ORIGINAL ARTICLE   

Il Giornale Italiano di Radiologia Medica 2019 Settembre-Ottobre;6(5):413-21

DOI: 10.23736/S2283-8376.19.00221-3

Copyright © 2019 EDIZIONI MINERVA MEDICA

language: English, Italian

Contrast-enhanced ultrasound in secondary prevention of testicular tumors

Giuseppina DELL’AVERSANO ORABONA ✉, Dario DE ROSA, Carmela NAPPI, Arturo BRUNETTI, Massimo IMBRIACO, Pietro GISONNI

Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy

BACKGROUND: This study evaluated the role of contrast-enhanced ultrasound (CEUS) for secondary prevention of testicular tumors.
METHODS: Forty patients (median age 25 years, range 18-36) with a focal testicular lesion underwent B-mode ultrasound, Doppler ultrasound and CEUS. Final histopathological diagnosis was obtained in all patients after total orchiectomy. Histologic features and ultrasound imaging results were recorded and compared for each patient. Receiver operating characteristics analysis curves were obtained and compared among the different imaging modalities.
RESULTS: A total of 40 testicular lesions were included with a mean diameter of 12 mm (range 3-29). There were thirty neoplastic malignant lesions (75%), five neoplastic benign (12.5%) and five non-neoplastic lesions (12.5%). B-mode ultrasound detected neoplastic features in nine of 35 (26%) neoplastic (benign and malignant) lesions; in 10/35 (28%) tumors Doppler technique found intra-lesional hyper-vascularization; on CEUS qualitative evaluation, 34/35 (97%) of neoplastic lesions showed intense enhancement and with quantitative CEUS all malignant tumors showed rapid wash in and wash out; while benign tumors showed rapid wash-in and delayed wash-out. The unenhanced US findings suggestive of neoplastic disease were irregular margins and internal hyper-vascularization. On CEUS the features that enabled the differentiation of malignant tumors versus non-neoplastic lesions, were the peak enhancement and the rapidity of wash-in and wash-out.
CONCLUSIONS: CEUS shows high diagnostic accuracy in the differentiation between malignant and benign small testicular lesions, providing useful information for the early diagnosis of testicular cancer.

KEY WORDS: Testicular neoplasms; Ultrasonography; Diagnostic imaging