Radiological features characterising indeterminate testes masses: a systematic review and meta-analysis

ContextThe use of scrotal ultrasound (SUS) has increased the detection rate of indeterminate testicular masses. Defining radiological characteristics that identify malignancy may reduce the number of men undergoing unnecessary radical orchidectomy.ObjectiveTo define which SUS or scrotal magnetic resonance imaging (MRI) characteristics can predict benign or malignant disease in pre or post pubertal males with indeterminate testicular masses.Evidence acquisitionThis SR was conducted in accordance with Cochrane Collaboration guidance. Medline, Embase, Cochrane controlled trials and systematic reviews databases were searched from (1970 - March 26, 2021). Benign and malignant masses were classified using the reported reference test: i.e., histopathology, or 12 months progression-free radiological surveillance. Risk of bias was assessed using the Quality Assessment of Diagnostic Accuracy Studies-2 tool (QUADAS - 2).Evidence synthesis32 studies were identified, including 1692 masses of which 28 studies and 1550 masses reported SUS features, 4 studies and 142 masses reported MRI features. Meta-analysis of different SUS B mode values in post pubertal men demonstrated size of ≤0.5cm had a significant lower OR of malignancy compared to masses >0.5cm (p 1.5cm also demonstrated a significant lower OR of malignancy (p = 0.04). No significanct difference was observed between masses of 0.6-1.0cm and 1.1-1.5cm. SUS in post pubertal men also had a statistically significant lower odds of malignancy for heterogenous masses vs. homogenous masses (p = 0.04), hyperechogenic vs. hypoechogenic masses (p ConclusionsThis meta-analysis identifies radiological characteristics that have a lower odds of malignancy and may be of value in the management of the indeterminate testis mass.