1
|
Minhas K, Roebuck DJ, Sebire N, Cho A, Patel PA. Diagnostic yield and safety of ultrasound-guided percutaneous testicular biopsies in children. Pediatr Radiol 2023; 53:1903-1910. [PMID: 37052631 DOI: 10.1007/s00247-023-05649-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Revised: 03/14/2023] [Accepted: 03/15/2023] [Indexed: 04/14/2023]
Abstract
BACKGROUND Traditionally, testicular biopsy is performed using an open surgical approach. Ultrasound-guided percutaneous biopsy is a less invasive alternative and can be performed in children. OBJECTIVE The aim of this study is to report our technique and to assess the diagnostic accuracy and safety of ultrasound-guided percutaneous biopsy of testicular masses in children. MATERIALS AND METHODS This is a 16-year retrospective review of ultrasound-guided percutaneous testicular biopsies at a single pediatric hospital. RESULTS We performed nine ultrasound-guided testicular biopsies in 9 patients (median age: 3 years, range: 4 months-11 years; median weight: 20.9 kg, range: 8.4-35 kg; median volume of testicular lesion biopsied: 4.4 mL, range: 1.2-17 mL). A percutaneous co-axial technique was used for 5/9 biopsies with absorbable gelatin sponge tract embolization performed in 4 of those biopsies. A non-co-axial technique was used in 4/9 biopsies. A median of three cores, range 2-6, were obtained. The diagnostic yield was 89% with one biopsy yielding material suggestive of, but insufficient for, a definitive diagnosis. The most common histological diagnosis was leukemic infiltration, occurring in 6/9 biopsies. Of the remaining three biopsies, one biopsy was suggestive of, but not confirmatory for, juvenile granulosa cell tumor and two biopsies confirmed normal testicular tissue; the long-term follow-up of which demonstrated normal growth and no lasting damage. There was one (clinically insignificant) complication out of nine biopsies (11%, 95% confidence interval 0-44%): a mild, self-resolving scrotal hematoma. CONCLUSION Ultrasound-guided testicular biopsy can be performed safely in children as an alternative to open surgical biopsy, with a high diagnostic yield and low complication rate.
Collapse
Affiliation(s)
- Kishore Minhas
- Interventional Radiology, Radiology Department, Great Ormond Street Hospital for Children, Great Ormond Street, London, WC1N 3JH, UK
| | - Derek J Roebuck
- Interventional Radiology, Radiology Department, Great Ormond Street Hospital for Children, Great Ormond Street, London, WC1N 3JH, UK
- Division of Paediatrics, Medical School, University of Western Australia, Perth, WA, Australia
- Department of Medical Imaging, Perth Children's Hospital, Locked Bag 2010, Nedlands, WA, 6909, Australia
| | - Neil Sebire
- Department of Pathology, Great Ormond Street Hospital for Children, Great Ormond Street, London, WC1N 3JH, UK
| | - Alexander Cho
- Department of Urology, Great Ormond Street Hospital for Children, Great Ormond Street, London, WC1N 3JH, UK
| | - Premal A Patel
- Interventional Radiology, Radiology Department, Great Ormond Street Hospital for Children, Great Ormond Street, London, WC1N 3JH, UK.
| |
Collapse
|
2
|
Belfield J, Findlay-Line C. Testicular Germ Cell Tumours—The Role of Conventional Ultrasound. Cancers (Basel) 2022; 14:cancers14163882. [PMID: 36010875 PMCID: PMC9405778 DOI: 10.3390/cancers14163882] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 08/04/2022] [Accepted: 08/10/2022] [Indexed: 11/16/2022] Open
Abstract
Testicular tumours are the most common tumours found in young males and germ cell tumours account for 95% of testicular tumours. Ultrasound is the first-line radiological investigation for imaging of the testis. This article outlines how to undertake an ultrasound examination, including optimal patient position, scanning technique and imaging parameters. Classification of germ cell tumours is provided, and salient imaging features of different tumours are described. Difficulties and pitfalls of ultrasound are described, including tumours found after a trauma presentation, orchitis causing diagnostic difficulties and imaging of small testicular lesions. Other uses of ultrasound are outlined, including looking for a primary testicular tumour following the discovery of retroperitoneal lymph nodes, imaging when tumour-makers increase, local recurrence in the scrotum, and for solid organ biopsy in metastatic disease. Conclusion: Ultrasound remains the first-line of investigation for imaging of the testis, and conventional ultrasound still plays a large role in imaging. On ultrasound alone, accurate morphological characterisation of tumours remains a challenge, despite the imaging features that can be seen in different tumour types. Therefore, histology following orchidectomy of a germ cell tumour remains the gold standard for accurate tumour characterisation.
Collapse
|
3
|
Lewicki A, Freeman S, Jędrzejczyk M, Dobruch J, Dong Y, Bertolotto M, Dietrich CF. Incidental Findings and How to Manage Them: Testis- A WFUMB Position Paper. ULTRASOUND IN MEDICINE & BIOLOGY 2021; 47:2787-2802. [PMID: 34303560 DOI: 10.1016/j.ultrasmedbio.2021.05.022] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 05/18/2021] [Accepted: 05/19/2021] [Indexed: 06/13/2023]
Abstract
Testicular incidentalomas are non-palpable, asymptomatic lesions, most frequently detected on ultrasound examinations. Each incidentaloma should undergo a standardized diagnostic workup to exclude malignancy and recognize other potentially significant non-malignant conditions that may first present with an incidental finding on scrotal ultrasound. This position statement of the World Federation of Ultrasound in Medicine and Biology (WFUMB) summarizes the available evidence on management of testicular incidentalomas and describes efficient management strategies with particular reference to the role of ultrasound techniques.
Collapse
Affiliation(s)
- Andrzej Lewicki
- Department of Urology, Postgraduate Medical Education Centre, Professor Witold Orłowski Independent Public Clinical Hospital, Warsaw, Poland
| | - Simon Freeman
- Imaging Directorate, Derriford Hospital, University Hospitals Plymouth NHS Trust. Derriford Road, Plymouth, Devon, United Kingdom
| | - Maciej Jędrzejczyk
- Department of Diagnostic Imaging, Faculty of Medical Sciences, Medical University of Warsaw, Warsaw, Poland
| | - Jakub Dobruch
- Department of Urology, Postgraduate Medical Education Centre, Professor Witold Orłowski Independent Public Clinical Hospital, Warsaw, Poland
| | - Yi Dong
- Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China
| | | | - Christoph F Dietrich
- Department Allgemeine Innere Medizin, Kliniken Hirslanden Beau Site, Salem und Permanence, Bern, Switzerland.
| |
Collapse
|
4
|
Khanna M, Abualruz AR, Yadav SK, Mafraji M, Al-Rumaihi K, Al-Bozom I, Kumar D, Tsili AC, Schieda N. Diagnostic performance of multi-parametric MRI to differentiate benign sex cord stromal tumors from malignant (non-stromal and stromal) testicular neoplasms. Abdom Radiol (NY) 2021; 46:319-330. [PMID: 32572513 DOI: 10.1007/s00261-020-02621-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 06/01/2020] [Accepted: 06/13/2020] [Indexed: 02/01/2023]
Abstract
PURPOSE Testicular stromal tumors are uncommon, although mostly benign. The purpose of this study is to assess the role of multi-parametric MRI in differentiating benign testicular stromal tumors from malignant testicular neoplasms (non-stromal and stromal). METHODS A single-center retrospective study comparing benign stromal tumors (STs) to malignant testicular neoplasms (MTNs) was conducted. MR imaging assessment included tumor size, T2- and T1-weighted signal intensity, T2- and T1-weighted texture pattern, diffusion restriction, presence of hemorrhage and/or necrosis, and measurement of apparent diffusion coefficient and dynamic contrast enhancement (DCE). Inter-observer agreement was assessed using Cohen's kappa and Bland-Altman and data were compared using independent t-tests or χ2. Receiver operating characteristic curve analysis was used to test models incorporating various imaging features. RESULTS Radical orchiectomy and histopathology revealed 20 testicular neoplasms: seven STs (35%) and thirteen MTNs (65%). MTNs were significantly larger in size than STs (5.1 ± 2.36 cm vs. 1.27 ± 0.56 cm; p-value < 0.001). STs demonstrated more hypointense T2W signal (85.7% vs. 46.2%; p-value < 0.09), less T2W heterogeneous texture (14.3% vs. 61.5%; p-value < 0.04), and less diffusion restriction (16.7% vs. 83.3%; p-value < 0.01) in comparison to MTNs. STs demonstrated mainly homogenous post-contrast enhancement pattern (71.4% vs. 7.7%; p-value < 0.004), while MTNs showed primarily heterogeneous enhancement pattern (77% vs. 14.3%; p-value < 0.02). STs revealed greater corrected venous phase enhancement (STs: 0.59 ± 0.29; MTNs: 0.25 ± 0.25; p-value < 0.03). STs showed higher ADC values, though the difference was not statistically significant (p-value < 0.25). A model combining T2W, DWI, and DCE features showed the best overall diagnostic accuracy with area under ROC curve of 0.99 and confidence interval ranging from 0.94 to 1. CONCLUSION Multi-parametric MRI can potentially differentiate benign stromal tumors from malignant testicular neoplasms, which can help to avoid radical orchiectomy. However, future studies using larger sample sizes are needed to validate our results.
Collapse
|
5
|
Testicular tumours in children: an approach to diagnosis and management with pathologic correlation. Insights Imaging 2020; 11:74. [PMID: 32462465 PMCID: PMC7253550 DOI: 10.1186/s13244-020-00867-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Accepted: 04/02/2020] [Indexed: 02/07/2023] Open
Abstract
Testicular tumours are rare in children. Painless scrotal mass is the most frequent clinical presentation. Tumoural markers (alpha-fetoprotein, beta-human gonadotropin chorionic) and hormone levels (testosterone) contribute to the diagnosis and management of a testicular mass in boys. Ultrasonography is the best imaging modality to study testicular tumours. A benign tumour is suggested when ultrasonography shows a mainly cystic component, well-defined borders, echogenic rim or normal to increased echogenicity lesion when compared to the healthy testicular parenchyma. Malignant tumour is suspected when ultrasonography shows inhomogeneous, hypoechoic, not well-circumscribed or diffuse infiltration lesion. However, these ultrasonographic findings may overlap. Colour Doppler, power Doppler, elastography and contrast-enhanced ultrasonography are useful complementary methods to characterise the focal testicular lesions. Chest computerised tomography and abdominopelvic magnetic resonance are necessary to establish the extension in case of malignant proved tumours. Benign tumours are more frequent in prepuberal boys and malignant tumours in pubertal boys. Mature teratoma prepubertal-type is the most common histologic type. Testicular sparing surgery is the choice in benign tumours. Radical inguinal orchiectomy is indicated in malignant tumours. Prognostic is excellent. The purpose of our study is to show an approach to the diagnosis and management of the most frequent testicular tumours in children according to clinical manifestations, imaging findings and tumour markers levels based on histologically confirmed tumours in our hospital.
Collapse
|
6
|
A Management Protocol for Gonad Preservation in Patients with Androgen Insensitivity Syndrome. J Pediatr Adolesc Gynecol 2019; 32:605-611. [PMID: 31233832 PMCID: PMC6917890 DOI: 10.1016/j.jpag.2019.06.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Revised: 06/13/2019] [Accepted: 06/13/2019] [Indexed: 12/14/2022]
Abstract
Historically, individuals with androgen insensitivity syndrome (AIS) were managed with removal of gonadal tissue at various ages to avert the risk of gonadal malignancy. Recently, clinical practice changed, with gonadectomy being postponed until late adolescence. Adolescents and adults with complete AIS have questioned this approach. Additionally, testicular germ cell tumors are increasingly believed to be quite rare with rates as low as 0% in molecularly confirmed individuals with AIS. Gonadectomy deprives patients of the benefits of their endogenous hormones and potential fertility. Furthermore, human rights organizations advocate for deferring irreversible surgery in conditions known as differences of sex development, which includes AIS, to allow patient autonomy in decision-making. Recent literature supports an approach that uses risk stratification to manage gonads in AIS. Herein we review what is known about malignancy risk in the different subtypes of AIS and propose a management protocol for gonad retention.
Collapse
|
7
|
Abstract
OBJECTIVE The purpose of this review is to evaluate the current role of percutaneous testicular biopsy in the diagnosis of focal testicular lesions. CONCLUSION Percutaneous testicular biopsy can be either fine needle aspiration biopsy or trucut core needle biopsy. It is a well-tolerated and effective procedure useful in small testicular lesions, multifocal lesions, hematological malignancies, and focal lesions in single testis.
Collapse
Affiliation(s)
- Subramaniyan Ramanathan
- Department of Radiology, Al-Wakra Hospital, Hamad Medical Corporation, PO Box 82228, Doha, Qatar.
- Department of Radiology, Weil Cornell Medical College, Doha, Qatar.
| | - Vikram Dogra
- Department of Imaging Science, University of Rochester Medical Center, 601 Elmwood Ave, Rochester, NY, 14642, USA
| |
Collapse
|
8
|
Rajasekaran J, Tripathy J, Vij M, Scott JX. Unusual cause for testicular swelling in a child. BMJ Case Rep 2017; 2017:bcr-2016-217656. [PMID: 28446480 DOI: 10.1136/bcr-2016-217656] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Myeloid sarcoma is a rare solid tumour composed of primitive precursors of granulocytic series of white blood cells involving extramedullary anatomic site. Here we report the case of a 10-month-old with testicular swelling, who was finally diagnosed with granulocytic sarcoma. This case demonstrates that Granulocytic sarcoma should be considered as a part of the differential diagnosis for testicular swelling in spite of having normal peripheral counts and absence of hepatosplenomegaly.
Collapse
Affiliation(s)
| | - Jigisa Tripathy
- Pediatrics, Sri Ramachandra University, Chennai, Tamilnadu, India
| | - Mukul Vij
- Department of Pathology, Global Health City, Chennai, Tamilnadu, India
| | - Julius Xavier Scott
- Paediatric Hemato-Oncology, Sri Ramachandra University, Chennai, Tamilnadu, India
| |
Collapse
|
9
|
Incidentally detected non-palpable testicular tumours in adults at scrotal ultrasound: impact of radiological findings on management Radiologic review and recommendations of the ESUR scrotal imaging subcommittee. Eur Radiol 2015; 26:2268-78. [DOI: 10.1007/s00330-015-4059-7] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2015] [Revised: 09/04/2015] [Accepted: 10/06/2015] [Indexed: 02/01/2023]
|
10
|
Harvey CJ. Male urogenital disorders. Br J Radiol 2012; 85 Spec No 1:S1-2. [DOI: 10.1259/bjr/23337502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
|