title: Detection of small testicular masses in monorchid patients using US, CPDUS, CEUS and US-guided biopsy.
abstract: OBJECTIVE
  Testis sparing surgery (TSS) is a well-known technique in the treatment of small testicular masses. Grayscale ultrasound (US), color/power Doppler US (CPDUS) and contrast-enhanced ultrasound (CEUS) are considered the best diagnostic imaging tools in those patients. Aim of this study was to assess the role of US imaging in the detection of small testicular masses in monorchid patients after orchiectomy for malignant neoplasm, and in guiding surgery to reach the target and also to differentiate lesions which presented vascular activity within the mass.
  
  
  METHODS
  From January 2011 to October 2014, 18 patients were enrolled in this study. They had previously undergone orchiectomy and were investigated for suspected contralateral disease. During routine follow-up, all patients underwent grayscale US. If findings were positive, CPDUS and CEUS were performed and eventually all patients underwent surgery. After exteriorization of the testis, the small mass was identified by intraoperative US, and a needle was placed under US guidance. After excision of the mass, frozen section examination was performed. When malignancy was found, radical orchiectomy was performed; if histological outcome was negative, the healthy testis was conserved.
  
  
  RESULTS
  All patients underwent grayscale US examination, which showed small hypoechoic masses. Each mass identified at US imaging was confirmed at surgery. All patients underwent CPDUS; 12/19 lesions showed blood flow while 7/19 showed absence of blood flow. At CEUS, 16/19 lesions showed enhancement and subsequent histological examination revealed that 8 were seminomas and 3 were Leydig cell tumors. In 5/19 cases CEUS showed the presence of lesions (focal inflammatory lesions) and in 3/19 cases CEUS was negative.
  
  
  CONCLUSIONS
  TSS in monorchid patients may be a safe procedure leading to excellent results. We therefore consider it a valid alternative to radical orchiectomy, and US imaging is essential to guide the resection of non-palpable neoplasms and to exclude concomitant lesions.
authors.affiliation: Dipartimento di Radiologia Centrale, Università degli studi "La Sapienza", Viale del Policlinico, 155 00161 Rome, Italy.
authors.forename: F M
authors.initials: FM
authors.lastname: Drudi
authors.affiliation: Dipartimento di Radiologia Centrale, Università degli studi "La Sapienza", Viale del Policlinico, 155 00161 Rome, Italy.
authors.forename: F
authors.initials: F
authors.lastname: Maghella
authors.affiliation: Dipartimento di Scienze Chirurgiche, Sezione interdisciplinare di Chirurgia "F. Durante", Università degli studi "La Sapienza", Viale del Policlinico, 155 00161 Rome, Italy.
authors.forename: G
authors.initials: G
authors.lastname: Martino
authors.affiliation: Dipartimento di Radiologia Centrale, Università degli studi "La Sapienza", Viale del Policlinico, 155 00161 Rome, Italy.
authors.forename: D
authors.initials: D
authors.lastname: Messineo
authors.affiliation: Dipartimento di Radiologia Centrale, Università degli studi "La Sapienza", Viale del Policlinico, 155 00161 Rome, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Ciccariello
authors.affiliation: Dipartimento di Radiologia Centrale, Università degli studi "La Sapienza", Viale del Policlinico, 155 00161 Rome, Italy.
authors.forename: V
authors.initials: V
authors.lastname: Cantisani
authors.affiliation: Dipartimento di Radiologia Centrale, Università degli studi "La Sapienza", Viale del Policlinico, 155 00161 Rome, Italy.
authors.forename: F
authors.initials: F
authors.lastname: Malpassini
authors.affiliation: Dipartimento di Radiologia Centrale, Università degli studi "La Sapienza", Viale del Policlinico, 155 00161 Rome, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Liberatore
authors.affiliation: Dipartimento di Radiologia Centrale, Università degli studi "La Sapienza", Viale del Policlinico, 155 00161 Rome, Italy.
authors.forename: F
authors.initials: F
authors.lastname: D'Ambrosio
mesh_terms: D000328:Adult; D003287:Contrast Media; D006061:Gonadal Dysgenesis, 46,XY; D006801:Humans; D061705:Image-Guided Biopsy; D008297:Male; D009919:Orchiectomy; D013736:Testicular Neoplasms / Q000000981:diagnostic imaging* / Q000601:surgery; D013737:Testis / Q000002:abnormalities; D018615:Ultrasonography, Doppler, Color
chemical_list: D003287:Contrast Media
keywords: CEUS; Color-doppler; Monorchid; Testicular neoplasm; Ultrasound