Abstract
The increasing detection of small testicular lesions by ultrasound (US) in adults can lead to unnecessary orchiectomies. This article describes their nature, reviews the available literature on this subject and illustrates some classical lesions. We also suggest recommendations to help characterization and management. The ESUR scrotal imaging subcommittee searched for original and review articles published before May 2015 using the Pubmed and Medline databases. Key words used were 'testicular ultrasound', 'contrast-enhanced sonography', 'sonoelastography', 'magnetic resonance imaging', 'testis-sparing surgery', 'testis imaging', 'Leydig cell tumour', 'testicular cyst'. Consensus was obtained amongst the members of the subcommittee, urologist and medical oncologist. Simple cysts are frequent and benign, and do not require follow up or surgery. Incidentally discovered small solid testicular lesions detected are benign in up to 80%, with Leydig cell tumours being the most frequent. However, the presence of microliths, macrocalcifications and hypoechoic areas surrounding the nodule are findings suggestive of malignant disease. Asymptomatic small testicular lesions found on ultrasound are mainly benign, but findings such as microliths or hypoechoic regions surrounding the nodules may indicate malignancy. Colour Doppler US remains the basic examination for characterization. The role of newer imaging modalities in characterization is evolving. • Characterization of testicular lesions is primarily based on US examination. • The role of MRI, sonoelastography, contrast-enhanced ultrasound is evolving. • Most small non-palpable testicular lesions seen on ultrasound are benign simple cysts. • Leydig cell tumours are the most frequent benign lesions. • Associated findings like microliths or hypoechoic regions may indicate malignancy.
Highlights
Breast cancer is the most common cancer in women worldwide, with an estimated 1·6 million new cases reported every year.[1]. The proportion of these that are diagnosed as ductal carcinoma in situ (DCIS) has substantially increased over the past few decades due to the introduction of mammographic screening
A further PubMed search was performed in October, 2015, which found no further published articles except the National Surgical Adjuvant Breast and Bowel Project (NSABP) B-35 trial conference abstract
Patients treated by mastectomy were not eligible for this study but could be included in the IBIS-II breast cancer prevention trial.[11]
Summary
Breast cancer is the most common cancer in women worldwide, with an estimated 1·6 million new cases reported every year.[1] The proportion of these that are diagnosed as ductal carcinoma in situ (DCIS) has substantially increased over the past few decades due to the introduction of mammographic screening. In the National Surgical Adjuvant Breast and Bowel Project (NSABP) B-24 trial, all women with DCIS received radiotherapy before being randomly assigned to tamoxifen or matching placebo. After a median of 6 years of follow-up, a significant 37% reduction in breast cancer recurrence was observed with tamoxifen compared with placebo. After a median of 12·7 years of follow-up, tamoxifen significantly reduced all new breast cancer events by 29%, with a significant effect on ipsilateral DCIS recurrence and contralateral tumours, but no effect on ipsilateral invasive recurrence. A further PubMed search was performed in October, 2015, which found no further published articles except the NSABP B-35 trial conference abstract
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