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Huang DY, Alsadiq M, Yusuf GT, Deganello A, Sellars ME, Sidhu PS. Multiparametric Ultrasound for Focal Testicular Pathology: A Ten-Year Retrospective Review. Cancers (Basel) 2024; 16:2309. [PMID: 39001372 PMCID: PMC11240835 DOI: 10.3390/cancers16132309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2024] [Revised: 06/21/2024] [Accepted: 06/22/2024] [Indexed: 07/16/2024] Open
Abstract
Conventional ultrasonography (US), including greyscale imaging and colour Doppler US (CDUS), is pivotal for diagnosing scrotal pathologies, but it has limited specificity. Historically, solid focal testicular abnormalities often led to radical orchidectomy. This retrospective study evaluated the utilisation of contrast-enhanced ultrasound (CEUS) and strain elastography (SE) in investigating intratesticular focal abnormalities. A total of 124 cases were analysed. This study underscored the superior diagnostic capabilities of CEUS in detecting vascular enhancement in all malignant cases, even those with undetectable vascularity by CDUS. It also highlighted the potential of CEUS in identifying distinctive vascular patterns in benign vascular tumours. Definitive confirmation of benignity could be obtained when the absence of enhancement was demonstrated on CEUS. While SE alone offered no distinctive advantage in differentiating between benign and malignant pathologies, we demonstrated that incorporating a combination of CEUS and SE into the evaluation of focal testicular abnormalities could improve diagnostic performance metrics over conventional CDUS. Our findings underscore the role of advanced ultrasound techniques in enhancing the evaluation of focal testicular abnormalities in clinical practice and could aid a shift towards testis-sparing management strategies.
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Affiliation(s)
- Dean Y Huang
- Department of Clinical Radiology, King's College Hospital, London SE5 9RS, UK
- Department of Imaging Sciences, School of Biomedical Engineering and Imaging Sciences, Faculty of Life Sciences and Medicine, King's College London, London SE1 7EH, UK
| | - Majed Alsadiq
- Department of Imaging, The Royal London Hospital, London E1 1FR, UK
| | - Gibran T Yusuf
- Department of Clinical Radiology, King's College Hospital, London SE5 9RS, UK
- Department of Imaging Sciences, School of Biomedical Engineering and Imaging Sciences, Faculty of Life Sciences and Medicine, King's College London, London SE1 7EH, UK
| | - Annamaria Deganello
- Department of Clinical Radiology, King's College Hospital, London SE5 9RS, UK
- Department of Imaging Sciences, School of Biomedical Engineering and Imaging Sciences, Faculty of Life Sciences and Medicine, King's College London, London SE1 7EH, UK
| | - Maria E Sellars
- Department of Clinical Radiology, King's College Hospital, London SE5 9RS, UK
| | - Paul S Sidhu
- Department of Clinical Radiology, King's College Hospital, London SE5 9RS, UK
- Department of Imaging Sciences, School of Biomedical Engineering and Imaging Sciences, Faculty of Life Sciences and Medicine, King's College London, London SE1 7EH, UK
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2
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Sugar BP, Thomas JM, Beutler BD, Clifford TG, Tchelepi H. Contrast-enhanced ultrasound (CEUS) for the characterization of intra-scrotal lesions. Eur J Radiol 2024; 175:111453. [PMID: 38598965 DOI: 10.1016/j.ejrad.2024.111453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2024] [Revised: 03/16/2024] [Accepted: 04/04/2024] [Indexed: 04/12/2024]
Abstract
Contrast-enhanced ultrasound (CEUS) has emerged as a promising imaging modality for the characterization of hepatic and renal lesions. However, there is a paucity of data describing the use of CEUS for the evaluation of intra-scrotal pathology. In the following review, we describe the clinical utility of CEUS for the characterization and differentiation of common and uncommon intra-scrotal conditions, including testicular torsion, infection, trauma, and benign and malignant intratesticular and extratesticular neoplasms. In addition, we outline key principles of CEUS and provide case examples from our institution.
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Affiliation(s)
- Benjamin P Sugar
- University of Southern California, Keck School of Medicine, Los Angeles, CA 90033, United States
| | - Jerry M Thomas
- University of Southern California, Keck School of Medicine, Los Angeles, CA 90033, United States
| | - Bryce D Beutler
- University of Southern California, Keck School of Medicine, Los Angeles, CA 90033, United States.
| | - Thomas G Clifford
- University of Southern California, Keck School of Medicine, Los Angeles, CA 90033, United States
| | - Hisham Tchelepi
- Los Angeles General Medical Center, Los Angeles, CA 90033, United States
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3
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Croghan SM, Malak JW, Rohan P, Byrne C, McGrath A, Cullen IM, Davis NF. Diagnosis and management of indeterminate testicular lesions. Nat Rev Urol 2024; 21:7-21. [PMID: 37414958 DOI: 10.1038/s41585-023-00786-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/25/2023] [Indexed: 07/08/2023]
Abstract
The sophistication and accessibility of modern-day imaging result in frequent detection of small or equivocal lesions of the testes. Traditionally, diagnosis of a testicular lesion with any possibility of malignancy would usually prompt radical orchidectomy. However, awareness is growing that a substantial proportion of these lesions might be benign and that universal application of radical orchidectomy risks frequent overtreatment. Given the potentially profound effects of radical orchidectomy on fertility, endocrine function and psychosexual well-being, particularly in scenarios of an abnormal contralateral testis or bilateral lesions, organ-preserving strategies for equivocal lesions should be considered. Image-based active surveillance can be applied for indeterminate lesions measuring ≤15 mm with a low conversion rate to surgical treatment. However, these outcomes are early and from relatively small, selected cohorts, and concerns prevail regarding the metastatic potential of even small undiagnosed germ cell tumours. No consensus exists on optimal surveillance (short interval (<3 months) ultrasonography is generally adopted); histological sampling is a widespread alternative, involving inguinal delivery of the testis and excisional biopsy of the lesion, with preoperative marking or intraoperative ultrasonographic localization when necessary. Frozen section analysis in this context demonstrates excellent diagnostic accuracy. Histological results support that approximately two-thirds of marker-negative indeterminate solitary testicular lesions measuring ≤25 mm overall are benign. In summary, modern imaging detects many small indeterminate testicular lesions, of which the majority are benign. Awareness is growing of surveillance and organ-sparing diagnostic and treatment strategies with the aim of minimizing rates of overtreatment with radical orchidectomy.
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Affiliation(s)
- Stefanie M Croghan
- Department of Surgery, Royal College of Surgeons, Dublin, Ireland.
- Department of Urology, Blackrock Clinic, Dublin, Ireland.
| | - Jamil W Malak
- Department of Surgery, Royal College of Surgeons, Dublin, Ireland
- Department of Urology, Blackrock Clinic, Dublin, Ireland
| | - Pat Rohan
- Department of Radiology, Beaumont Hospital, Dublin, Ireland
| | - Caoimhe Byrne
- Department of Radiology, Mater Hospital, Dublin, Ireland
| | - Andrew McGrath
- Department of Radiology, Beaumont Hospital, Dublin, Ireland
| | - Ivor M Cullen
- Department of Urology & Andrology, Beaumont Hospital, Dublin, Ireland
| | - Niall F Davis
- Department of Surgery, Royal College of Surgeons, Dublin, Ireland
- Department of Urology, Blackrock Clinic, Dublin, Ireland
- Department of Urology & Andrology, Beaumont Hospital, Dublin, Ireland
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4
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Pozza C, Tenuta M, Sesti F, Bertolotto M, Huang DY, Sidhu PS, Maggi M, Isidori AM, Lotti F. Multiparametric Ultrasound for Diagnosing Testicular Lesions: Everything You Need to Know in Daily Clinical Practice. Cancers (Basel) 2023; 15:5332. [PMID: 38001591 PMCID: PMC10670367 DOI: 10.3390/cancers15225332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 10/20/2023] [Accepted: 10/24/2023] [Indexed: 11/26/2023] Open
Abstract
BACKGROUND Ultrasonography (US) represents the gold standard imaging method for the assessment of testicular lesions (TL). The gray-scale (GSUS) and color-Doppler (CDUS) ultrasound examination allow sonographers to investigate the size, margins, echotexture, and vascular features of TLs with the aim to differentiate benign from malignant lesions. Recently, the use of contrast-enhanced US (CEUS) and sonoelastography (SE) has led to further improvements in the differential diagnosis of TL. Although GSUS and CDUS are often sufficient to suggest the benign or malignant nature of the TL, CEUS can be decisive in the differential diagnosis of unclear findings, while SE can help to strengthen the diagnosis. The contemporary combination of GSUS, CDUS, CEUS, and SE has led to a new diagnostic paradigm named multiparametric US (mp-US), which is able to provide a more detailed characterization of TLs than single techniques alone. This narrative and pictorial review aimed to describe the mp-US appearance of several TLs. METHODS An extensive Medline search was performed to identify studies in the English language focusing on the mp-US evaluation of TLs. RESULTS A practical mp-US "identity card" and iconographic characterization of several benign and malignant TLs is provided herein. CONCLUSIONS The mp-US characterization of TL reported herein can be useful in daily clinical practice.
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Affiliation(s)
- Carlotta Pozza
- Department of Experimental Medicine, Sapienza University of Rome, 00161 Rome, Italy; (C.P.); (M.T.); (F.S.); (A.M.I.)
| | - Marta Tenuta
- Department of Experimental Medicine, Sapienza University of Rome, 00161 Rome, Italy; (C.P.); (M.T.); (F.S.); (A.M.I.)
| | - Franz Sesti
- Department of Experimental Medicine, Sapienza University of Rome, 00161 Rome, Italy; (C.P.); (M.T.); (F.S.); (A.M.I.)
| | - Michele Bertolotto
- Department of Radiology, Ospedale Di Cattinara, University of Trieste, Strada di Fiume 447, 34149 Trieste, Italy;
| | - Dean Y. Huang
- Department of Imaging Sciences, Faculty of Life Sciences and Medicine, School of Biomedical Engineering and Imaging Sciences, King’s College London, London WC2R 2LS, UK; (D.Y.H.); (P.S.S.)
| | - Paul S. Sidhu
- Department of Imaging Sciences, Faculty of Life Sciences and Medicine, School of Biomedical Engineering and Imaging Sciences, King’s College London, London WC2R 2LS, UK; (D.Y.H.); (P.S.S.)
| | - Mario Maggi
- Endocrinology Unit, Department of Experimental and Clinical Biomedical Sciences “Mario Serio”, University of Florence, 50139 Florence, Italy;
| | - Andrea M. Isidori
- Department of Experimental Medicine, Sapienza University of Rome, 00161 Rome, Italy; (C.P.); (M.T.); (F.S.); (A.M.I.)
| | - Francesco Lotti
- Andrology, Female Endocrinology and Gender Incongruence Unit, Department of Experimental and Clinical Biomedical Sciences “Mario Serio”, University of Florence, Viale Pieraccini 6, 50139 Florence, Italy
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5
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Ager M, Donegan S, Boeri L, de Castro JM, Donaldson JF, Omar MI, Dimitropoulos K, Tharakan T, Janisch F, Muilwijk T, Yuan C, Tudur-Smith C, Nijman RJM, Radmayr C, Salonia A, Laguna Pes MP, Minhas S. Radiological features characterising indeterminate testes masses: a systematic review and meta-analysis. BJU Int 2023; 131:288-300. [PMID: 35980855 DOI: 10.1111/bju.15869] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
CONTEXT The use of scrotal ultrasonography (SUS) has increased the detection rate of indeterminate testicular masses. Defining radiological characteristics that identify malignancy may reduce the number of men undergoing unnecessary radical orchidectomy. OBJECTIVE To define which SUS or scrotal magnetic resonance imaging (MRI) characteristics can predict benign or malignant disease in pre- or post-pubertal males with indeterminate testicular masses. EVIDENCE ACQUISITION This systematic review was conducted in accordance with Cochrane Collaboration guidance. Medline, Embase, Cochrane controlled trials and systematic reviews databases were searched from (1970 to 26 March 2021). Benign and malignant masses were classified using the reported reference test: i.e., histopathology, or 12 months progression-free radiological surveillance. Risk of bias was assessed using the Quality Assessment of Diagnostic Accuracy Studies-2 tool (QUADAS-2). EVIDENCE SYNTHESIS A total of 32 studies were identified, including 1692 masses of which 28 studies and 1550 masses reported SUS features, four studies and 142 masses reported MRI features. Meta-analysis of different SUS (B-mode) values in post-pubertal men demonstrated that a size of ≤0.5 cm had a significantly lower odds ratio (OR) of malignancy compared to masses of >0.5 cm (P < 0.001). Comparison of masses of 0.6-1.0 cm and masses of >1.5 cm also demonstrated a significantly lower OR of malignancy (P = 0.04). There was no significant difference between masses of 0.6-1.0 and 1.1-1.5 cm. SUS in post-pubertal men also had a statistically significantly lower OR of malignancy for heterogenous masses vs homogenous masses (P = 0.04), hyperechogenic vs hypoechogenic masses (P < 0.01), normal vs increased enhancement (P < 0.01), and peripheral vs central vascularity (P < 0.01), respectively. There were limited data on pre-pubertal SUS, pre-pubertal MRI and post-pubertal MRI. CONCLUSIONS This meta-analysis identifies radiological characteristics that have a lower OR of malignancy and may be of value in the management of the indeterminate testis mass.
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Affiliation(s)
- Michael Ager
- Department of Urology, Imperial College Healthcare NHS Trust, London, UK
| | - Sarah Donegan
- Department of Health Data Science, University of Liverpool, Liverpool, UK
| | - Luca Boeri
- Department of Urology, Foundation IRCCS Ca' Granda, Ospedale Maggiore Policlinico Hospital, University of Milan, Milan, Italy
| | | | - James F Donaldson
- Department of Urology, Aberdeen Royal Infirmary, Aberdeen, UK.,Academic Urology Unit, University of Aberdeen, Aberdeen, UK
| | | | - Konstantinos Dimitropoulos
- Department of Urology, Aberdeen Royal Infirmary, Aberdeen, UK.,Academic Urology Unit, University of Aberdeen, Aberdeen, UK
| | - Tharu Tharakan
- Department of Urology, Imperial College Healthcare NHS Trust, London, UK
| | - Florian Janisch
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Tim Muilwijk
- Department of Urology, University Hospitals Leuven, Leuven, Belgium
| | - Cathy Yuan
- Division of Gastroenterology, Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Catrin Tudur-Smith
- Department of Health Data Science, University of Liverpool, Liverpool, UK
| | - Rien J M Nijman
- Department of Urology, Martini Ziekenhuis, Groningen, the Netherlands
| | - Christian Radmayr
- Department of Urology, Medizinische Universität Innsbruck, Innsbruck, Austria
| | - Andrea Salonia
- Department of Urology, Vita-Salute San Raffaele University, Milan, Italy
| | | | - Suks Minhas
- Department of Urology, Imperial College Healthcare NHS Trust, London, UK
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6
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What Is the Malignant Potential of Small (<2 cm), Nonpalpable Testicular Incidentalomas in Adults? A Systematic Review. Eur Urol Focus 2022; 9:361-370. [PMID: 36257887 DOI: 10.1016/j.euf.2022.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 08/10/2022] [Accepted: 10/01/2022] [Indexed: 11/22/2022]
Abstract
CONTEXT Unlike palpable lumps, a large number of nonpalpable testicular lesions found incidentally at ultrasound in asymptomatic postpuberal males are either benign tumours or non-neoplastic lesions. The prevalence of malignancy, however, is appraised based on small case series. Dedicated studies report a large number of patients, and systematic review articles are lacking. OBJECTIVE This systematic review is aimed to assess, from the analysis of the pooled data of the available literature, the incidence of benign tumours, malignant tumours, and non-neoplastic lesions, and to identify predictive characteristics for malignancy. EVIDENCE ACQUISITION A systematic review of PubMed, Scopus, Google Scholar, Turning Research Into Practice (TRIP) database, and the Cochrane Library was conducted on January 6, 2022, according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) statement. Studies were retrieved reporting on adult asymptomatic men, with single, incidentally identified small testicular lesions, either fertile or infertile, with negative tumour markers and without specific risk factors for malignancy. Lesions ≤20 mm were considered small. Seventy-four studies were selected for inclusion in this analysis. Twenty-six additional publications have been retrieved by the bibliography quoted in the selected articles. EVIDENCE SYNTHESIS Pooled data of 1348 lesions in 1348 patients were collected. Of these lesions, 408 could be retrieved individually, 44.6% were benign, 27.2% were malignant, and 20.8% were non-neoplastic. Virtually all lesions <3 mm and 86.6% of lesions <5 mm were benign. Lesions >10 mm have a 38.14% probability of being benign. Hyperechoic lesions are likely benign. Fertility status does not affect the risk of malignancy. CONCLUSIONS Very small (<3 mm) and small (<5 mm) incidentally detected testicular lesions in asymptomatic postpuberal men with normal tumour markers could be frequently benign. More prospective studies are needed to better support this finding. Management strategies should be developed for these patients to reduce overtreatment. PATIENT SUMMARY Small testicular lesions are incidentally founded at ultrasound. It is not easy to distinguish a benign lesion from a malignant one. Results of this study are reporting a higher incidence of benign lesions with a diameter of <5 mm. More studies are needed to better understand the biology and the management strategy for small testicular lesions.
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7
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Ultrasound and Magnetic Resonance Imaging of Burned-Out Testicular Tumours: The Diagnostic Keys Based on 48 Cases. Cancers (Basel) 2022; 14:cancers14164013. [PMID: 36011006 PMCID: PMC9406361 DOI: 10.3390/cancers14164013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Revised: 08/09/2022] [Accepted: 08/10/2022] [Indexed: 12/04/2022] Open
Abstract
The spontaneous regression of testicular germ-cell tumours is a rare event whose mechanisms have yet to be elucidated. In the majority of published cases, tumour regression is concomitant with the metastatic development of the disease. Residual lesions, often referred to as burned-out testicular tumours (BOTTs), are difficult to diagnose due to the paucity of published data, especially in the field of imaging. The aim of this article is to describe the radiological signs of BOTTs on multimodal ultrasound and multiparametric MRI from a series of 48 patients whose diagnosis was confirmed histologically. The demographic, clinical and laboratory characteristics of the patients are studied, as well as the data of the imaging examinations, including conventional scrotal ultrasound, shear-wave elastography, contrast-enhanced ultrasound (CEUS) and multiparametric MRI. A total of 27 out of 48 patients were referred for investigation of primary testicular lesion following the discovery of retroperitoneal metastases, 18/48 patients were referred because of lesions suspected on an ultrasound that was performed for an infertility work-up, and 3/48 were referred because of scrotal clinical signs. Of these last 21 patients (infertility work-up/scrotal clinical sign), 6 were found to be metastatic on the extension work-up. Of the 48 orchiectomy specimens, tumour involution was complete in 41 cases, and a small active contingent remained in 7 cases, with 6 suspected upon advanced US and MRI. Typically, BOTTs appear on a conventional ultrasound as ill-delineated, hypoechoic and hypovascular nodular areas. Clustered microliths (60.4%) and macrocalcifications (35.4%) were frequent. Shear-wave elastography showed areas of focal induration (13.5 ± 8.4 vs. 2.7 ± 1.2 kPa for normal parenchyma, p < 0.01) in 92.5% of the patients for whom it was performed, and contrast ultrasonography demonstrated hypoperfusion of these lesions. Of the 42 MRIs performed, BOTTs corresponded to nodules on T2-weighted sequences (hyposignal) with significantly increased ADC values compared with healthy parenchyma (2 ± 0.3 versus 1.3 ± 0.3 × 10−3 mm2/s, p < 0.01) and an enhancement defect after injection. This enhancement defect overlapped the lesions visible on T2-weighted sequences in most cases. In the case of predominant partial regression, an enhanced portion after contrast injection was visible on MRI in all seven patients of our series, and in six of them a focal diffusion restriction zone was also present. Spontaneously involuted testicular germ-cell tumours have specific radiological signs, and all of the mentioned examinations contribute to this difficult diagnosis, even histologically, because there is no tumour cell left. These signs are similar whether the patient is initially symptomatic metastatic or whether the discovery is fortuitous on the occasion of an infertility work-up, and whatever the seminomatous or non-seminomatous nature of the germ-cell tumour, when this can be determined. The appearance of regressed germ-cell tumours is often trivialized, which can lead to the wrong diagnosis of an extra gonadal germ-cell tumour (in metastatic patients) or of scarring from an acute event such as trauma or infection, which is not recognized or forgotten. In our series, two patients had an unrecognized diagnosis in their history, with local and/or distant recurrence. An improvement in diagnosing burned-out tumours, combining advanced US and MRI, is necessary in order to optimize patient management, with special attention paid to asymptomatic patients, to prompt extension screening and orchiectomy with analysis of the whole testis. This may reveal a persistent viable tumour or lesions of germinal neoplasia in situ, which are precursors of testicular germ-cell tumours.
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8
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Leydig Cell Tumors of the Testis: An Update of the Imaging Characteristics of a Not So Rare Lesion. Cancers (Basel) 2022; 14:cancers14153652. [PMID: 35954321 PMCID: PMC9367522 DOI: 10.3390/cancers14153652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 07/24/2022] [Accepted: 07/25/2022] [Indexed: 12/02/2022] Open
Abstract
Simple Summary Stromal tumors of the testis are rare. However, among this group, Leydig cell tumors (LCT) are the most frequent, and recent studies suggest that LCTs account for up to 22% of small testicular nodules. It is now accepted that small LCTs can benefit from testis-sparing surgery or in some selected cases radiological surveillance. Since percutaneous testicular biopsy is still not recommended, the diagnosis of LCT rests on multimodal imaging techniques. Therefore, it is essential for the radiologist and the urologist to know the main imaging features of LCTs in ultrasound and MRI. Abstract Pre-operative testicular tumor characterization is a challenge for radiologists and urologists. New data concerning imaging approaches or immunochemistry markers improve the management of patients presenting with a testicular tumor, sometimes avoiding radical orchiectomy. In the past 20 years, imaging modalities, especially ultrasound (US) and magnetic resonance imaging (MRI), improved, allowing for great progress in lesion characterization. Leydig cell tumors (LCT) are rare testicular tumors developing from the stromal tissue, with relatively scarce literature, as most of the studies focus on the much more frequent germ cell tumors. However, with the increase in testicular sonography numbers, the incidence of LCT appears much higher than expected, with some studies reporting up to 22% of small testicular nodules. Multimodal ultrasound using Doppler, Elastography, or injection of contrast media can provide crucial arguments to differentiate LCT from germ cell tumors. Multiparametric MRI is a second intention exam, but it allows for extraction of quantifiable data to assess the diagnosis of LCT. The aims of this article are to review the latest data regarding LCT imaging features, using multimodal ultrasound and multiparametric MRI, and to focus on the peculiar aspect of the testis of patients with Klinefelter’s syndrome. The possibility of an LCT should be raised in front of a small hypoechoic tumor with a marked corbelling hypervascularization in an otherwise normal testicular pulp. Ultrasonographic modules, such as ultrasensitive Doppler, contrast-enhanced ultrasonography, or elastography, can be used to reinforce the suspicion of LCT. MRI provides objective data regarding vascularization and enhancement kinetics.
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Corcioni B, Brandi N, Marasco G, Gaudiano C, De Cinque A, Ciccarese F, Ercolino A, Schiavina R, Brunocilla E, Renzulli M, Golfieri R. Multiparametric Ultrasound for the diagnosis of Leydig cell tumours in non‐palpable testicular lesions. Andrology 2022; 10:1387-1397. [DOI: 10.1111/andr.13233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Revised: 07/12/2022] [Accepted: 07/13/2022] [Indexed: 11/27/2022]
Affiliation(s)
- Beniamino Corcioni
- Department of Radiology IRCCS Azienda Ospedaliero‐Universitaria di Bologna Via Albertoni 15 Bologna Italia
| | - Nicolò Brandi
- Department of Radiology IRCCS Azienda Ospedaliero‐Universitaria di Bologna Via Albertoni 15 Bologna Italia
| | - Giovanni Marasco
- Internal Medicine and Digestive Physiopathology Unit IRCCS Azienda Ospedaliero‐Universitaria di Bologna Bologna Italia
| | - Caterina Gaudiano
- Department of Radiology IRCCS Azienda Ospedaliero‐Universitaria di Bologna Via Albertoni 15 Bologna Italia
| | - Antonio De Cinque
- Department of Radiology IRCCS Azienda Ospedaliero‐Universitaria di Bologna Via Albertoni 15 Bologna Italia
| | - Federica Ciccarese
- Department of Radiology IRCCS Azienda Ospedaliero‐Universitaria di Bologna Via Albertoni 15 Bologna Italia
| | - Amelio Ercolino
- Division of Urology IRCCS, Azienda Ospedaliero‐Universitaria di Bologna Bologna Italy
| | - Riccardo Schiavina
- Division of Urology IRCCS, Azienda Ospedaliero‐Universitaria di Bologna Bologna Italy
| | - Eugenio Brunocilla
- Division of Urology IRCCS, Azienda Ospedaliero‐Universitaria di Bologna Bologna Italy
| | - Matteo Renzulli
- Department of Radiology IRCCS Azienda Ospedaliero‐Universitaria di Bologna Via Albertoni 15 Bologna Italia
| | - Rita Golfieri
- Department of Radiology IRCCS Azienda Ospedaliero‐Universitaria di Bologna Via Albertoni 15 Bologna Italia
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10
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Hermann AL, L’Herminé-Coulomb A, Irtan S, Audry G, Cardoen L, Brisse HJ, Vande Perre S, Pointe HDL. Imaging of Pediatric Testicular and Para-Testicular Tumors: A Pictural Review. Cancers (Basel) 2022; 14:3180. [PMID: 35804952 PMCID: PMC9265135 DOI: 10.3390/cancers14133180] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2022] [Revised: 06/24/2022] [Accepted: 06/27/2022] [Indexed: 02/04/2023] Open
Abstract
Pre- and post-pubertal testicular tumors are two distinct entities in terms of epidemiology, diagnosis and treatment. Most pre-pubertal tumors are benign; the most frequent are teratomas, and the most common malignant tumors are yolk-sac tumors. Post-pubertal tumors are similar to those found in adults and are more likely to be malignant. Imaging plays a pivotal role in the diagnosis, staging and follow-up. The appearance on ultrasonography (US) is especially helpful to differentiate benign lesions that could be candidates for testis-sparing surgery from malignant ones that require radical orchidectomy. Some specific imaging patterns are described for benign lesions: epidermoid cysts, mature cystic teratomas and Leydig-cell tumors. Benign tumors tend to be well-circumscribed, with decreased Doppler flow on US, but malignancy should be suspected when US shows an inhomogeneous, not-well-described lesion with internal blood flow. Imaging features should always be interpreted in combination with clinical and biological data including serum levels of tumor markers and even intra-operative frozen sections in case of conservative surgery to raise any concerns of malignity. This review provides an overview of imaging features of the most frequent testicular and para-testicular tumor types in children and the value of imaging in disease staging and monitoring children with testicular tumors or risk factors for testicular tumors.
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Affiliation(s)
- Anne-Laure Hermann
- Department of Pediatric and Prenatal Imaging, Armand-Trousseau Hospital, APHP, Sorbonne University, 75012 Paris, France; (S.V.P.); (H.D.L.P.)
| | - Aurore L’Herminé-Coulomb
- Department of Pathology, Armand-Trousseau Hospital, APHP, Sorbonne University, 75012 Paris, France;
| | - Sabine Irtan
- Department of Pediatric Surgery, Armand-Trousseau Hospital, APHP, Sorbonne University, 75012 Paris, France;
| | - Georges Audry
- Department of Imaging, Institut Curie, 75005 Paris, France; (G.A.); (L.C.); (H.J.B.)
| | - Liesbeth Cardoen
- Department of Imaging, Institut Curie, 75005 Paris, France; (G.A.); (L.C.); (H.J.B.)
| | - Hervé J. Brisse
- Department of Imaging, Institut Curie, 75005 Paris, France; (G.A.); (L.C.); (H.J.B.)
| | - Saskia Vande Perre
- Department of Pediatric and Prenatal Imaging, Armand-Trousseau Hospital, APHP, Sorbonne University, 75012 Paris, France; (S.V.P.); (H.D.L.P.)
| | - Hubert Ducou Le Pointe
- Department of Pediatric and Prenatal Imaging, Armand-Trousseau Hospital, APHP, Sorbonne University, 75012 Paris, France; (S.V.P.); (H.D.L.P.)
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11
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Li M, Wang J, Wang J, Zhang D, Hua Y, Liu F, Lu P, Liu J, Liu X, Lin T, Wei G, He D. Characteristics and outcomes of pediatric testicular yolk Sac tumor. Front Pediatr 2022; 10:1024906. [PMID: 36601033 PMCID: PMC9806341 DOI: 10.3389/fped.2022.1024906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 11/30/2022] [Indexed: 12/23/2022] Open
Abstract
PURPOSE Pediatric testicular yolk sac tumor is a rare malignant germ cell tumor and there is a lack of large clinical studies. The purpose of this study is to summarize the clinical characteristics of pediatric testicular yolk tumor and evaluate the prognostic factors. MATERIALS AND METHODS The medical records of children with testicular yolk sac tumor in one pediatric medical centre in China from January 2005 to January 2021 were retrospectively investigated. Data regarding clinical characteristics, treatment and prognosis were collected. RESULTS A total of 109 patients with a median diagnosed age of 18 months (range 2-69) were included in this study; of them 100 were diagnosed as stage I, 6 as stage II and 3 as stage IV. All patients underwent radical orchiectomy, and 61 of them underwent postoperative chemotherapy. The mean follow-up time was 61.3 months (range 3-259), during that time, 8 patients experienced relapse. The five-year overall survival was 90.6% (95% CI 84.6%-96.7%). Univariate Cox regression analysis showed that disease stage, relapse, maximum tumor diameter, and alpha-fetoprotein returning to normal within 2 months postoperatively were risk factors for survival (HRs of 25.43, 26.43, 1.48 and 0.08, respectively, p < 0.05). Multivariate Cox regression analysis suggested that higher disease stage and relapse were independent adverse factors for survival (HRs of 148.30 and 94.58, respectively, p < 0.05). CONCLUSIONS The prognosis of pediatric testicular yolk sac tumor is generally excellent. A higher disease stage and the occurrence of relapse could predict a poor prognosis. The individualized management of children with testicular yolk sac tumor according to risk classification is feasible.
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Affiliation(s)
- Maoxian Li
- Department of Urology, Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Children's Hospital of Chongqing Medical University, Chongqing, China.,Chongqing Key Laboratory of Pediatrics, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Jinkui Wang
- Department of Urology, Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Children's Hospital of Chongqing Medical University, Chongqing, China.,Chongqing Key Laboratory of Pediatrics, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Jianyu Wang
- Department of Urology, Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Children's Hospital of Chongqing Medical University, Chongqing, China.,Chongqing Key Laboratory of Pediatrics, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Deying Zhang
- Department of Urology, Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Children's Hospital of Chongqing Medical University, Chongqing, China.,Chongqing Key Laboratory of Pediatrics, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Yi Hua
- Department of Urology, Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Children's Hospital of Chongqing Medical University, Chongqing, China.,Chongqing Key Laboratory of Pediatrics, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Feng Liu
- Department of Urology, Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Children's Hospital of Chongqing Medical University, Chongqing, China.,Chongqing Key Laboratory of Pediatrics, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Peng Lu
- Department of Urology, Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Children's Hospital of Chongqing Medical University, Chongqing, China.,Chongqing Key Laboratory of Pediatrics, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Junhong Liu
- Department of Urology, Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Children's Hospital of Chongqing Medical University, Chongqing, China.,Chongqing Key Laboratory of Pediatrics, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Xing Liu
- Department of Urology, Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Children's Hospital of Chongqing Medical University, Chongqing, China.,Chongqing Key Laboratory of Pediatrics, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Tao Lin
- Department of Urology, Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Children's Hospital of Chongqing Medical University, Chongqing, China.,Chongqing Key Laboratory of Pediatrics, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Guanghui Wei
- Department of Urology, Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Children's Hospital of Chongqing Medical University, Chongqing, China.,Chongqing Key Laboratory of Pediatrics, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Dawei He
- Department of Urology, Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Children's Hospital of Chongqing Medical University, Chongqing, China.,Chongqing Key Laboratory of Pediatrics, Children's Hospital of Chongqing Medical University, Chongqing, China.,Chongqing Higher Institution Engineering Research Center of Children's Medical Big Data Intelligent Application, Children's Hospital of Chongqing Medical University, Chongqing, China
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12
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The Value of Contrast-Enhanced Ultrasound (CEUS) in Differentiating Testicular Masses: A Systematic Review and Meta-Analysis. APPLIED SCIENCES-BASEL 2021. [DOI: 10.3390/app11198990] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Ultrasound (US) still represents the mainstay of scrotal imaging. However, contrast-enhanced ultrasound (CEUS) is a relatively novel, but increasingly utilized diagnostic modality. In consequence, we performed a systematic review (SR) and pooled meta-analysis to investigate the diagnostic performance of CEUS in the evaluation of testicular masses (TM). A SR up to June 2021 was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. The diagnostic performance of CEUS was evaluated basing on two different endpoints: neoplastic vs. non-neoplastic and malignant vs. benign TM. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) from eligible studies were pooled and summary receiver operating characteristic (SROC) curves were constructed for each endpoint. Overall, six qualified studies were deemed suitable for this meta-analysis. Diagnostic performance of CEUS showed an accuracy of 0.96 in detecting neoplastic masses (sensitivity of 0.89, PPV of 0.85, specificity of 0.62, and NPV of 0.69) and an accuracy of 0.96 in detecting malignant masses (sensitivity of 0.86, PPV of 0.73, specificity of 0.87, and NPV of 0.91). Taken together, CEUS may represent a promising minimally invasive diagnostic tool for characterization of TM, since it allows clinicians to identify neoplastic lesions and exclude malignant tumor.
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13
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Yu J, Jiang XH, Du LF, Bai M, Li ZJ, Shi QS, Jiang Q, Li F. Contrast-enhanced ultrasound as a valuable imaging modality for characterizing testicular lesions. Asian J Androl 2021; 24:201-206. [PMID: 34528518 PMCID: PMC8887098 DOI: 10.4103/aja202158] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Contrast-enhanced ultrasound (CEUS) is a new form of ultrasound (US) that can dynamically display microvessels in a highly sensitive manner. The purpose of this study was to investigate the efficacy of CEUS for characterizing testicular lesions in comparison with conventional US. Forty-seven patients with testicular lesions were enrolled. The histopathology results revealed that 31 cases were neoplastic (11 cases of seminomas, 8 nonseminomatous germ cell tumors, 8 lymphomas, 2 Leydig cell tumors, and 2 nonspecific tumors), and 16 cases were nonneoplastic (8 cases of infarctions, 3 epidermoid cysts, and 5 inflammation). The indicators of shallow lobulated morphology and cystic-solid echogenicity on conventional US were suggestive of germ cell tumors. More indicators on CEUS were found to be useful for characterizing testicular lesions. All the neoplastic lesions showed hyperenhancement on CEUS. Moreover, germ cell tumors presented with heterogeneous enhancement (73.7%, 14/19), a twisted blood vessel pattern, rapid wash-in and wash-out, and peripheral rim hyperenhancement signs. Lymphoma was characterized by nonbranching linear vessel patterns (87.5%, 7/8), rapid wash-in and slow wash-out. In nonneoplastic lesions, infarction and epidermoid cysts showed no enhancement, and abscesses were observed with marginal irregular enhancement. The sensitivity, specificity, and accuracy of CEUS for differentiating between neoplastic and nonneoplastic lesions were 100%, 93.8%, and 97.9%, respectively, and these values were higher than those for conventional US (90.3%, 62.5%, and 80.9%, respectively). CEUS can sensitively reflect the microvascular perfusion in testicular lesions and offers high accuracy for characterizing them.
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Affiliation(s)
- Jie Yu
- Department of Ultrasound, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 201620, China
| | - Xin-Hui Jiang
- Department of Medical Ultrasound, Shanghai Baoshan Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai 201999, China
| | - Lian-Fang Du
- Department of Ultrasound, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 201620, China
| | - Min Bai
- Department of Ultrasound, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 201620, China
| | - Zhao-Jun Li
- Department of Ultrasound, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 201620, China
| | - Qiu-Sheng Shi
- Department of Ultrasound, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 201620, China
| | - Qi Jiang
- Department of Urology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200080, China
| | - Fan Li
- Department of Ultrasound, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 201620, China
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14
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Pinto SP, Huang DY, Dinesh AA, Sidhu PS, Ahmed K. A Systematic Review on the Use of Qualitative and Quantitative Contrast-enhanced Ultrasound in Diagnosing Testicular Abnormalities. Urology 2021; 154:16-23. [DOI: 10.1016/j.urology.2021.02.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 02/06/2021] [Accepted: 02/10/2021] [Indexed: 02/06/2023]
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15
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Tenuta M, Sesti F, Bonaventura I, Mazzotta P, Pofi R, Gianfrilli D, Pozza C. Use of contrast enhanced ultrasound in testicular diseases: A comprehensive review. Andrology 2021; 9:1369-1382. [PMID: 34043256 PMCID: PMC8640938 DOI: 10.1111/andr.13057] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Revised: 05/12/2021] [Accepted: 05/24/2021] [Indexed: 01/17/2023]
Abstract
Background Contrast‐enhanced ultrasound (CEUS) is a sonographic technique that increases the diagnostic accuracy of ultrasound and color Doppler ultrasound (CDUS) when studying testicular abnormalities. However, its role in clinical practice is still debatable because there are no accepted standards regarding how and when this technique should be used for patients with testicular disease. Objectives To perform a nonsystematic review of the current literature to highlight the strength and flaws of performing CEUS and to provide a critical overview of current research evidence on this topic. Materials and methods A thorough search of published peer‐reviewed studies in PubMed was performed using proper keywords. Results Strong enhancement of neoplastic lesions (both benign and malignant) during CEUS aids in differential diagnosis with non‐neoplastic lesions, which usually appears either nonenhanced or enhanced in a manner similar to that of the surrounding parenchyma. CEUS enhancement has a high predictive value in the identification of neoplastic lesions, whereas a similar or complete absence of enhancement may be interpreted as strong evidence of benignity, although there are exceptions. Literature on quantitative analysis is still scarce, though promising, particularly in distinguishing benign from malignant neoplasms. Furthermore, CEUS may be useful in many emergency situations, such as acute scrotum, blunt scrotal trauma, and focal infarction of the testis. Finally, CEUS can help increase the probability of sperm recovery in azoospermic males. Discussion and conclusion CEUS is a safe, easy‐to‐perform, and cost‐effective diagnostic tool that can provide a more accurate diagnosis in testicular lesions and acute scrotal disease. However, further studies with larger cohorts are required to refine the differential diagnosis between benign and malignant neoplasms. Finally, these preliminary results can instigate the development of innovative research on pre‐testicular sperm extraction to increase the chances of sperm recovery.
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Affiliation(s)
- Marta Tenuta
- Department of Experimental Medicine, Sapienza University, Rome, Italy
| | - Franz Sesti
- Department of Experimental Medicine, Sapienza University, Rome, Italy
| | | | - Paola Mazzotta
- Department of Experimental Medicine, Sapienza University, Rome, Italy
| | - Riccardo Pofi
- Department of Experimental Medicine, Sapienza University, Rome, Italy
| | | | - Carlotta Pozza
- Department of Experimental Medicine, Sapienza University, Rome, Italy
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16
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Obstructive oligospermia: the role of interventional radiology in its diagnosis and treatment. Pol J Radiol 2021; 86:e204-e207. [PMID: 34093916 PMCID: PMC8147715 DOI: 10.5114/pjr.2021.105590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 10/04/2020] [Indexed: 11/17/2022] Open
Abstract
Purpose According to the latest World Health Organization guidelines (2010), oligo-sperm it is due to a sperm concentration of less than 15 million/ml of seminal fluid. The cause can be obstructive and non-obstructive. Interventional radiology allows diagnosis and, in some cases, minimally invasive treatment. Case presentation A 28-year-old man with oligospermia (7 million/ml of seminal fluid), surgically treated 2 years ago for clinical grade III bilateral varicocele (according to Dubin’s classification), was admitted to the Urology Department for suspected accidental surgical ligation of the left vas deferens. The patient underwent several diagnostic tests including phlebography of the left pampiniform plexus, bilateral vesico-deferentography. The steno-occlusion of the ejaculatory ducts was diagnosed, which was resolved through an innovative interventional radiology treatment. Conclusions Interventional radiology has played a decisive role in the diagnosis and treatment of the causes of male infertility. In our experience, it has considerable potential in the minimally invasive treatment of steno-obstructive pathologies of the vesico-deferential system.
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17
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Persano G, Crocoli A, De Pasquale MD, Cozza R, Alaggio R, Diomedi Camassei F, Beati F, Di Paolo P, Martucci C, Inserra A. Burned-Out Testicular Tumors in Adolescents: Clinical Aspects and Outcome. Front Pediatr 2021; 9:688021. [PMID: 34513760 PMCID: PMC8424195 DOI: 10.3389/fped.2021.688021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 07/22/2021] [Indexed: 11/26/2022] Open
Abstract
Purpose: Testicular germ cell tumors are the fourth most common neoplasm in adolescents, accounting for 8% of all tumors in the age group 15-19 years. On rare instances, the primary testicular lesion is not clinically or radiologically evident while nodal or visceral metastases represent the clinical manifestations of the disease. This phenomenon is described as "burned-out testicular tumor." In this paper, the authors report a single-institution experience with burned-out testicular tumors in adolescents and discuss their clinical implications. Patients and Methods: All the patients diagnosed with metastatic testicular germ cell tumors at Bambino Gesù Children Hospital between January 1, 2010, and June 30, 2020, were included in the study. Patients were categorized into two groups: "primary testicular" and "burned out." All the patients were staged and treated according to the AIEOP-TCGM 2004 protocol. Results: Eleven patients were classified as "primary testicular," and five patients were classified as "burned out." "Burned-out" tumors were associated with the presence of systemic symptoms compared to "primary testicular" tumors (80 vs. 0%; p = 0.0027) and higher aFP, hCG, and LDH levels (p < 0.00001). The "burned-out" population had a statistically significant higher incidence of relevant toxicity than the "primary testicular" population (80 vs. 18%; p = 0.0357) and a worse outcome in terms of both mean overall survival (15 vs. 43 months; p = 0.0299) and mean event-free survival (12 vs. 38 months; p = 0.0164). Conclusion: "Burned-out" testicular tumors seem to be a well-distinct clinical entity with a high treatment-related toxicity and poor prognosis. Further studies are needed to clarify the "burned-out phenomenon" and to identify more effective therapeutic strategies for these patients.
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Affiliation(s)
- Giorgio Persano
- Surgical Oncology-General and Thoracic Surgery Unit, Department of Surgery, Bambino Gesù Children Hospital IRCCS, Rome, Italy
| | - Alessandro Crocoli
- Surgical Oncology-General and Thoracic Surgery Unit, Department of Surgery, Bambino Gesù Children Hospital IRCCS, Rome, Italy
| | - Maria Debora De Pasquale
- Oncohematology Unit, Department of Oncohematology and Gene Therapy, Bambino Gesù Children Hospital IRCCS, Rome, Italy
| | - Raffaele Cozza
- Oncohematology Unit, Department of Oncohematology and Gene Therapy, Bambino Gesù Children Hospital IRCCS, Rome, Italy
| | - Rita Alaggio
- Pathology Unit, Department of Laboratories, Bambino Gesù Children Hospital IRCCS, Rome, Italy
| | | | - Federico Beati
- Surgical Oncology-General and Thoracic Surgery Unit, Department of Surgery, Bambino Gesù Children Hospital IRCCS, Rome, Italy
| | - Pierluigi Di Paolo
- Radiology Unit, Department of Diagnostic Imaging, Bambino Gesù Children Hospital IRCCS, Rome, Italy
| | - Cristina Martucci
- Surgical Oncology-General and Thoracic Surgery Unit, Department of Surgery, Bambino Gesù Children Hospital IRCCS, Rome, Italy
| | - Alessandro Inserra
- Surgical Oncology-General and Thoracic Surgery Unit, Department of Surgery, Bambino Gesù Children Hospital IRCCS, Rome, Italy
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18
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Luo ZY, Hong YR, Yan CX, Wang Y, Ye Q, Huang P. Utility of quantitative contrast-enhanced ultrasound for the prediction of lymph node metastasis in patients with papillary thyroid carcinoma. Clin Hemorheol Microcirc 2020; 80:37-48. [PMID: 33252064 DOI: 10.3233/ch-200909] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVES The aim of this study was to find the optimal parameters and cutoffs to differentiate metastatic lymph nodes (LNs) from benign LNs in the patients with papillary thyroid carcinoma (PTC) on the quantitative contrast-enhanced ultrasound (CEUS) features. METHODS A total of 134 LNs in 105 patients with PTCs were retrospectively enrolled. All LNs were evaluated by conventional ultrasound (US) and CEUS before biopsy or surgery. The diagnostic efficacy of CEUS parameters was analyzed. RESULTS Univariate analysis indicated that metastatic LNs more often manifested centripetal or asynchronous perfusion, hyper-enhancement, heterogeneous enhancement, ring-enhancing margins, higher PI, larger AUC, longer TTP and DT/2 than benign LNs at pre-operative CEUS (p < 0.001, for all). Multivariate analysis showed that centripetal or asynchronous perfusion (OR = 3.163; 95% CI, 1.721-5.812), hyper-enhancement(OR = 0.371; 95% CI, 0.150-0.917), DT/2 (OR = 7.408; 95% confidence interval CI, 1.496-36.673), and AUC (OR = 8.340; 95% CI, 2.677-25.984) were predictive for the presence of metastatic LNs. The sensitivity and accuracy of the quantitative CEUS were higher than qualitative CEUS (75% vs 55 % and 83.6% vs 76.1 % , respectively). CONCLUSIONS Quantitative CEUS parameters can provide more information to distinguish metastatic from benign LNs in PTC patients; In particular, DT/2 and AUC have a higher sensitivity and accuracy in predicting the presence of metastatic LNs and reduce unnecessary sampling of benign LNs.
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Affiliation(s)
- Zhi-Yan Luo
- Department of Ultrasound in Medicine, Second Affiliated Hospital, Zhejiang University College of Medicine, Hangzhou City, Zhejiang Province, China
| | - Yu-Rong Hong
- Department of Ultrasound in Medicine, Second Affiliated Hospital, Zhejiang University College of Medicine, Hangzhou City, Zhejiang Province, China
| | - Cao-Xin Yan
- Department of Ultrasound in Medicine, Second Affiliated Hospital, Zhejiang University College of Medicine, Hangzhou City, Zhejiang Province, China
| | - Yong Wang
- Department of Surgery, Second Affiliated Hospital, Zhejiang University College of Medicine, Hangzhou City, Zhejiang Province, China
| | - Qin Ye
- Department of Pathology, Second Affiliated Hospital, Zhejiang University College of Medicine, Hangzhou City, Zhejiang Province, China
| | - Pintong Huang
- Department of Ultrasound in Medicine, Second Affiliated Hospital, Zhejiang University College of Medicine, Hangzhou City, Zhejiang Province, China
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19
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Lung PFC, Fang C, Jaffer OS, Deganello A, Shah A, Hedayati V, Obaro A, Yusuf GT, Huang DY, Sellars ME, Quinlan DJ, Sidhu PS. Vascularity of Intra-testicular Lesions: Inter-observer Variation in the Assessment of Non-neoplastic Versus Neoplastic Abnormalities After Vascular Enhancement With Contrast-Enhanced Ultrasound. ULTRASOUND IN MEDICINE & BIOLOGY 2020; 46:2956-2964. [PMID: 32863063 DOI: 10.1016/j.ultrasmedbio.2020.07.028] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 07/08/2020] [Accepted: 07/30/2020] [Indexed: 06/11/2023]
Abstract
The aim of this study is to assess the additional benefit of contrast-enhanced ultrasound (CEUS) over conventional ultrasonography (US) in identifying intra-testicular abnormalities among observers of different experiences. In this study, 91 focal testicular lesions (46 neoplastic, 45 non-neoplastic) imaged with gray-scale US/Doppler US and CEUS were classified using a 5-point scale. Three experienced and four inexperienced observers rated each lesion using gray-scale/color Doppler US alone and then with the addition of CEUS. Improved diagnostic specificity and accuracy with the addition of CEUS was observed for both experienced (specificity: 71.1% vs. 59.3%, p = 0.005; accuracy: 83.5% vs. 76.9%, p = 0.003) and inexperienced observers (specificity: 75.6% vs. 51.7%, p = 0.005; accuracy: 80.2% vs. 72.0%, p < 0.001). Significant inter-observer variability between the experienced and inexperienced observers when assessing conventional US alone was eliminated with the addition of CEUS. CEUS improves diagnostic accuracy of focal intra-testicular lesions for both experienced and inexperienced observers and reduces inter-observer variability in inexperienced operators.
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Affiliation(s)
- Phillip F C Lung
- Department of Radiology, King's College Hospital, Denmark Hill, London, United Kingdom
| | - Cheng Fang
- Department of Radiology, King's College Hospital, Denmark Hill, London, United Kingdom
| | - Ounali S Jaffer
- Department of Radiology, King's College Hospital, Denmark Hill, London, United Kingdom
| | - Annamaria Deganello
- Department of Radiology, King's College Hospital, Denmark Hill, London, United Kingdom
| | - Aarti Shah
- Department of Radiology, King's College Hospital, Denmark Hill, London, United Kingdom
| | - Venus Hedayati
- Department of Radiology, King's College Hospital, Denmark Hill, London, United Kingdom
| | - Anu Obaro
- Department of Radiology, King's College Hospital, Denmark Hill, London, United Kingdom
| | - Gibran T Yusuf
- Department of Radiology, King's College Hospital, Denmark Hill, London, United Kingdom
| | - Dean Y Huang
- Department of Radiology, King's College Hospital, Denmark Hill, London, United Kingdom
| | - Maria E Sellars
- Department of Radiology, King's College Hospital, Denmark Hill, London, United Kingdom
| | - Daniel J Quinlan
- Department of Radiology, King's College Hospital, Denmark Hill, London, United Kingdom
| | - Paul S Sidhu
- Department of Radiology, King's College Hospital, Denmark Hill, London, United Kingdom.
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20
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Huang DY, Pesapane F, Rafailidis V, Deganello A, Sellars ME, Sidhu PS. The role of multiparametric ultrasound in the diagnosis of paediatric scrotal pathology. Br J Radiol 2020; 93:20200063. [PMID: 32271626 PMCID: PMC10993215 DOI: 10.1259/bjr.20200063] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Revised: 04/01/2020] [Accepted: 04/03/2020] [Indexed: 02/06/2023] Open
Abstract
Multiparametric ultrasound (MPUS), combining conventional techniques (greyscale and colour Doppler ultrasound), ultrasound strain elastography, and contrast-enhanced ultrasound (CEUS), has been successfully used in the assessment of adult scrotal pathology. Contrast-enhanced ultrasound can confidently establish testicular tissue vascularity even in the small-volume paediatric testis. Elastography provides further assessment of tissue stiffness, potentially adding useful diagnostic information. In children, ultrasonography is particularly advantageous, being safe, radiation-free and negating the need for sedation or general anaesthesia during the imaging evaluation. In this review article, we aim to familiarise readers with the MPUS scanning protocol used for paediatric scrotal examination and provide an overview of scrotal MPUS features, with particular focus to clinical indications where MPUS may be advantageous over conventional ultrasonography.
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Affiliation(s)
- Dean Y. Huang
- Department of Radiology, King’s College Hospital,
London. Denmark Hill, London SE5 9RS
U.K, United Kingdom
| | - Filippo Pesapane
- Breast Imaging Division, IEO European Institute of Oncology
IRCCS, Via Giuseppe Ripamonti 435, 20141,
Milan, Italy
| | - Vasileios Rafailidis
- Department of Radiology, King’s College Hospital,
London. Denmark Hill, London SE5 9RS
U.K, United Kingdom
| | - Annamaria Deganello
- Department of Radiology, King’s College Hospital,
London. Denmark Hill, London SE5 9RS
U.K, United Kingdom
| | - Maria E. Sellars
- Department of Radiology, King’s College Hospital,
London. Denmark Hill, London SE5 9RS
U.K, United Kingdom
| | - Paul S Sidhu
- Department of Radiology, King’s College Hospital,
London. Denmark Hill, London SE5 9RS
U.K, United Kingdom
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21
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Lerchbaumer MH, Auer TA, Marticorena GS, Stephan C, Hamm B, Jung EM, Fischer T. Diagnostic performance of contrast-enhanced ultrasound (CEUS) in testicular pathologies: Single-center results. Clin Hemorheol Microcirc 2019; 73:347-357. [DOI: 10.3233/ch-190579] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- Markus Herbert Lerchbaumer
- Charité – Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
- Berlin Institute of Health, Department of Radiology, Berlin, Germany
| | - Timo Alexander Auer
- Charité – Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
- Berlin Institute of Health, Department of Radiology, Berlin, Germany
| | - Garcia Stephan Marticorena
- Charité – Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
- Berlin Institute of Health, Department of Radiology, Berlin, Germany
| | - Carsten Stephan
- Charité – Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
- Berlin Institute of Health, Department of Urology and Berlin Institute for Urologic Research, Berlin, Germany
| | - Bernd Hamm
- Charité – Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
- Berlin Institute of Health, Department of Radiology, Berlin, Germany
| | - Ernst-Michael Jung
- University Medical Center Regensburg, Department of Radiology, Regensburg, Germany
| | - Thomas Fischer
- Charité – Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
- Berlin Institute of Health, Department of Radiology, Berlin, Germany
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Rocher L, Ksouri A, Maxwell F, Bresson B, Hindawi G, Balasa C, Bellin MF, Albiges L. [Testicular tumors: A diagnostic challenge of imaging]. Bull Cancer 2019; 106:875-886. [PMID: 31088679 DOI: 10.1016/j.bulcan.2019.03.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Revised: 03/07/2019] [Accepted: 03/08/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVES Reviewing the characterization and the follow-up imaging of testicular tumors. MATERIAL AND METHODS Literature review (PubMed, Medline) of urological and radiological studies dealing with testicular tumors using keywords: Testicular tumors; Color Doppler ultrasound; US elastography; Magnetic resonance imaging; Contrast enhanced sonography. RESULTS Ultrasound remains the basic exam for the tumor characterization. Among the other techniques, MRI, elastography, contrast enhanced ultrasound, although still in evaluation, will be increasingly used in the future. The frequency of benign Leydig cell tumors justifies a testicular preservation approach, through improvement of characterization, monitoring or tumorectomy. The follow-up of testicular lesions must be indicated on precise indications: follow-up of the contralateral testicle in the case of germi cell tumor, follow-up by of a supposed benign lesion, such as a small Leydig cell tumor in an infertile patient, follow-up when ultra-sound findings are not sufficiently worrying to require immediate diagnosis but which include pejorative criteria. The tumor markers and the extension screening remain systematic. CONCLUSION The era of total orchiectomy for any uncertain testicular lesion is over. We try the challenge of characterization, and define management's algorithms based on clinical biological data and suspected nature of the tumor at imaging.
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Affiliation(s)
- Laurence Rocher
- Hôpitaux Paris Sud, service de radiologie diagnostique et interventionnelle, site Bicêtre, 94270 Le Kremlin Bicêtre, France; Université Paris Sud, 63, rue Gabriel-Péri, 94270 Le Kremlin Bicêtre, France; Université Paris Sud, service hospitalier Frédéric-Joliot, imagerie par résonance magnétique médicale et multimodalités, CNRS UMR8081, 4, place du Gal Leclerc, 91401 Orsay cedex, France.
| | - Aïda Ksouri
- Hôpitaux Paris Sud, service de radiologie diagnostique et interventionnelle, site Bicêtre, 94270 Le Kremlin Bicêtre, France
| | - Florian Maxwell
- Hôpitaux Paris Sud, service de radiologie diagnostique et interventionnelle, site Bicêtre, 94270 Le Kremlin Bicêtre, France
| | - Bertrand Bresson
- Hôpitaux Paris Sud, service de radiologie diagnostique et interventionnelle, site Bicêtre, 94270 Le Kremlin Bicêtre, France; Université Paris Sud, 63, rue Gabriel-Péri, 94270 Le Kremlin Bicêtre, France; Université Paris Sud, service hospitalier Frédéric-Joliot, imagerie par résonance magnétique médicale et multimodalités, CNRS UMR8081, 4, place du Gal Leclerc, 91401 Orsay cedex, France
| | - Ghina Hindawi
- Hôpitaux Paris Sud, service de radiologie diagnostique et interventionnelle, site Bicêtre, 94270 Le Kremlin Bicêtre, France
| | - Cristina Balasa
- Hôpitaux Paris Sud, service de radiologie diagnostique et interventionnelle, site Bicêtre, 94270 Le Kremlin Bicêtre, France
| | - Marie France Bellin
- Hôpitaux Paris Sud, service de radiologie diagnostique et interventionnelle, site Bicêtre, 94270 Le Kremlin Bicêtre, France; Université Paris Sud, 63, rue Gabriel-Péri, 94270 Le Kremlin Bicêtre, France; Université Paris Sud, service hospitalier Frédéric-Joliot, imagerie par résonance magnétique médicale et multimodalités, CNRS UMR8081, 4, place du Gal Leclerc, 91401 Orsay cedex, France
| | - Laurence Albiges
- Institut Gustave-Roussy, département d'oncologie, 114, rue Edouard-Vaillaxnt, 94805 Villejuif, France
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