Are ultrasonographic measurements a reliable parameter to choose non-palpable testicular masses amenable to treatment with sparing surgery?

Purpose: To analyze the dimensional characteristics between non-palpable testicular masses detected during ultrasonographic (US) study and their postoperative dimensions reported in definitive histological diagnosis, and evaluate if the sonographic measurements may be a relevant parameter to improve the identification of testicular lesions amenable to treatment with testicular-sparing surgery (TSS).
Methods: A total of 77 patients who underwent radical orchiectomy or TSS for non-palpable testicular masses suspected for malignant neoplasms were included into this study. Preoperative US studies were also carried out in all patients to evaluate the diameter, volume and sonographic characteristics of the testicular lesions and the contralateral testes. All patients underwent inguinal orchiectomy or testicular exploration (for masses ≤1.5 cm) through an inguinal approach.
Results: The mean age at the time of diagnosis was 36.5 years. The predominant finding was a hypoechoic mass (71.4%). The vast majority of all malignant masses appeared markedly hypoechoic (89.8%); moreover, this differed significantly from benign lesions (39.3%, p<0.001). Calcified lesions were significantly associated with benign tumors (77.8%, p<0.002). The mean maximum lesion diameter of the affected testicle determined by preoperative US study was 14.1 mm (range 7-21). The mean maximum lesion determined postoperatively by pathology was 13.4 mm (range 5-20). Tumor lesions estimated by US study were more accurate in benign tumors, but the results were not statistically significant (p=0.323).
Conclusions: We demonstrated that the sonographic diameter of the testicular lesions seems to be one of the most important parameter for the indication of an elective TSS and US is an accurate method for detecting and measuring these lesions.