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Testicular ultrasound underestimates the size of small testicular masses: a radiologic–pathologic correlation study

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Abstract

Purpose

Increasing use and resolution of testicular ultrasound imaging has resulted in a greater diagnosis of non-palpable small testicular masses and subsequent over-treatment with orchiectomy. Our aim was to determine the diagnostic accuracy of testicular ultrasound to accurately determine the pathologic size of small testicular masses (SMTMs) and to evaluate the association of various measurements with benign pathology.

Methods

Retrospectively, an institutional testicular cancer database was reviewed to evaluate the patients who underwent an orchiectomy for a testicular mass seen on ultrasound from 2003 to 2017. Three-dimensional measurements were compared from the ultrasound and pathology specimens, including other measures such as tumor volume and percentage of testicular volume. Finally, the predictive accuracy of maximum diameter and tumor volume to predict benign pathology was evaluated using receiver-operating curve analysis.

Results

We identified 208 patients and showed that ultrasound significantly underestimated sub-centimeter testicular masses (mean difference 0.56 cm, 95%CI 0.89–0.14, p = 0.004) and testicular masses between 1 and < 2 cm (mean difference 0.50 cm, 95%CI 0.97–0.15, p = 0.009). Tumor volume measured on ultrasound was consistently similar to pathologic tumor volume across all sizes and was significantly correlated (Spearman’s Rho = 0.81). Mass volume had a greater predictive accuracy for benign pathology than maximum diameter using a 1 cm cut-off (AUC 0.65 vs 0.60).

Conclusion

Using the maximal diameter, testicular ultrasound significantly miscalculated the pathologic dimensions of masses less than 2 cm compared to orchiectomy specimens. Volumetric measurements may better represent actual tumor sizes for SMTMs and may be a more useful measure for identifying those a higher risk for benign pathology, however, further studies are required.

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Acknowledgements

Timothy Phelps, MS, FAMI, professor and medical illustrator. Department of Art as Applied to Medicine, Johns Hopkins University.

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Authors and Affiliations

  1. Department of Urology, The James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, 600 North Wolfe Street, Park 213, Baltimore, MD, 21287, USA

    Zeyad R. Schwen, James L. Liu, Andrew T. Gabrielson, Hiten D. Patel, Mohit Gupta, Steven P. Rowe, Amin S. Herati & Phillip M. Pierorazio

  2. Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA

    Steven P. Rowe

  3. Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA

    Zeyad R. Schwen

Authors
  1. Zeyad R. Schwen
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  2. James L. Liu
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  3. Andrew T. Gabrielson
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  4. Hiten D. Patel
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  5. Mohit Gupta
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  6. Steven P. Rowe
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  7. Amin S. Herati
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  8. Phillip M. Pierorazio
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Contributions

ZS: protocol/project development, data collection, data analysis, manuscript writing/editing. JL: data analysis, manuscript writing/editing. AG: manuscript writing/editing. HP: data analysis, manuscript writing/editing. MG: protocol/project development. SR: protocol/project development. AM: protocol/project development. PP: data analysis, manuscript writing/editing, protocol/project development.

Corresponding author

Correspondence to Zeyad R. Schwen.

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The authors declare no conflicts of interest.

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An institutional review board approved this study.

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Supplemental Figure 1:

Theorized explanation for significantly reduced mass diameter on ultrasound relative to pathology for small testicular masses. A) Ultrasound probe prior to contact with testicle and scrotum with no distortion of testicular mass. B) Reduced diameter of testicular mass upon compression and distortion of testicle and mass with ultrasound probe. (PPTX 13456 KB)

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Schwen, Z.R., Liu, J.L., Gabrielson, A.T. et al. Testicular ultrasound underestimates the size of small testicular masses: a radiologic–pathologic correlation study. World J Urol 39, 3399–3405 (2021). https://doi.org/10.1007/s00345-021-03655-z

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  • DOI: https://doi.org/10.1007/s00345-021-03655-z

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