Department of Medical Ultrasound, Center of Minimally Invasive Treatment for Tumor, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, Shanghai 200072, China.
Ultrasound Research and Education Institute, Clinical Research Center for Interventional Medicine, School of Medicine, Tongji University, Shanghai 200072, China.
Asian J Androl. 2023 Jan-Feb;25(1):50-57. doi: 10.4103/aja202235.
The purpose of this study was to evaluate the diagnostic performance of multiparametric ultrasound (mpUS; grayscale US, color Doppler US, strain elastography, and contrast-enhanced US) in the assessment of testicular lesions with negative tumoral markers. MpUS imaging data, patient age, serum tumor markers, scrotal pain, cryptorchidism, and related clinical information were retrospectively collected for patients who underwent mpUS examination between January 2013 and December 2019. Histologic results or follow-up examinations were used as the reference standard. In total, 83 lesions from 79 patients were included in the analysis. Fifty-six patients were finally diagnosed with benign tumors, and 23 patients were ultimately diagnosed with malignant tumors. Chi-square tests or Fisher's exact tests were used to assess the difference between the two groups. Stepwise multivariate logistic regression analysis showed that lesion diameter (odds ratio [OR] = 1.072, P = 0.005), vascularization on color Doppler US (OR = 4.066, P = 0.001), and hyperenhancement during the early phase (OR = 6.465, P = 0.047) were significant independent risk factors for malignancy; however, when compared with neoplastic lesions, pain (OR = 0.136, P < 0.001), absence of vascularization on color Doppler US (OR = 1.680, P = 0.042), and nonenhancement during the late phase (OR = 3.461, P = 0.031) were strongly associated with nonneoplastic lesions. MpUS features are useful for differentiating testicular lesions with negative tumoral markers and improving the preoperative diagnosis, which may avoid inappropriate radical orchiectomy.
本研究旨在评估多参数超声（mpUS；灰阶超声、彩色多普勒超声、应变弹性成像和对比增强超声）在评估肿瘤标志物阴性的睾丸病变中的诊断性能。回顾性收集了 2013 年 1 月至 2019 年 12 月间接受 mpUS 检查的患者的 mpUS 成像数据、患者年龄、血清肿瘤标志物、阴囊疼痛、隐睾和相关临床信息。组织学结果或随访检查被用作参考标准。共纳入 79 例患者的 83 个病灶进行分析。56 例患者最终诊断为良性肿瘤，23 例患者最终诊断为恶性肿瘤。卡方检验或 Fisher 确切概率法用于评估两组间的差异。逐步多因素逻辑回归分析显示，病灶直径（比值比[OR] = 1.072，P = 0.005）、彩色多普勒超声的血管化（OR = 4.066，P = 0.001）和早期高增强（OR = 6.465，P = 0.047）是恶性肿瘤的显著独立危险因素；然而，与肿瘤性病变相比，疼痛（OR = 0.136，P < 0.001）、彩色多普勒超声无血管化（OR = 1.680，P = 0.042）和晚期无增强（OR = 3.461，P = 0.031）与非肿瘤性病变密切相关。mpUS 特征有助于区分肿瘤标志物阴性的睾丸病变，提高术前诊断水平，从而避免不必要的根治性睾丸切除术。
