Abstract
Ultrasound (US) still represents the mainstay of scrotal imaging. However, contrast-enhanced ultrasound (CEUS) is a relatively novel, but increasingly utilized diagnostic modality. In consequence, we performed a systematic review (SR) and pooled meta-analysis to investigate the diagnostic performance of CEUS in the evaluation of testicular masses (TM). A SR up to June 2021 was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. The diagnostic performance of CEUS was evaluated basing on two different endpoints: neoplastic vs. non-neoplastic and malignant vs. benign TM. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) from eligible studies were pooled and summary receiver operating characteristic (SROC) curves were constructed for each endpoint. Overall, six qualified studies were deemed suitable for this meta-analysis. Diagnostic performance of CEUS showed an accuracy of 0.96 in detecting neoplastic masses (sensitivity of 0.89, PPV of 0.85, specificity of 0.62, and NPV of 0.69) and an accuracy of 0.96 in detecting malignant masses (sensitivity of 0.86, PPV of 0.73, specificity of 0.87, and NPV of 0.91). Taken together, CEUS may represent a promising minimally invasive diagnostic tool for characterization of TM, since it allows clinicians to identify neoplastic lesions and exclude malignant tumor.
Highlights
Identification and differential diagnosis of testicular masses (TM) in daily practice is often challenging
contrast-enhanced ultrasound (CEUS) is always performed after conventional B-mode US, it must be regarded as a combination of both methods
Some studies described the role of CEUS, as a promising approach in differential diagnosis of testicular masses [6,7]
Summary
Identification and differential diagnosis of testicular masses (TM) in daily practice is often challenging. There is an urgent need for new, minimally invasive, cost-effective, and highly reproducible imaging techniques for real-time evaluation of TM. Some studies described the role of CEUS, as a promising approach in differential diagnosis of testicular masses [6,7]. The use of qualitative and quantitative parameters, such as evaluating wash-in, washout, and the time-intensity curves, may help distinguish between malignant and benign neoplastic TM [8]. Fewer studies evaluated the role of CEUS in nonneoplastic testicular lesions, such as segmental ischemia, abscess, and orchiepididymitis, with overlapping results [7,9,10]
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