Division of Pediatric Urology, Children's Hospital Colorado and Division of Urology, Department of Surgery, University of Colorado School of Medicine, Aurora, CO, USA.
Division of Pediatric Urology, Children's Hospital Colorado and Division of Urology, Department of Surgery, University of Colorado School of Medicine, Aurora, CO, USA.
J Pediatr Urol. 2019 Feb;15(1):70.e1-70.e6. doi: 10.1016/j.jpurol.2018.10.011. Epub 2018 Oct 23.
In children, most small testicular tumors are benign, and testicular-sparing surgery (TSS) is a viable treatment option.
The objective of this study is to assess for correlation between the tumor size and final pathologic diagnoses appropriate for TSS for pediatric and adolescent patients with an intratesticular mass and negative serum tumor markers (STMs).
A retrospective review of 24 patients (aged 0-18 years) who underwent radical or partial orchiectomy between 2003 and 2015. Patients with unifocal, unilateral intratesticular tumors and negative STMs were included. Tumors with benign and non-germ cell histology were considered appropriate for TSS, and active germ cell tumor elements on final histology were categorized as inappropriate for TSS. Baseline characteristics, tumor size, and frozen section results were evaluated for association, for the entire cohort and then for a subset of pubertal and postpubertal patients (defined as ≥10 years old).
Patients with testicular tumor pathology inappropriate for TSS were significantly older (median age 17.1 years, P = 0.03). A 2-cm size cutoff did not accurately predict pathology for the entire cohort, or for just pubertal and postpubertal patients (P = 0.132, P = 0.154, respectively). Frozen section and final pathology demonstrated good agreement (κ = 0.826, P < 0.001) as did pre-operative and final pathologic size measurement (κ = 0.703, P < 0.001). Frozen section analysis did not miss a TSS inappropriate pathology.
The present data refute the finding in adults that a 2-cm cutoff accurately predicts pathology in pediatric patients with an intratesticular mass and normal STMs. These data suggest that TSS should still be offered, regardless of the tumor size alone, but frozen section appears to more accurately predict pathology than the tumor size, and its use should, thus, be emphasized. There are several limitations of this study to mention. First, this is a retrospective review of a small cohort of patients with a rare clinical scenario, which necessitated the combination of pediatric and adolescent patients. The study did not evaluate oncologic outcomes.
In children with an intratesticular tumor and normal STMs, a tumor size cutoff of 2 cm does not appear to accurately predict the final pathology. However, the data presented support the continued use intra-operative frozen section analysis in both children and adolescents undergoing TSS.
在儿童中，大多数小的睾丸肿瘤是良性的，并且睾丸保留手术（TSS）是一种可行的治疗选择。
本研究的目的是评估对于肿瘤大小与最终病理诊断之间的相关性，以确定对于血清肿瘤标志物（STMs）阴性的患有睾丸内肿块的儿科和青少年患者，进行 TSS 的治疗方案。
对 2003 年至 2015 年间接受根治性或部分睾丸切除术的 24 名患者（年龄 0-18 岁）进行回顾性分析。纳入单侧睾丸内肿瘤且 STMs 阴性的患者。肿瘤具有良性和非生殖细胞组织学特征被认为适合 TSS，而最终组织学上存在活跃的生殖细胞瘤元素则被归类为不适合 TSS。评估了基线特征、肿瘤大小和冷冻切片结果与整个队列的相关性，然后评估了青春期前和青春期后患者（定义为≥10 岁）的亚组。
肿瘤病理不适合 TSS 的患者年龄明显较大（中位数年龄 17.1 岁，P=0.03）。2cm 大小的截断值不能准确预测整个队列的病理，也不能准确预测仅青春期前和青春期后患者的病理（P=0.132，P=0.154）。冷冻切片和最终病理显示出良好的一致性（κ=0.826，P<0.001），术前和最终病理大小测量也显示出良好的一致性（κ=0.703，P<0.001）。冷冻切片分析并未遗漏不适合 TSS 的病理。
本研究数据反驳了成人研究中 2cm 截断值可准确预测睾丸内肿块且 STMs 正常的儿科患者病理的发现。这些数据表明，无论肿瘤大小如何，都应仍然提供 TSS，但冷冻切片似乎比肿瘤大小更准确地预测病理，因此应强调其使用。本研究有几个局限性需要提及。首先，这是一项回顾性研究，纳入了一组罕见临床情况下的小患者队列，因此需要将儿科和青少年患者结合起来。该研究未评估肿瘤学结果。
在血清肿瘤标志物（STMs）阴性的睾丸内肿瘤患儿中，肿瘤大小的截断值为 2cm 似乎不能准确预测最终病理。然而，目前的数据支持在接受 TSS 的儿童和青少年中继续使用术中冷冻切片分析。
