小睾丸肿块的管理：来自单中心专科多学科团队的结果

Management of small testicular masses: outcomes from a single-centre specialist multidisciplinary team.

作者信息

Wardak Shafi, Pang Karl H, Castiglione Fabio, Lindsay Jamie, Walkden Miles, Ho Dan Heffernan, Kirkham Alex, Hadway Paul, Nigam Raj, Rees Rowland, Alifrangis Constantine, Alnajjar Hussain M, Muneer Asif

机构信息

Department of Urology, Royal Berkshire NHS Foundation Trust, Reading, UK.

Male Genital Cancer Centre, Institute of Andrology, University College London Hospitals NHS Foundation Trust, London, UK.

出版信息

BJU Int. 2023 Jan;131(1):73-81. doi: 10.1111/bju.15874. Epub 2022 Sep 21.

DOI:10.1111/bju.15874

PMID:35986901

Abstract

OBJECTIVES

To report the management outcomes of men with ≤20-mm small testicular masses (STMs) and to identify clinical and histopathological factors associated with malignancy.

PATIENTS AND METHODS

A retrospective analysis of men managed at a single centre between January 2010 and December 2020 with a STM ≤20 mm in size was performed.

RESULTS

Overall, 307 men with a median (interquartile range [IQR]) age of 36 (30-44) years were included. Of these, 161 (52.4%), 82 (26.7%), 62 (20.2%) and 2 men (0.7%) underwent surveillance with interval ultrasonography (USS), primary excisional testicular biopsy (TBx) or primary radical orchidectomy (RO), or were discharged, respectively. The median (IQR) surveillance duration was 6 (3-18) months. The majority of men who underwent surveillance had lesions <5 mm (59.0%) and no lesion vascularity (67.1%) on USS. Thirty-three (20.5%) men undergoing surveillance had a TBx based on changes on interval USS or patient choice; seven (21.2%) were found to be malignant. The overall rate of malignancy in the surveillance cohort was 4.3%. The majority of men who underwent primary RO had lesions ≥10 mm (85.5%) and the presence of vascularity (61.7%) on USS. Nineteen men (23.2%) who underwent primary TBx (median lesion size 6 mm) had a malignancy confirmed on biopsy and underwent RO. A total of 88 men (28.7%) underwent RO, and malignancy was confirmed in 73 (83.0%) of them. The overall malignancy rate in the whole STM cohort was 23.8%. Malignant RO specimens had significantly larger lesion sizes (median [IQR] 11 [8-15] mm, vs benign: median [IQR] 8 [5-10] mm; P = 0.04).

CONCLUSIONS

Small testicular masses can be stratified and managed based on lesion size and USS features. The overall malignancy rate in men with an STM was 23.8% (4.3% in the surveillance group). Surveillance should be considered in lesions <10 mm in size, with a TBx or frozen-section examination offered prior to RO in order to preserve testicular function.

摘要

目的

报告睾丸小肿块（STM）直径≤20mm男性患者的治疗结果，并确定与恶性肿瘤相关的临床和组织病理学因素。

患者与方法

对2010年1月至2020年12月在单一中心接受治疗的STM直径≤20mm的男性患者进行回顾性分析。

结果

共纳入307例男性患者，年龄中位数（四分位间距[IQR]）为36（30 - 44）岁。其中，分别有161例（52.4%）、82例（26.7%）、62例（20.2%）和2例（0.7%）接受了定期超声检查（USS）监测、原发性切除睾丸活检（TBx）或原发性根治性睾丸切除术（RO），或出院。监测的中位（IQR）持续时间为6（3 - 18）个月。接受监测的大多数男性患者的病变在USS上<5mm（59.0%）且无病变血管（67.1%）。33例（20.5%）接受监测的男性患者基于定期USS检查结果变化或患者选择进行了TBx；其中7例（21.2%）被发现为恶性。监测队列中的总体恶性肿瘤发生率为4.3%。接受原发性RO的大多数男性患者的病变在USS上≥10mm（85.5%）且存在血管（61.7%）。19例接受原发性TBx（病变大小中位数为6mm）的男性患者活检确诊为恶性并接受了RO。共有88例（28.7%）患者接受了RO，其中73例（83.0%）确诊为恶性。整个STM队列中的总体恶性肿瘤发生率为23.8%。恶性RO标本的病变大小明显更大（中位数[IQR]为11[8 - 15]mm，良性为：中位数[IQR]为8[5 - 10]mm；P = 0.04）。