title: Testicular microlithiasis imaging and follow-up: guidelines of the ESUR scrotal imaging subcommittee.
abstract: OBJECTIVE
  The subcommittee on scrotal imaging, appointed by the board of the European Society of Urogenital Radiology (ESUR), have produced guidelines on imaging and follow-up in testicular microlithiasis (TML).
  
  
  METHODS
  The authors and a superintendent university librarian independently performed a computer-assisted literature search of medical databases: MEDLINE and EMBASE. A further parallel literature search was made for the genetic conditions Klinefelter's syndrome and McCune-Albright syndrome.
  
  
  RESULTS
  Proposed guidelines are: follow-up is not advised in patients with isolated TML in the absence of risk factors (see Key Points below); annual ultrasound (US) is advised for patients with risk factors, up to the age of 55; if TML is found with a testicular mass, urgent referral to a specialist centre is advised.
  
  
  CONCLUSIONS
  Consensus opinion of the scrotal subcommittee of the ESUR is that the presence of TML alone in the absence of other risk factors is not an indication for regular scrotal US, further US screening or biopsy. US is recommended in the follow-up of patients at risk, where risk factors other than microlithiasis are present. Risk factors are discussed and the literature and recommended guidelines are presented in this article.
  
  
  CONCLUSIONS
  • Follow up advised only in patients with TML and additional risk factors. • Annual US advised for patients with risk factors up to age 55. • If TML is found with testicular mass, urgent specialist referral advised. • Risk factors - personal/ family history of GCT, maldescent, orchidopexy, testicular atrophy.
authors.affiliation: Royal Sussex County Hospital Brighton and Brighton and Sussex Medical School, Brighton, Sussex, UK, Jonathan.richenberg@bsuh.nhs.uk.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Richenberg
authors.forename: Jane
authors.initials: J
authors.lastname: Belfield
authors.forename: Parvati
authors.initials: P
authors.lastname: Ramchandani
authors.forename: Laurence
authors.initials: L
authors.lastname: Rocher
authors.forename: Simon
authors.initials: S
authors.lastname: Freeman
authors.forename: Athina C
authors.initials: AC
authors.lastname: Tsili
authors.forename: Faye
authors.initials: F
authors.lastname: Cuthbert
authors.forename: Michal
authors.initials: M
authors.lastname: Studniarek
authors.forename: Michele
authors.initials: M
authors.lastname: Bertolotto
authors.forename: Ahmet Tuncay
authors.initials: AT
authors.lastname: Turgut
authors.forename: Vikram
authors.initials: V
authors.lastname: Dogra
authors.forename: Lorenzo E
authors.initials: LE
authors.lastname: Derchi
mesh_terms: D000293:Adolescent; D000328:Adult; D017668:Age of Onset; D000368:Aged; D001706:Biopsy; D002137:Calculi / Q000000981:diagnostic imaging*; D002648:Child; D002675:Child, Preschool; D003937:Diagnosis, Differential; D005359:Fibrous Dysplasia, Polyostotic / Q000000981:diagnostic imaging; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007248:Infertility, Male / Q000000981:diagnostic imaging; D007713:Klinefelter Syndrome / Q000000981:diagnostic imaging; D008297:Male; D008875:Middle Aged; D010375:Pedigree; D012307:Risk Factors; D012611:Scrotum / Q000000981:diagnostic imaging; D013733:Testicular Diseases / Q000000981:diagnostic imaging*; D013736:Testicular Neoplasms / Q000000981:diagnostic imaging / Q000235:genetics; D014463:Ultrasonography; D055815:Young Adult