The role of radiological surveillance in the conservative management of incidental small testicular masses: A systematic review

Brown, Dominic; Tsampoukas, Georgios; Popov, Elenko; Aldin, Zaid; Moussa, Mohamad; Papatsoris, Athanasios; Buchholz, Noor

doi:10.1080/2090598x.2021.1885949

Cited by 4 publications

(4 citation statements)

References 29 publications

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“…STMs are most efficiently characterized as non-palpable testicular lesions measuring < 25 mm in diameter. However, a specific size cutoff is difficult to define and the exact dimensions are still debated in the literature (5,6). In this size though, the probability of benign pathology is regarded as significantly high, and thus, a stepwise approach of inguinal surgical exploration, delivery of the organ and frozen section examination is recommended.…”

Section: Original Papermentioning

confidence: 99%

“…The combination of elastography with contrast-enhanced scrotal ultrasound demonstrated a sensitivity of 100%, a specificity of 93%, and a positive likelihood ratio of 14.3 for malignancy (37). Magnetic Resonance Imaging (MRI) might also increase the diagnostic accuracy in its ability to distinguish between fat, fluid, fibrosis, cystic and solid lesions; gadolinium contrast enhancement technique may also be able to differentiate between benign and malignant lesions (6,20). Thus, MRI can assist the decision making in cases of diagnostic uncertainty favoring a testicular sparing approach in patients with low suspicion of malignancy (6,38,39).…”

Section: Role Of Imaging In the Assessment Of The Malignant Potential Of The Lesionmentioning

confidence: 99%

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Incidental testicular masses and the role of organ-sparing approach

Narayan

Brown

Ivaz

et al. 2021

Arch Ital Urol Androl

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Objectives: The widespread use of ultrasonography for the investigation of common urological conditions, such as infertility or pain, has resulted in an increased incidence of incidental non-palpable testicular masses. The majority of these are expected to be benign therefore a conservative approach, either active monitoring or organsparing approach, is recommended. However, there are no clinical or radiological parameters which define the exact nature of such lesions and optimal patient selection criteria are lacking. In this comprehensive review we discuss the significance of incidental, small testicular masses (STMs) and the role of organ-sparing approach in the management of these lesions. Materials and methods: A non-systematic search was performed using PubMed to identify articles that covered the following topics; clinical implications at diagnosis, role of imaging in identifying the malignant capabilities of a lesion, role of surgery and the final pathology. Results: Incidental STMs are routinely identified following ultrasound examination of infertile men. STMs usually measure a few millimeters in size and the majority of these are benign. Therefore, strict follow up or an organ-sparing approach, with utilisation of frozen section analysis (FSA), is favored for STMs. FSA has a high correlation with final pathology and prevents unnecessary orchidectomies. Advances in imaging, namely ultrasound and magnetic resonance imaging may provide enhanced assessment of STMs and guidance intraoperatively. Conclusions: The optimal approach is not well defined and there is no specific clinical parameter that can predict the nature of STMs. The increasing incidence of small, benign testicular masses has resulted in the development of organ-sparing surgery to investigate and manage these lesions. Organ-sparing surgery has been shown to be practical and carries excellent oncological outcomes.

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Section: Original Papermentioning

confidence: 99%

Section: Role Of Imaging In the Assessment Of The Malignant Potential Of The Lesionmentioning

confidence: 99%

Incidental testicular masses and the role of organ-sparing approach

Narayan

Brown

Ivaz

et al. 2021

Arch Ital Urol Androl

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“…While palpable lesions in fertile men often warrant orchiectomy due to a high likelihood of malignancy [ 103 , 104 ], the management of non-palpable testicular lesions involves different treatment options. These options may include ultrasound follow-up, radical orchiectomy, or testicular exploration, with the final decision based on frozen section analysis results [ 105 , 106 , 107 ].…”

Section: How To Evaluate the Risk Of Tc In Male Infertile Patients?mentioning

confidence: 99%

Male Infertility and the Risk of Developing Testicular Cancer: A Critical Contemporary Literature Review

et al. 2023

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Background and Objectives: The relationship between male infertility (MI) and testicular cancer (TC) is bilateral. On one hand, it is well-established that patients diagnosed with TC have a high risk of pre- and post-treatment infertility. On the other hand, the risk of developing TC in male infertile patients is not clearly defined. The objective of this review is to analyze the histopathological, etiological, and epidemiological associations between MI and the risk of developing testicular cancer. This review aims to provide further insights and offer a guide for assessing the risk factors for TC in infertile men. Materials and Methods: A comprehensive literature search was conducted to identify relevant studies discussing the relationship between MI and the risk of developing TC. Results: The incidence rates of germ cell neoplasia in situ (GCNIS) appear to be high in infertile men, particularly in those with low sperm counts. Most epidemiological studies have found a statistically significant risk of developing TC among infertile men compared to the general or fertile male populations. The concept of Testicular Dysgenesis Syndrome provides an explanatory model for the common etiology of MI, TC, cryptorchidism, and hypospadias. Clinical findings such as a history of cryptorchidism could increase the risk of developing TC in infertile men. Scrotal ultrasound evaluation for testis lesions and microlithiasis is important in infertile men. Sperm analysis parameters can be useful in assessing the risk of TC among infertile men. In the future, sperm and serum microRNAs (miRNAs) may be utilized for the non-invasive early diagnosis of TC and GCNIS in infertile men. Conclusions: MI is indeed a risk factor for developing testicular cancer, as demonstrated by various studies. All infertile men should undergo a risk assessment using clinical examination, ultrasound, and semen parameters to evaluate their risk of TC.

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“…Unfortunately, no features of STM presentation have been found to date for accurate discrimination between benign and malignant masses. Lesion size, growth rate, calcification, and vascularity on ultrasound have all been described, but reliable discrimination has not been proved for any of these parameters [11] , [12] . Until we have the means to differentiate which tumors are malignant, a valid approach would be to surgically resect these STMs.…”

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confidence: 99%