Incidentally detected non-palpable testicular tumours in adults at scrotal ultrasound: impact of radiological findings on management Radiologic review and recommendations of the ESUR scrotal imaging subcommittee.
OBJECTIVE
The increasing detection of small testicular lesions by ultrasound (US) in adults can lead to unnecessary orchiectomies. This article describes their nature, reviews the available literature on this subject and illustrates some classical lesions. We also suggest recommendations to help characterization and management.


METHODS
The ESUR scrotal imaging subcommittee searched for original and review articles published before May 2015 using the Pubmed and Medline databases. Key words used were 'testicular ultrasound', 'contrast-enhanced sonography', 'sonoelastography', 'magnetic resonance imaging', 'testis-sparing surgery', 'testis imaging', 'Leydig cell tumour', 'testicular cyst'. Consensus was obtained amongst the members of the subcommittee, urologist and medical oncologist.


RESULTS
Simple cysts are frequent and benign, and do not require follow up or surgery. Incidentally discovered small solid testicular lesions detected are benign in up to 80 %, with Leydig cell tumours being the most frequent. However, the presence of microliths, macrocalcifications and hypoechoic areas surrounding the nodule are findings suggestive of malignant disease.


CONCLUSIONS
Asymptomatic small testicular lesions found on ultrasound are mainly benign, but findings such as microliths or hypoechoic regions surrounding the nodules may indicate malignancy. Colour Doppler US remains the basic examination for characterization. The role of newer imaging modalities in characterization is evolving.


CONCLUSIONS
• Characterization of testicular lesions is primarily based on US examination. • The role of MRI, sonoelastography, contrast-enhanced ultrasound is evolving. • Most small non-palpable testicular lesions seen on ultrasound are benign simple cysts. • Leydig cell tumours are the most frequent benign lesions. • Associated findings like microliths or hypoechoic regions may indicate malignancy.
Hopitaux Paris Sud, APHP, site Bicêtre, 78 avenue du Général Leclerc, 94270, Le Kremlin Bicêtre, France. laurence.rocher@aphp.fr.|Université Parid Sud, Ecole Doctorale Biosigne, ED 419, 63 rue Gabriel Péri, 94270, Le Kremlin Bicêtre, France. laurence.rocher@aphp.fr.|Institut Langevin, 1 rue Jussieu, 75005, Paris, France. laurence.rocher@aphp.fr.
Laurence
L
Rocher
Perelman School of Medicine, University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA, 19104, USA.
Parvati
P
Ramchandani
Royal Liverpool University Hospital, Prescot Street, Liverpool, L7 8XP, UK.
Jane
J
Belfield
Uco di Radiologia Dell 'Universita' di Trieste, Strada di Fiume 447, Trieste, Italy.
Michele
M
Bertolotto
Universita di Genova, Largo R. Benzi, 8, Genova, Italy.
Lorenzo E
LE
Derchi
Université Paris Descartes, Hôpital Necker, APHP, Institut Langevin, 149 rue de Sèvres, Paris 15, Paris, France.
Jean Michel
JM
Correas
Radiology, University Hospital Leuven, UZ Herestraat 49, box 7003 54, 3000, Leuven, Belgium.
Raymond
R
Oyen
University of Ioannina, Pl. Pargis, 2, Ionnina, 45332, Greece.
Athina C
AC
Tsili
Radiology, Sokak Huner Sitesi No: 18/30, 25. Cadde 362, Ankara, 6530, Turkey.
Ahmet Tuncay
AT
Turgut
Department of Imaging Sciences, University of Rochester School of Medicine and Dentistry, 601 Elmwood Ave, Box 648, Rochester, NY, USA.
Vikram
V
Dogra
Université Paris Sud, Institut Gustave Roussy, 114 rue Edouard Vaillant, 94805, Villejuif, France.
Karim
K
Fizazi
Plymouth Hospitals NHS Trust, Devon, UK.
Simon
S
Freeman
Royal Sussex County Hospital Brighton and Brighton and Sussex Medical School, East Sussex, UK.
Jonathan
J
Richenberg
D000328:Adult; D005060:Europe; D006801:Humans; D033162:Incidental Findings; D008297:Male; D012611:Scrotum / Q000000981:diagnostic imaging* / Q000473:pathology; D012955:Societies, Medical; D013736:Testicular Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology; D014463:Ultrasonography / Q000379:methods*
Colour Doppler ultrasound; Contrast-enhanced sonography; Magnetic resonance Imaging; Sonoelastography; Testicular tumours