Ketul Patel, Presenter: Nothing to Disclose

Subash Navaratne MBBS, MRCS, Abstract Co-Author: Nothing to Disclose

Emily Bartlett, Abstract Co-Author: Nothing to Disclose

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

Jane L. Clarke MS, Abstract Co-Author: Nothing to Disclose

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

Testicular microlithiasis (TM) is frequently an incidental finding on ultrasound (US). An increased incidence of germ cell tumours (GCT) is seen in the presence of TM suggesting TM is a premalignant condition and routine surveillance is advocated. There is no evidence of a causal link between TM and the development of GCT. We present the largest cohort of patients with TM followed up in a single centre and deliberate on the merits of annual US surveillance.

A retrospective analysis of male patients undergoing US of the testis for a variety of reasons between 1998 and 2012 was performed. Routine 1-yearly US follow-up was offered to all patients with TM and a database of attendances was maintained. Patient demographics, follow-up details and the development of a testicular mass were recorded. For those found to have a testicular mass, detailed analysis of the radiological and histological findings were recoded. The TM was divided into limited (5 microliths/field) and florid (‘snowstorm’ appearance). Any co-existing tumor at presentation with background TM was recorded.

20,224 patients were examined with US of which 867 (4.3%) (median age 38 years, range 4-86) had TM. 21/867 (2.4%) had neoplastic tumors on presentation. All patients consented to follow-up with 461 patients (53%) achieving this and entered into the follow-up program (median duration 420 days, range 138-4957). Three patients developed tumors during the follow-up period, two of which were malignant (seminomas), the other a benign adenomatoid tumor. Of the two malignant tumors, one had a history of orchiectomy for contralateral GCT and developed a palpable mass on day 616 of follow-up. The other had an atrophic testis and the tumor was found at day 1886 of follow-up. There was no relationship to the classification of the TM.

On follow-up of 461 patients with TM for median duration of 420 days, we demonstrated the de-novo occurrence of GCT in only 2 patients. Both of these patients were high risk exclusive of their TM status. Our findings strongly support the impression that patients with TM and no other clinical risk factors for testicular GCT do not require routine surveillance.

We present 14 year data of the largest single centre cohort of patients with testicular microlithiasis and demonstrate no increase in the tumour detection rate from routine ultrasound surveillance.

Patel, K, Navaratne, S, Bartlett, E, Sellars, M, Clarke, J, Sidhu, P, Testicular Microlithiasis: Is Ultrasound Surveillance Necessary? A 14 year Experience in 461 Patients in a Single Centre.  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14004996.html