What is it about?

The management outcomes of men with small testicular masses (≤20mm) and clinical and histopathological factors associated with malignancy were reported. A retrospective analysis of 307 men was performed. Overall, 23.8% of the whole STM cohort had malignancy. Men who underwent surveillance had smaller lesions (median size 4mm) without vascularity on USS. Men who underwent primary radical orchidectomy (RO) had larger lesions (median size 12mm) with vascularity on USS. Men who underwent primary excisional testicular biopsy (TBx) had lesions of median size 6mm with vascularity on USS. Of the 307 men, 52.4% underwent surveillance with interval ultrasonography (USS), 26.7% underwent primary excisional testicular biopsy (TBx), 20.2% underwent primary radical orchidectomy (RO), and 0.7% were discharged. The median surveillance duration was 6 months. Most men who underwent surveillance had lesions <5mm with no vascularity on USS. In the surveillance cohort, 20.5% underwent a TBx, based mainly on changes in USS lesion characteristics or patient choice. The majority of these biopsies were benign. All the men who had malignancy confirmed on TBx had changes on interval USS and underwent a completion RO. The overall malignancy rate in men undergoing surveillance was low at 4.3%. Therefore, men undergoing surveillance can safely avoid unnecessary RO.

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Why is it important?

This research is important because it provides valuable insights into the management of small testicular masses (STMs) and identifies clinical and histopathological factors associated with malignancy. By analyzing data from a large cohort of men managed at a single center between January 2010 and December 2020, the study helps clinicians better understand the nature of STMs and the most appropriate management strategies for different cases. Key Takeaways: 1. Small testicular masses can be stratified and managed based on lesion size and USS features. 2. Lesion size and presence of lesion vascularity on USS appear to be the main factors influencing the decision to proceed with surgery (RO). 3. Men undergoing surveillance can safely avoid unnecessary RO, as the overall malignancy rate in this cohort was low (4.3%). 4. Men with <5 mm lesions who underwent primary RO had a higher malignancy rate (57.1%), compared to those with lesions between 5-9 mm (29.2%). 5. Primary RO procedures for <5 mm lesions revealed no TC, but small lesions must be kept under surveillance or offered a TBx. 6. Infertility is an important clinical presentation for STMs, and men with STMs should be investigated and excluded for testicular cancer (TC) if they present with infertility.

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This page is a summary of: Management of small testicular masses: outcomes from a single‐centre specialist multidisciplinary team, BJU International, September 2022, Wiley,
DOI: 10.1111/bju.15874.
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