title: Small incidentally discovered testicular masses in infertile men--is active surveillance the new standard of care?
abstract: OBJECTIVE
  The management of small, incidental testicular masses found on scrotal ultrasound is controversial. Although these neoplasms are classically treated with surgical excision, ultrasound surveillance has been proposed as an alternative to surgery.
  
  
  METHODS
  We reviewed our experience of ultrasound surveillance for small testicular masses at Mount Sinai Hospital Fertility Clinic from 2001 to 2008, offered to all patients with subcentimeter, incidentally discovered hypoechoic testicular lesions. Patient age, semen parameters, the size and growth of the lesion on serial ultrasounds, need for surgery and pathological diagnosis were collected in a database.
  
  
  RESULTS
  Of 4,418 patients evaluated 46 (1%) met the study inclusion criteria. Mean age was 35 years, and 39 patients (85%) presented with infertility. Semen analysis revealed azoospermia, oligospermia and normospermia in 15, 18 and 7 patients, respectively, and was unavailable in 6. Mean ultrasound followup was 253 days and mean number of ultrasounds was 2.8. Mean lesion diameter was 4.3 mm (range 1 to 10). There were 38 patients with serial ultrasound followup only with a mean growth of 0.5 mm per year (95% CI -2.2-3.3). Three patients underwent immediate surgery and 5 underwent surgery following a period of ultrasound followup. Indications for surgery were interval growth in 2 patients and patient choice in 6. Larger size (p = 0.02) and presence of vascular flow (p <0.01) were associated with intervention. One patient underwent radical orchiectomy for pure seminoma identified due to interval growth from 3 to 6 mm at 3 months. The other 7 masses excised with partial orchiectomy were benign.
  
  
  CONCLUSIONS
  Ultrasound surveillance of small (less than 1 cm) incidental testicular masses is a safe alternative to immediate surgical removal.
authors.affiliation: Division of Urology, Department of Surgery, Mount Sinai Hospital and New Women's College Hospital, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Paul J
authors.initials: PJ
authors.lastname: Toren
authors.forename: Matthew
authors.initials: M
authors.lastname: Roberts
authors.forename: Irene
authors.initials: I
authors.lastname: Lecker
authors.forename: Ethan D
authors.initials: ED
authors.lastname: Grober
authors.forename: Keith
authors.initials: K
authors.lastname: Jarvi
authors.forename: Kirk C
authors.initials: KC
authors.lastname: Lo
mesh_terms: D000328:Adult; D000368:Aged; D006801:Humans; D033162:Incidental Findings; D008297:Male; D008875:Middle Aged; D011159:Population Surveillance; D013736:Testicular Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology / Q000628:therapy; D014463:Ultrasonography; D055815:Young Adult