Testicular microlithiasis: is there a need for surveillance in the absence of other risk factors?
OBJECTIVE
Ultrasound surveillance of patients with testicular microlithiasis (TM) has been advocated following the reported association with testicular cancer. The aim of this study was to assess the evidence base supporting such surveillance.


METHODS
Formal literature review identified cohort studies comprising at least 15 patients followed up for at least 24 months. Combining an institutional audit with the identified studies in a pooled analysis the incidence of new cancers during the surveillance period was evaluated.


RESULTS
Literature review identified eight studies. Our institutional audit comprised 2,656 men referred for scrotal ultrasound. Fifty-one men (1.92 %) with TM were identified, none of whom developed testicular cancer (mean follow-up: 33.3 months). In a combined population of 389 men testicular cancer developed in 4. Excluding 3 who had additional risk factors, only 1 of 386 developed testicular cancer during follow-up (95 % CI 0.05-1.45 %).


CONCLUSIONS
Ultrasound surveillance is unlikely to benefit patients with TM in the absence of other risk factors. In the presence of additional risk factors (previous testicular cancer, a history of maldescent or testicular atrophy) patients are likely to be under surveillance; nonetheless monthly self-examination should be encouraged, and open access to ultrasound and formal annual surveillance should be offered.


CONCLUSIONS
• The literature reports a high association between testicular microlithiasis and testicular cancer.                                                     • Our study and meta-analysis suggest no causal link between microlithiasis and cancer.                                                     • In the absence of additional risk factors surveillance is not advocated.                                                     • In the presence of additional risk factors surveillance is recommended.                                                     • Such surveillance is primarily aimed at engaging patients in regular follow-up.
Department of Radiology, Brighton and Sussex University Hospitals NHS Trust, Eastern Road, Brighton, BN2 5BE, UK. Jonathan.Richenberg@bsuh.nhs.uk
Jonathan
J
Richenberg
Nick
N
Brejt
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002137:Calculi / Q000175:diagnosis* / Q000473:pathology*; D055088:Early Detection of Cancer / Q000379:methods; D006801:Humans; D008297:Male; D008495:Medical Oncology / Q000379:methods; D008875:Middle Aged; D015995:Prevalence; D015203:Reproducibility of Results; D012307:Risk Factors; D012611:Scrotum / Q000000981:diagnostic imaging; D013733:Testicular Diseases / Q000175:diagnosis* / Q000473:pathology*; D013736:Testicular Neoplasms / Q000175:diagnosis; D013737:Testis / Q000000981:diagnostic imaging; D014463:Ultrasonography