Abstract
Testicular lesions of unknown significance, assessed with conventional ultrasound, are often managed with radical orchidectomy (RO). Our study investigated the use of contrast-enhanced ultrasound and strain elastography (CEUS+SE), in combination with testis-sparing surgery (TSS) as a less-invasive alternative. We performed an analysis of men who underwent CEUS+SE from 2009 to 2019 with a small testicular mass ≤20mm in size with a minimum followup of 3 months. 93 patients (39.2 years, mean age) were included. Mean surveillance duration was 21.8 months. The malignancy rate was 35.5% (33 patients, median lesion size [IQR] 7 [4.6-12]mm). The histological concordance rates between CEUS+SE vs. conventional US were 90.9% and 72.7% respectively for malignancy.
50 men (53.8%) underwent RO (median lesion size [IQR] 6.8 [4.3-11.8]mm), with lesions ≥10 mm in 52% of cases. 12 men (12.9%) underwent TSS (median lesion size [IQR] 6.7 [4.6-12]mm), and 11 (91.7%) had benign histology. 31 men (33.3%) underwent surveillance (median lesion size [IQR] 6.8 [4-12]mm), with 5 (16.1%) showing progression on interval scans, and 3 (9.7%) progressing to RO, with 2 (6.5%) having malignant histology. Our study found CEUS+SE with TSS may offer a safe approach to reducing unnecessary radial orchidectomies.
Authors
Aman Saini
King's College Hospital, London, United Kingdom
Pranay Ruperalia
King's College Hospital, London, United Kingdom
Elizabeth Wolfe
King's College Hospital, London, United Kingdom
Theodore Patel
King's College Hospital, London, United Kingdom
Thensiniya Jeyapalan
King's College Hospital, London, United Kingdom
Nawal Khan
King's College Hospital, London, United Kingdom
Zhi-Yang Low
King's College Hospital, London, United Kingdom
Fabio Castiglione
King's College Hospital, London, United Kingdom
Maria Satchi
King's College Hospital, London, United Kingdom
Dean Huang
King's College Hospital, London, United Kingdom