Beneficial value of testicular sperm extraction-AgarCyto in addition to the standard testicular biopsy for diagnosis of testicular germ cell tumors in nonobstructive azoospermia.
OBJECTIVE
To study whether immunohistochemical detection of germ cell neoplasia in situ (GCNIS) in AgarCytos, made of the remnants of the testicular sperm extraction (TESE) specimen, is equally accurate as in a standard testicular biopsy.


METHODS
Prospective cohort study performed between January 2013 and May 2014.


METHODS
University hospital.


METHODS
All men with nonobstructive azoospermia (n = 197) undergoing a urological work-up followed by a unilateral or bilateral TESE for fertility treatment were consecutively included.


METHODS
An AgarCyto was made of the remnants of these TESE biopsies. Simultaneously a standard testicular biopsy was performed. For all cases a routine hematoxylin-eosin (H & E) staining was performed as well as immunohistochemistry (PLAP and OCT3/4) to detect GCNIS.


METHODS
The presence or absence of GCNIS in the TESE-AgarCyto and standard testicular biopsy.


RESULTS
Six men (3.0%) were diagnosed with a germ cell (pre)malignancy by immunohistochemistry. No cases were encountered in which the TESE-AgarCyto was negative, whereas the standard testicular biopsy was positive for GCNIS. In one case the TESE-AgarCyto detected a premalignancy that was missed by standard testicular biopsy. Unfortunately a standard testicular biopsy was not available for direct comparison in 50% of the GCNIS-positive patients due to various reasons.


CONCLUSIONS
Because GCNIS is heterogeneously distributed in the testis, the TESE-AgarCyto can diagnose GCNIS even when the standard testicular biopsy is negative. Direct comparison of accuracy, however, is not reliable due to the low prevalence of GCNIS and the lack of a standard biopsy when an orchidectomy was performed simultaneously with TESE.
Department of Obstetrics and Gynecology, Division of Reproductive Medicine, Radboud University Medical Center, Nijmegen, the Netherlands. Electronic address: Marloes.Hessel@radboudumc.nl.
Marie-Louise
ML
Hessel
Department of Obstetrics and Gynecology, Division of Reproductive Medicine, Radboud University Medical Center, Nijmegen, the Netherlands.
Liliana
L
Ramos
Department of Urology, Radboud University Medical Center, Nijmegen, the Netherlands.
Kathleen W M
KW
D'Hauwers
Department of Obstetrics and Gynecology, Division of Reproductive Medicine, Radboud University Medical Center, Nijmegen, the Netherlands.
Didi D M
DD
Braat
Department of Pathology, Radboud University Medical Center, Nijmegen, the Netherlands.
Christina A
CA
Hulsbergen-van de Kaa
D000328:Adult; D000469:Alkaline Phosphatase / Q000032:analysis; D053713:Azoospermia / Q000473:pathology*; D014408:Biomarkers, Tumor / Q000032:analysis; D001706:Biopsy; D006785:Hospitals, University; D006801:Humans; D007150:Immunohistochemistry; D007527:Isoenzymes / Q000032:analysis; D008297:Male; D009373:Neoplasms, Germ Cell and Embryonal / Q000737:chemistry / Q000473:pathology*; D009426:Netherlands; D050814:Octamer Transcription Factor-3 / Q000032:analysis; D011237:Predictive Value of Tests; D011446:Prospective Studies; D015203:Reproducibility of Results; D053625:Sperm Retrieval; D013736:Testicular Neoplasms / Q000737:chemistry / Q000473:pathology*
D014408:Biomarkers, Tumor; D007527:Isoenzymes; D050814:Octamer Transcription Factor-3; C494173:POU5F1 protein, human; C055791:germ-cell AP isoenzyme; D000469:Alkaline Phosphatase
Germ cell neoplasia in situ; immunohistochemistry; infertility; screening; testicular sperm extraction