The Value of Active Ultrasound Surveillance for Patients With Small Testicular Lesions

Abstract

This study aimed to determine whether active ultrasound surveillance may obviate the need for surgical resection in selected patients with small testicular lesions (STLs). A retrospective 11-year review was conducted of adults who were diagnosed with an STL on scrotal ultrasonography and who either had orchiectomy or sonographic follow-up during a period of at least 3 months. A total of 101 subjects were enrolled. Ultrasound findings, clinical features, histopathology/follow-up imaging were recorded. Logistic regression analysis was performed to select independent risk factors for the diagnosis of malignancy. Seventeen (16.8%) subjects underwent immediate surgery, 8 (7.9%) of 101 underwent surgery after ultrasound follow-up, and 76 (75.3%) of 101 were followed with ultrasound only. The follow-up period ranged from 1 to 7 months in the 8 patients who ultimately underwent surgery after ultrasound follow-up and from 6 to 84 months in the 76 patients followed up with ultrasound only. All 15 malignant cases underwent immediate surgery without follow-up sonography. The frequency of lesions, either benign at surgery or stable on ultrasound, was 85.1% (86 of 101; 95% confidence interval, 77%-91%). Logistic regression analysis showed that lesion size was the only independent risk factor for malignancy in hypoechoic STLs (P < 0.05). Most of the STLs were stable on serial sonograms and likely benign. Active ultrasound surveillance may be an appropriate management strategy in patients with STLs.

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

“…Six studies [11][12][13][14][15][16] were identified for inclusion in the review all of which were published in the last 14 years. All studies were retrospective except for one prospective study [11].…”

“…Infertility was the main indication for US leading to the diagnosis of an incidental STM followed by scrotal or testicular pain, epididymitis, and contralateral cyst or tumour [11][12][13][14][15][16]. The dominant modality for radiological surveillance was US, whilst surveillance protocol was similar across studies consisting mostly of repeat US at 3-monthly intervals with follow-up durations ranging from 1 month to 16 years.…”

“…Only two of the 10 malignant tumours were metastatic; one anaplastic seminoma, and one embryonal carcinoma. Data from the included studies are presented in Table 1 [11][12][13][14][15][16].…”

“…A total of 293 patients underwent radiological surveillance following detection of an incidental STM. The mean mass size was between 4 and 5 mm in three studies [ 12 , 13 , 16 ] and all tumours were either <10 mm [ 14 , 15 ] or <15 mm [ 11 ] diameter in the remaining studies.…”

“… 29.6 (6–72) 1 Increase in mass size (1) 1 malignant -1 seminoma Toren et al ., 2010 [ 12 ] 46 35 (21–71) Infertility (40) Orchalgia (4) LUTS (1) Unknown (1) 4.3 (1–10) 3-monthly scrotal US 8.4 (ns) 8 Patient choice (6) Interval growth (2) 1 malignant -1 Pure seminoma 7 benign -3 Leydig cell tumour -2 Leydig cell hyperplasia -1 fibrotic nodule -1 No path. diagnosis Isidori et al ., 2014 [ 11 ] 27 34 Infertility (ns) Routine screening (ns) Testicular pain (ns) Contralateral tumour (ns) <15 3-monthly scrotal US ns (≥18) 2 Extragonadal metastases (2) 2 malignant -1 anaplastic seminoma -1 embryonal carcinoma Bieniek et al ., 2018 [ 13 ] 120 36.7 (23–62) Infertility (120) 4.14 (±2 SD) Not stated 15.6 (1.2–202.8) 18 Mass growth (ns) +ve tumour markers (ns) Patient choice (ns) 6 malignant -6 seminoma 12 benign -12 pathology ns Li et al ., 2017 [ 14 ] 84 42 (ns) Scrotal pain (ns) <10 Not stated ns (1–84) 8 Internal vascularity (3) Size increase (1) New mass (1) 8 benign -6 Leydig cell hyperplasia -1 sarcoidosis -1 chronic inflammat...…”