Radiological Features of Indeterminate Testicular Masses: A Systematic Review and Meta-Analysis

What is it about?

The study aimed to determine the radiological features that differentiate benign and malignant disease in pre- or post-pubertal males with indeterminate testicular masses using scrotal ultrasonography (SUS) or scrotal magnetic resonance imaging (MRI). A total of 32 studies were identified, including 1692 masses, of which 28 studies and 1550 masses reported SUS features, and four studies and 142 masses reported MRI features. The study found that specific radiological features on SUS can be diagnostic in differentiation of benign and malignant disease when faced with an indeterminate mass of the testes. Mass size is an important factor, and masses of ≤0.5 cm have a significantly lower odds ratio of malignancy compared to any masses >0.5 cm. Additionally, heterogenous masses, hyperechogenicity, peripheral Doppler flow, and non-enhancement on SUS had lower odds of malignancy. Only four studies reported on scrotal MRI outcomes, and none of the three studies reported on any significant findings with regards to either SUS or scrotal MRI characteristics that could distinguish between benign and malignant disease in pre-pubertal males.

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Why is it important?

This research is important as it aims to identify radiological characteristics that can predict benign or malignant disease in pre- or post-pubertal males with indeterminate testicular masses. The use of scrotal ultrasonography (SUS) and scrotal magnetic resonance imaging (MRI) has increased the detection rate of indeterminate testicular masses, and defining radiological characteristics that identify malignancy may reduce the number of men undergoing unnecessary radical orchidectomy. Key Takeaways: 1. A total of 32 studies were identified, including 1692 masses of which 28 studies and 1550 masses reported SUS features, and four studies and 142 masses reported MRI features. 2. Specific radiological features on SUS can be diagnostic in differentiating benign and malignant disease when faced with an indeterminate mass of the testes. 3. Mass size is an important factor, and masses of ≤0.5 cm have a significantly lower odds of malignancy compared to any masses >0.5 cm. 4. Heterogenous masses, hyperechogenicity, peripheral Doppler flow, and non-enhancement on SUS had lower odds of malignancy. 5. Four studies reported on scrotal MRI outcomes, and Manganaro et al. and Sanharawi et al. both reported on DCE outcomes of TTP enhancement and the maximal peak enhancement, favoured benign disease with indeterminate masses demonstrating a shorter TTP enhancement and a higher maximal peak. 6. Only three studies reported on indeterminate masses in 77 pre-pubertal males, and none of these papers reported on any significant findings with regards to either SUS or scrotal MRI characteristics that could distinguish between benign and malignant disease.