title: Diagnostic ultrasound-guided excisional testicular biopsy for small (< 1 cm) incidental nodules. A single institution experience.
abstract: OBJECTIVE
  The widespread use of scrotal ultrasound (SUS) has led to a marked increase in the number of incidentally detected testicular lesions. A small incidental nodule (STN) has defined as a non palpable (< 10 mm), asymptomatic solid lesion with normal levels of oncological testicular markers. Nowadays the lack of agreement on the topic causes managing problems to andrologists. We present our experience consisting in 8 cases of STN discovered by SUS performed for different clinical indications.
  
  
  METHODS
  We retrieved from our ultrasonographic files the clinical information about 717 patients evaluated for andrological problems. Patients with STN underwent to a complete clinical history and physical examination as well as oncological testicular markers measurement and ormonal assessment and then received a diagnostic ultrasound guided excisional biopsy (DEB). Surgical approach was performed through an inguinal incision. Using the coordinates previously obtained from preoperative SUS, STN was localized by intraoperative SUS. The lesion was enucleated and sent to the Pathology department for frozen section examination (FSE). Biopsies of affected testis (TB) were also performed. Post-excision ultrasound has been used to confirm the complete removal of the nodule. Whether pathological findings were benign, testis sparing surgery (TSS) was performed. Immediate radical orchidectomy (IRO) was performed if FSE and TB findings suggested a malignant lesion.
  
  
  RESULTS
  STNs were discovered in 8 patients (1,1%). Very small lesions (< 5 mm) were detected in 50% of cases. We performed four IRO and four DEB with consequent TSS. In one case we performed a delayed radical orchidectomy (DRO). At FSE pathologist reported 3 Leydig cell tumor and 3 seminoma and an inflammatory regressive lesion in one case. FSE on TB reported intratesticular neoplasia (TIN) in three cases. In one case nodule wasn't sent to FSE. We observed a concordance between FSE and definitive pathologic report in six cases (75%).
  
  
  CONCLUSIONS
  The management of STN is still a challenge for the surgical andrologist. A correct diagnosis has a crucial role in making the best treatment and patients outcome. Ultrasound guided excisional biopsy and the close collaboration with a dedicated pathologist are very useful in reducing errors.
authors: Surgery Dpt, Section of Urology, ASUR Marche Area Vasta 3, Macerata Hospital, Macerata. andreadoc1@libero.it.
authors: Andrea
authors: A
authors: Fabiani
authors: Alessandra
authors: A
authors: Filosa
authors: Fabrizio
authors: F
authors: Fioretti
authors: Lucilla
authors: L
authors: Servi
authors: Mara
authors: M
authors: Piergallina
authors: Giovanni
authors: G
authors: Ciccotti
authors: Valentina
authors: V
authors: Maurelli
authors: Matteo
authors: M
authors: Tallè
authors: Gabriele
authors: G
authors: Mammana
mesh_terms: D000293:Adolescent; D000328:Adult; D006801:Humans; D061705:Image-Guided Biopsy / Q000379:methods; D008297:Male; D012611:Scrotum / Q000000981:diagnostic imaging; D013733:Testicular Diseases / Q000000981:diagnostic imaging* / Q000473:pathology*; D013737:Testis / Q000000981:diagnostic imaging* / Q000473:pathology*; D018084:Ultrasonography, Interventional; D055815:Young Adult