CT of the chest can hinder the management of seminoma of the testis; it detects irrelevant abnormalities

ACR Appropriateness Criteria® Staging and Surveillance of Testicular Cancer: 2021 Update

The staging and surveillance of testicular cancer is a complex topic, which integrates clinical, biochemical, and imaging components. The use of imaging for staging and surveillance of testicular cancer is individually tailored to each patient by considering tumor histology and prognosis. This document discusses the rationale for use of imaging by imaging modality during the initial staging of testicular seminoma and nonseminoma tumors and during the planned surveillance of stage IA and IB testicular cancer by histological subtype integrating clinical suspicion for disease recurrence in surveillance protocols. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.

Are there any metastases to the chest in non-muscle-invasive bladder cancer patients on follow-up computed tomography?

PURPOSE

The purpose of the study was to retrospectively determine whether there are metastases to the chest in patients with primary non-muscle-invasive urothelial carcinoma in the bladder on the follow-up computed tomography (CT).

METHODS

We analyzed 328 patients with follow-up chest CT for urothelial carcinoma of the bladder diagnosed between January 2004 and September 2013. We divided patients into four groups: Ta (n = 74), T1 (n = 78), carcinoma in situ (CIS, n = 25), and ≥ T2 (n = 151). We used the chest CT to determine whether there were positive findings of metastasis. Univariate and multivariate analyses were achieved using categories of T stage, histological grade, multifocal lesions, and recurrence.

RESULTS

On univariate analysis, there were significant differences on T stage (p < 0.001) and histological grade (p = 0.001), and there was no significant difference on multifocal lesions (p = 0.11) and recurrence (p = 0.34). Positive findings of metastases were observed in 1.4% (1/74) of the Ta patients, 0% (0/78) of the T1 patients, 8.0% (2/25) of the patients with carcinoma in situ (CIS), and 27.2% (41/151) of the ≥ T2 patients (p < 0.001). On multivariate analysis, T staging was independent variable for positive findings of metastasis (Odds ratio; 2.84, 95% Confidence Interval; 1.65-4.89). In contrast, histological grade, multifocal lesions, and recurrence were not independent variables.

CONCLUSIONS

T stage would affect to metastasis to the chest. It might be appropriate to omit chest CT in patients with Ta or T1 without upstaging in the course of follow-up. We may suggest that the follow-up chest CT in patients with CIS.

Bilateral cryptorchidism with bilateral synchronous abdominal testicular germ cell tumour

Cryptorchidism or undescended testis is a very common anomaly of the male genitourinary system. It is one of the established risk factors for testicular tumour. The commonest malignancy noted in cryptorchidism is seminoma testis. The presence of bilateral abdominal synchronous testicular tumour in cryptorchidism is very rare.