title: Correlation between semiquantitative sonoelastography and immunohistochemistry in the evaluation of testicular focal lesions.
abstract: BACKGROUND
  Sonoelastography is a novel and promising imaging tool, which has been applied to breast, thyroid, and prostate tissues. The aim of this study was to evaluate focal lesions of the testes with diameters of <10 mm using sonoelastography, B-mode sonography (US), and colour Doppler ultrasonography (CDU).
  
  
  METHODS
  Thirty patients who were referred to our outpatient clinics for varicocoeles, scrotal pain, scrotal enlargements, epididymitis, palpable testicular nodules, or infertility, were prospectively enrolled into this study. Ultrasound evaluations had revealed that 27 subjects had focal testicular lesions with diameters of <10 mm and 3 subjects had 10-mm spherical non-homogeneous testicular nodules. All lesions were evaluated using semiquantitative sonoelastography, and the patients underwent orchifunicolectomies. The testicular lesions were examined histopathologically. The vascularization of the lesions and the surrounding testicular parenchyma was evaluated by analysing the immunohistochemical distribution of the cluster of differentiation 31 and by calculating the vascular indices (VI). Potential associations between the strain ratios (stiffness of the lesions) and the VI were tested.
  
  
  RESULTS
  Analyses of the strain fields obtained using semiquantitative sonoelastography yielded different values for the masses and the surrounding tissues, which led to significant increases in the strain ratios. Sonoelastography upheld all of the diagnoses that were suspected when the patients were physically examined, when the serum markers were analysed, and after the patients had undergone US and CDU. Histopathological examinations confirmed the neoplastic characteristics of these masses. A significant inverse correlation was determined between the sonoelastographic strain ratio and the VI (Pearson correlation coefficient, r, = - 0.93; P < 0.001).
  
  
  CONCLUSIONS
  Our investigation shows that semiquantitative sonoelastography may provide additional objective information to support the algorithm used to diagnose testicular lesions. This might be of crucial diagnostic importance for lesions with diameters of <10 mm, particularly if they are not palpable, are negative for serum tumour markers, and if the findings from ultrasonography and CDU are equivocal. The findings from semiquantitative sonoelastography might indicate the need for surgical exploration. Further investigations with larger numbers of patients are required to corroborate these data and to support the use of semiquantitative sonoelastography in the evaluation of testicular lesions.
authors.forename: Antonio Luigi
authors.initials: AL
authors.lastname: Pastore
authors.forename: Giovanni
authors.initials: G
authors.lastname: Palleschi
authors.forename: Piero
authors.initials: P
authors.lastname: Maceroni
authors.forename: Giorgia
authors.initials: G
authors.lastname: Manfredonia
authors.forename: Domenico
authors.initials: D
authors.lastname: Autieri
authors.forename: Jessica
authors.initials: J
authors.lastname: Cacciotti
authors.forename: Barbara
authors.initials: B
authors.lastname: Sardella
authors.forename: Natale
authors.initials: N
authors.lastname: Porta
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Petrozza
authors.forename: Antonio
authors.initials: A
authors.lastname: Carbone
mesh_terms: D000328:Adult; D054459:Elasticity Imaging Techniques / Q000379:methods*; D006801:Humans; D007150:Immunohistochemistry; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D013737:Testis / Q000000981:diagnostic imaging* / Q000473:pathology*; D018615:Ultrasonography, Doppler, Color