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Fang F, Sun Y, Huang H, Huang Y, Luo X, Yao W, Wei L, Xie G, Wu Y, Lu Z, Zhao J, Li C. Ultrasound-based deep learning radiomics nomogram for risk stratification of testicular masses: a two-center study. J Cancer Res Clin Oncol 2024; 150:18. [PMID: 38240867 PMCID: PMC10798931 DOI: 10.1007/s00432-023-05549-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 11/22/2023] [Indexed: 01/22/2024]
Abstract
OBJECTIVE To develop an ultrasound-driven clinical deep learning radiomics (CDLR) model for stratifying the risk of testicular masses, aiming to guide individualized treatment and minimize unnecessary procedures. METHODS We retrospectively analyzed 275 patients with confirmed testicular lesions (January 2018 to April 2023) from two hospitals, split into training (158 cases), validation (68 cases), and external test cohorts (49 cases). Radiomics and deep learning (DL) features were extracted from preoperative ultrasound images. Following feature selection, we utilized logistic regression (LR) to establish a deep learning radiomics (DLR) model and subsequently derived its signature. Clinical data underwent univariate and multivariate LR analyses, forming the "clinic signature." By integrating the DLR and clinic signatures using multivariable LR, we formulated the CDLR nomogram for testicular mass risk stratification. The model's efficacy was gauged using the area under the receiver operating characteristic curve (AUC), while its clinical utility was appraised with decision curve analysis(DCA). Additionally, we compared these models with two radiologists' assessments (5-8 years of practice). RESULTS The CDLR nomogram showcased exceptional precision in distinguishing testicular tumors from non-tumorous lesions, registering AUCs of 0.909 (internal validation) and 0.835 (external validation). It also excelled in discerning malignant from benign testicular masses, posting AUCs of 0.851 (internal validation) and 0.834 (external validation). Notably, CDLR surpassed the clinical model, standalone DLR, and the evaluations of the two radiologists. CONCLUSION The CDLR nomogram offers a reliable tool for differentiating risks associated with testicular masses. It augments radiological diagnoses, facilitates personalized treatment approaches, and curtails unwarranted medical procedures.
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Affiliation(s)
- Fuxiang Fang
- Department of Urology, The First Affiliated Hospital of Guangxi Medical University, 6 Shuangyong Road, Nanning, 530021, China
| | - Yan Sun
- Department of Urology, The First Affiliated Hospital of Guangxi Medical University, 6 Shuangyong Road, Nanning, 530021, China
| | - Hualin Huang
- Department of Emergency, The First Affiliated Hospital of Guangxi Medical University, Nanning, 530021, China
| | - Yueting Huang
- Department of Epidemiology and Health Statistics, School of Public Health of Guangxi Medical University, Nanning, 530021, China
| | - Xing Luo
- Department of Urology, Baise People's Hospital, Baise, 533099, China
| | - Wei Yao
- Department of Urology, The First Affiliated Hospital of Guangxi Medical University, 6 Shuangyong Road, Nanning, 530021, China
| | - Liyan Wei
- Department of Ultrasound, The First Affiliated Hospital of Guangxi Medical University, Nanning, 530021, China
| | - Guiwu Xie
- Department of Urology, The First Affiliated Hospital of Guangxi Medical University, 6 Shuangyong Road, Nanning, 530021, China
| | - Yongxian Wu
- Department of Urology, The First Affiliated Hospital of Guangxi Medical University, 6 Shuangyong Road, Nanning, 530021, China
| | - Zheng Lu
- Department of Urology, The First Affiliated Hospital of Guangxi Medical University, 6 Shuangyong Road, Nanning, 530021, China
| | - Jiawen Zhao
- Department of Urology, The First Affiliated Hospital of Guangxi Medical University, 6 Shuangyong Road, Nanning, 530021, China.
| | - Chengyang Li
- Department of Urology, The First Affiliated Hospital of Guangxi Medical University, 6 Shuangyong Road, Nanning, 530021, China.
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Zhang L, Xuan J, Li M, Zhang M, Song Y, Pan Z, Fan B, Lu L, Zhou H, Li Y. Case report: Misdiagnosis of primary mucinous cystadenoma of the testicle by ultrasound. Front Oncol 2023; 13:1206697. [PMID: 37731639 PMCID: PMC10508290 DOI: 10.3389/fonc.2023.1206697] [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: 04/16/2023] [Accepted: 08/21/2023] [Indexed: 09/22/2023] Open
Abstract
Testicular mucinous cystadenoma is a rare benign testicular tumor with the characteristics of being potentially malignant and showing atypical clinical symptoms; this article reports a case of a primary testicular mucinous cystadenoma misdiagnosed as testicular teratoma by ultrasound. A 69-year-old man was admitted to the hospital because of a 1-year history of left-sided testicular enlargement with scrotal swelling and no obvious abnormalities on laboratory tests. Ultrasound examination revealed solid-mass lesions in the left testicle, suggesting a high probability of teratoma, and contrast-enhanced magnetic resonance imaging (MRI) examination suggested an increased possibility of epidermoid cysts. Contrast-enhanced computed tomography (CT) and contrast-enhanced MRI of the preoperative abdomen and pelvis showed no other primary adenocarcinoma. Doctors performed radical resection of the left testicle. The postoperative pathological diagnosis was mucinous cystadenoma, and calcification as well as partially mildly atypical epithelial cells were discovered. Furthermore, there were no neoplastic lesions in the epididymis or spermatic cord. No metastatic lesions were found after 6 months postoperative follow-up, and the patient's prognosis remains good.
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Affiliation(s)
- Linlin Zhang
- Department of Ultrasound, The Second Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Jianyuan Xuan
- Department of Ultrasound, The Second Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Manxi Li
- Department of Ultrasound, The Second Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Mei Zhang
- Department of Ultrasound, The Second Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Yu Song
- Department of Ultrasound, The Second Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Ziang Pan
- Department of Pathology, The Second Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Bo Fan
- Department of Urology, The Second Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Lin Lu
- Department of Ultrasound, The Second Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Hongyan Zhou
- Department of Ultrasound, The Second Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Yang Li
- Department of Ultrasound, The Second Affiliated Hospital of Dalian Medical University, Dalian, China
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Lai DKH, Cheng ESW, Mao YJ, Zheng Y, Yao KY, Ni M, Zhang YQ, Wong DWC, Cheung JCW. Sonoelastography for Testicular Tumor Identification: A Systematic Review and Meta-Analysis of Diagnostic Test Accuracy. Cancers (Basel) 2023; 15:3770. [PMID: 37568585 PMCID: PMC10417060 DOI: 10.3390/cancers15153770] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Revised: 07/18/2023] [Accepted: 07/21/2023] [Indexed: 08/13/2023] Open
Abstract
The objective of this review was to summarize the applications of sonoelastography in testicular tumor identification and inquire about their test performances. Two authors independently searched English journal articles and full conference papers from CINAHL, Embase, IEEE Xplore®, PubMed, Scopus, and Web of Science from inception and organized them into a PIRO (patient, index test, reference test, outcome) framework. Eleven studies (n = 11) were eligible for data synthesis, nine of which (n = 9) utilized strain elastography and two (n = 2) employed shear-wave elastography. Meta-analyses were performed on the distinction between neoplasm (tumor) and non-neoplasm (non-tumor) from four study arms and between malignancy and benignity from seven study arms. The pooled sensitivity of classifying malignancy and benignity was 86.0% (95%CI, 79.7% to 90.6%). There was substantial heterogeneity in the classification of neoplasm and non-neoplasm and in the specificity of classifying malignancy and benignity, which could not be addressed by the subgroup analysis of sonoelastography techniques. Heterogeneity might be associated with the high risk of bias and applicability concern, including a wide spectrum of testicular pathologies and verification bias in the reference tests. Key technical obstacles in the index test were manual compression in strain elastography, qualitative observation of non-standardized color codes, and locating the Regions of Interest (ROI), in addition to decisions in feature extractions. Future research may focus on multiparametric sonoelastography using deep learning models and ensemble learning. A decision model on the benefits-risks of surgical exploration (reference test) could also be developed to direct the test-and-treat strategy for testicular tumors.
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Affiliation(s)
- Derek Ka-Hei Lai
- Department of Biomedical Engineering, Faculty of Engineering, The Hong Kong Polytechnic University, Hong Kong, China
| | - Ethan Shiu-Wang Cheng
- Department of Electronic and Information Engineering, Faculty of Engineering, The Hong Kong Polytechnic University, Hong Kong, China
| | - Ye-Jiao Mao
- Department of Biomedical Engineering, Faculty of Engineering, The Hong Kong Polytechnic University, Hong Kong, China
| | - Yi Zheng
- Department of Biomedical Engineering, Faculty of Engineering, The Hong Kong Polytechnic University, Hong Kong, China
| | - Ke-Yu Yao
- Department of Materials, Imperial College, London SW7 2AZ, UK
| | - Ming Ni
- Department of Orthopaedics, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200240, China
- Laboratory of Prevention and Treatment of Bone and Joint Diseases, Shanghai Institute of Traumatology and Orthopaedics, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200240, China
| | - Ying-Qi Zhang
- Department of Orthopaedics, Tongji Hospital, School of Medicine, Tongji University, Shanghai 200065, China
| | - Duo Wai-Chi Wong
- Department of Biomedical Engineering, Faculty of Engineering, The Hong Kong Polytechnic University, Hong Kong, China
| | - James Chung-Wai Cheung
- Department of Biomedical Engineering, Faculty of Engineering, The Hong Kong Polytechnic University, Hong Kong, China
- Research Institute of Smart Ageing, The Hong Kong Polytechnic University, Hong Kong, China
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Trimukhe D, Phatak S, Dhok A, Mitra K, Bahurupe S. An Aberrant Seminoma as a Complication in an Undescended Testis: A Case Report and Review of Literature. Cureus 2023; 15:e39717. [PMID: 37398766 PMCID: PMC10309655 DOI: 10.7759/cureus.39717] [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] [Accepted: 05/28/2023] [Indexed: 07/04/2023] Open
Abstract
Testicular germ cell tumors are testicular neoplasms in young and middle-aged men. Undescended testis dramatically increases the risk of testicular germ cell tumors. We report the case of a 33-year-old male who complained of swelling and pain in his lower abdomen. The patient also had an undescended left testis. An intrabdominal mass was detected on ultrasound that was further characterized using contrast-enhanced CT. Imaging findings suggested testicular germ cell tumor, developing as a complication in the undescended testis. The patient was operated and the diagnosis was confirmed on histopathological examination.
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Affiliation(s)
- Deepali Trimukhe
- Radiodiagnosis, N. K. P. Salve Institute of Medical Sciences & Research Centre and Lata Mangeshkar Hospital, Nagpur, IND
| | - Suresh Phatak
- Radiodiagnosis, N. K. P. Salve Institute of Medical Sciences & Research Centre and Lata Mangeshkar Hospital, Nagpur, IND
| | - Avinash Dhok
- Radiodiagnosis, N. K. P. Salve Institute of Medical Sciences & Research Centre and Lata Mangeshkar Hospital, Nagpur, IND
| | - Kajal Mitra
- Radiodiagnosis, N. K. P. Salve Institute of Medical Sciences & Research Centre and Lata Mangeshkar Hospital, Nagpur, IND
| | - Suchita Bahurupe
- Radiodiagnosis, N. K. P. Salve Institute of Medical Sciences & Research Centre and Lata Mangeshkar Hospital, Nagpur, IND
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Dieckmann KP, Isbarn H, Grobelny F, Dumlupinar C, Utschig J, Wülfing C, Pichlmeier U, Belge G. Testicular Neoplasms: Primary Tumour Size Is Closely Interrelated with Histology, Clinical Staging, and Tumour Marker Expression Rates-A Comprehensive Statistical Analysis. Cancers (Basel) 2022; 14:5447. [PMID: 36358866 PMCID: PMC9653836 DOI: 10.3390/cancers14215447] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 10/31/2022] [Accepted: 11/03/2022] [Indexed: 11/09/2022] Open
Abstract
The role of primary tumour size (TS) in the clinical course of testicular tumours is incompletely understood. We retrospectively evaluated 641 consecutive patients with testicular neoplasms with regard to TS, histology, clinical stage (CS), serum tumour marker (STM) expression and patient age using descriptive statistical methods. TS ≤ 10 mm was encountered in 13.6% of cases. Median TS of 10 mm, 30 mm, 35 mm, and 53 mm were found in benign tumours, seminomas, nonseminomas, and other malignant tumours, respectively. In cases with TS ≤ 10 mm, 50.6% had benign tumours. Upon receiver operating characteristics analysis, TS of > 16 mm revealed 81.5% sensitivity and 81.0% specificity for detecting malignancy. In subcentimeter germ cell tumours (GCTs), 97.7% of cases had CS1, and CS1 frequency dropped with increasing TS. Expression rates of all STMs significantly increased with TS. MicroRNA-371a-3p (M371) serum levels had higher expression rates than classical STMs, with a rate of 44.1% in subcentimeter GCTs. In all, TS is a biologically relevant factor owing to its significant associations with CS, STM expression rates and histology. Importantly, 50% of subcentimeter testicular neoplasms are of benign nature, and M371 outperforms the classical markers even in subcentimeter tumours.
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Affiliation(s)
| | - Hendrik Isbarn
- Martini Klinik, Universitätsklinikum Eppendorf, Martinistrasse 52, D-20251 Hamburg, Germany
| | - Francesca Grobelny
- Tumour Genetics Department, Faculty of Biology and Chemistry, Tumour Genetics, University of Bremen, Leobener Strasse 2/FVG, 28359 Bremen, Germany
| | - Cansu Dumlupinar
- Tumour Genetics Department, Faculty of Biology and Chemistry, Tumour Genetics, University of Bremen, Leobener Strasse 2/FVG, 28359 Bremen, Germany
| | - Julia Utschig
- Department of Urology, Asklepios Klinik Altona, D-22763 Hamburg, Germany
| | - Christian Wülfing
- Department of Urology, Asklepios Klinik Altona, D-22763 Hamburg, Germany
| | - Uwe Pichlmeier
- Institute of Medical Biometry und Epidemiology, Universitätsklinikum Eppendorf, Martinistrasse 52, D-20251 Hamburg, Germany
| | - Gazanfer Belge
- Tumour Genetics Department, Faculty of Biology and Chemistry, Tumour Genetics, University of Bremen, Leobener Strasse 2/FVG, 28359 Bremen, Germany
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