Dean Yi-Hsiang Huang MBBS, FRCR, Presenter: Nothing to Disclose

Eleni Konstantatou MD, MSc, Abstract Co-Author: Nothing to Disclose

Robert John Eckersley PhD, Abstract Co-Author: Nothing to Disclose

Maria E. Sellars MD, FRCR, Abstract Co-Author: Nothing to Disclose

Paul Singh Sidhu MRCP, FRCR, Abstract Co-Author: Speaker, Bracco Group Speaker, Siemens AG Speaker, Hitachi, Ltd

The availability of scrotal ultrasonography has led to an increasing number of incidentally detected intra-testicular lesions, resulting in a number of unnecessary orchidectomies. Testis-sparing surgery (TSS) is the preferred option when there is a possibility of a benign lesion. We aim to evaluate the role of pre-operative multiparametric ultrasonography (MP-US), which include gray-scale and color Doppler sonography combined with contrast-enhanced ultrasound (CEUS) and real time elastography RTE), in facilitating case selection for patient selection for testis – sparing surgery.

Consecutive patients undergoing surgery for testicular lesions between 2010 and 2013 were studied. All lesions were assessed with MP-US pre-operatively and consensus imaging and clinical assessments were made at a multi-disciplinary meeting for suitability for TSS. Patient demographics, tumour characteristics and histological outcomes were recorded. Oncological outcome in the TSS group was assessed with follow-up ultrasound.

51 patients who had either orchidectomy or TSS were studied. 12 patients (median 39 years, range 24 - 48) underwent TSS for 13 testicular lesions (median size 6 mm, range 3.3 - 15 mm). 38 patients (median age 40 years, range 19-84) underwent orchidectomy for 38 lesions (median size 20.5 mm, range 7-50). All malignancies were correctly identified pre-operatively on MP-US. Histopathological findings for all 13 lesions selected for TSS confirm no malignant features, with final diagnosis including Leydig cell tumours (6), Epidermoid cysts (2), Sertoli cell tumour (1), sarcoidosis (2), focal testicular atrophy (1) and Leydig cell hyperplasia (1). The sensitivity, specitivity, positive predictive value and negative predictive value of MP-US for a benign lesion suitable for TSS are 96.3%, 92%, 92.86% and 95.8% respectively. Oncological follow-up reveals no disease recurrence in all patients in TSS group at 12 months.

Our experience suggests that multi-parametric ultrasonography could be a valuable non-invasive investigation to predict benign testicular disease, and improve pre-operative diagnostic confidence to allow testis-sparing surgery to be considered.

Multi-parametric ultrasonography could improve pre-operative diagnosis of testicular lesions. Clinicians should be aware of this possibility so unnecessary orchiectomies may be prevented.

Huang, D, Konstantatou, E, Eckersley, R, Sellars, M, Sidhu, P, Can Radiologists Prevent Unnecessary Orchiectomies? Role of Multiparametric Ultrasonography in Facilitating Testis - Sparing Surgery.  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14016763.html