Ager Michael, Donegan Sarah, Boeri Luca, de Castro Javier Mayor, Donaldson James F, Omar Muhammad Imran, Dimitropoulos Konstantinos, Tharakan Tharu, Janisch Florian, Muilwijk Tim, Yuan Cathy, Tudur-Smith Catrin, Nijman Rien J M, Radmayr Christian, Salonia Andrea, Laguna Pes Maria P, Minhas Suks
Department of Urology, Imperial College Healthcare NHS Trust, London, UK.
Department of Health Data Science, University of Liverpool, Liverpool, UK.
BJU Int. 2023 Mar;131(3):288-300. doi: 10.1111/bju.15869. Epub 2022 Oct 9.
The use of scrotal ultrasonography (SUS) has increased the detection rate of indeterminate testicular masses. Defining radiological characteristics that identify malignancy may reduce the number of men undergoing unnecessary radical orchidectomy.
To define which SUS or scrotal magnetic resonance imaging (MRI) characteristics can predict benign or malignant disease in pre- or post-pubertal males with indeterminate testicular masses.
This systematic review was conducted in accordance with Cochrane Collaboration guidance. Medline, Embase, Cochrane controlled trials and systematic reviews databases were searched from (1970 to 26 March 2021). Benign and malignant masses were classified using the reported reference test: i.e., histopathology, or 12 months progression-free radiological surveillance. Risk of bias was assessed using the Quality Assessment of Diagnostic Accuracy Studies-2 tool (QUADAS-2).
A total of 32 studies were identified, including 1692 masses of which 28 studies and 1550 masses reported SUS features, four studies and 142 masses reported MRI features. Meta-analysis of different SUS (B-mode) values in post-pubertal men demonstrated that a size of ≤0.5 cm had a significantly lower odds ratio (OR) of malignancy compared to masses of >0.5 cm (P < 0.001). Comparison of masses of 0.6-1.0 cm and masses of >1.5 cm also demonstrated a significantly lower OR of malignancy (P = 0.04). There was no significant difference between masses of 0.6-1.0 and 1.1-1.5 cm. SUS in post-pubertal men also had a statistically significantly lower OR of malignancy for heterogenous masses vs homogenous masses (P = 0.04), hyperechogenic vs hypoechogenic masses (P < 0.01), normal vs increased enhancement (P < 0.01), and peripheral vs central vascularity (P < 0.01), respectively. There were limited data on pre-pubertal SUS, pre-pubertal MRI and post-pubertal MRI.
This meta-analysis identifies radiological characteristics that have a lower OR of malignancy and may be of value in the management of the indeterminate testis mass.
阴囊超声检查（SUS）的应用提高了睾丸不确定肿块的检出率。确定能够识别恶性肿瘤的放射学特征可能会减少接受不必要根治性睾丸切除术的男性数量。
确定哪些SUS或阴囊磁共振成像（MRI）特征可预测青春期前或青春期后睾丸肿块不确定的男性的良性或恶性疾病。
本系统评价按照Cochrane协作网指南进行。检索了Medline、Embase、Cochrane对照试验和系统评价数据库（1970年至2021年3月26日）。使用报告的参考标准对良性和恶性肿块进行分类，即组织病理学或12个月无进展的放射学监测。使用诊断准确性研究质量评估-2工具（QUADAS-2）评估偏倚风险。
共纳入32项研究，包括1692个肿块，其中28项研究和1550个肿块报告了SUS特征，4项研究和142个肿块报告了MRI特征。对青春期后男性不同SUS（B超）值的荟萃分析表明，与大于0.5 cm的肿块相比，≤0.5 cm的肿块恶性肿瘤的比值比（OR）显著更低（P < 0.001）。比较0.6 - 1.0 cm的肿块和大于1.5 cm的肿块也显示恶性肿瘤的OR显著更低（P = 0.04）。0.6 - 1.0 cm和1.1 - 1.5 cm的肿块之间无显著差异。青春期后男性中，SUS对于异质性肿块与均匀性肿块、高回声与低回声肿块、正常强化与强化增加、外周血管与中央血管的恶性肿瘤OR也分别有统计学显著降低（P = 0.04、P < 0.01、P < 0.01、P < 0.01）。青春期前SUS、青春期前MRI和青春期后MRI的数据有限。
这项荟萃分析确定了恶性肿瘤OR较低的放射学特征，可能对睾丸不确定肿块的管理有价值。
