoospermia, the chance of a successful pregnancy depends strongly on testicular spermatogenesis function, and biopsy is the reference evaluation criterion (Male infertility Best Practice Policy Committee of the American Urological Association; Practice Committee of the American Society for Reproductive Medicine, 2006). Ultrasound (US) is the cornerstone of primary imaging modalities used for patients with testicular diseases (Lotti & Maggi, 2015; Pozza et al., 2020; Schurich et al., 2009). In addition, sonographic measurements of testicular volume and stiffness have been shown to be associated with male infertility (Du et al., 2010; Huang et al., 2018).…”