Is ultrasound of the retroperitoneum a valuable staging method in selecting testicular cancer patients for primary retroperitoneal lymph node dissection?
OBJECTIVE
In nonseminomatous testicular cancer patients with normal serum tumor markers and no distant metastasis, postorchiectomy surgery is a valid treatment option if the disease extension into the retroperitoneum is not advanced. We assessed the ability of ultrasound (US) to exclude the presence of bulky retroperitoneal disease.


METHODS
One hundred and forty testicular cancer patients underwent US and computed tomography (CT) of the retroperitoneum. US results were analyzed using three cutoffs: 5 cm (conventional staging), 3 cm (based on the minimal sonographical dimension of actual bulky disease) and 0 cm ('clean retroperitoneum' or any detectable nodes), and were compared with CT data using the 5-cm cutoff ('gold standard').


RESULTS
The sensitivity, specificity, overall accuracy, positive and negative predictive values of US in detecting of bulky retroperitoneum for the 5-cm cutoff were 83, 96, 93, 88 and 94%, for the 3-cm cutoff 100, 91, 94, 80 and 100%, and for the 0-cm cutoff 100, 66, 74, 49 and 100%, respectively.


CONCLUSIONS
In stage I and IIA/B marker-negative nonseminomas if the treatment strategy is surgery, US may facilitate the selection process; the report of a clean retroperitoneum safely excludes the presence of bulky disease and may be an indication for lymphadenectomy, although in case of positive findings a CT should be performed.
Mezvrishvili
Zaza
Z
National Centre of Urology, Tbilisi, Georgia. zazamezvrishvili@hotmail.com
Tchanturaia
Zaza
Z
Toidze
Tengiz
T
Turmanidze
Nino
N
Kekelidze
Maka
M
Managadze
Laurent
L
D000293:Adolescent; D000328:Adult; D006801:Humans; D008197:Lymph Node Excision / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging / Q000379:methods; D018579:Patient Selection; D012187:Retroperitoneal Space / Q000000981:diagnostic imaging*; D013736:Testicular Neoplasms / Q000473:pathology* / Q000601:surgery*; D014057:Tomography, X-Ray Computed; D014463:Ultrasonography