超声造影在50岁以上原发性睾丸生殖细胞肿瘤与非生殖细胞肿瘤鉴别诊断中的价值
The value of contrast-enhanced ultrasonography in differential diagnosis of primary testicular germ cell tumors and non-germ cell tumors over 50 years old.
作者信息
Xue Nianyu, Wang Guoyao, Zhang Shengmin, Lu Yijun
机构信息
Department of Ultrasonography, Ningbo First Hospital, Ningbo, China.
Department of Urology, Ningbo First Hospital, Ningbo, Zhejiang, China.
出版信息
Front Oncol. 2023 Feb 20;13:1090823. doi: 10.3389/fonc.2023.1090823. eCollection 2023.
BACKGROUND
Unlike young and middle-aged patients, seminoma is not common in patients with primary testicular tumors over the age of 50, so it cannot follow the general ideas and norms for diagnosing and treating testicular tumors, and its characteristics need to be considered separately.
METHODS
The conventional ultrasonography and contrast-enhanced ultrasonography (CEUS) findings of primary testicular tumors in patients over 50 years old were retrospectively analyzed and compared with the pathological results to compare the diagnostic value of these two methods.
RESULTS
Of the 13 primary testicular tumors, 8 were primary lymphomas. Conventional ultrasound of 13 cases of testicular tumors showed hypoechoic with rich blood flow, and it was difficult to identify the type accurately. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of conventional ultrasonography in diagnosing non-germ cell tumors (lymphoma and Leydig cell tumor) were 40.0%, 33.3%, 66.7%, 14.3%, and 38.5%, respectively. CEUS findings: 7 of 8 lymphomas showed uniform hyperenhancement. 2 cases of Leydig cell tumors showed uniform high enhancement. 2 cases of seminoma and 1 case of spermatocytic tumor showed heterogeneous enhancement, with necrosis in the interior. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy rate of non-germ cell tumor diagnosis according to the non-necrotic area of CEUS were 90.0%, 100.0%, 100.0%, 75.0% and 92.3%, respectively. Compared with conventional ultrasound, the difference was statistically significant (P=0.039).
CONCLUSIONS
Primary testicular tumors in patients over 50 years old are mainly lymphoma, and CEUS is significantly different between germ cell tumors and non-germ cell tumors. Compared with conventional ultrasound, CEUS can distinguish testicular germ cell tumors from non-germ cell tumors more accurately. Preoperative ultrasonography is significant for accurate diagnosis and can guide clinical treatment.
背景
与中青年患者不同，精原细胞瘤在50岁以上原发性睾丸肿瘤患者中并不常见，因此不能遵循睾丸肿瘤诊断和治疗的一般思路与规范，其特点需单独考虑。
方法
回顾性分析50岁以上原发性睾丸肿瘤患者的常规超声及超声造影（CEUS）表现，并与病理结果进行对比，以比较这两种检查方法的诊断价值。
结果
13例原发性睾丸肿瘤中，8例为原发性淋巴瘤。13例睾丸肿瘤的常规超声表现为低回声且血流丰富，难以准确判断肿瘤类型。常规超声诊断非生殖细胞肿瘤（淋巴瘤和间质细胞瘤）的敏感度、特异度、阳性预测值、阴性预测值及准确率分别为40.0%、33.3%、66.7%、14.3%和38.5%。CEUS表现：8例淋巴瘤中有7例呈均匀高增强。2例间质细胞瘤呈均匀高增强。2例精原细胞瘤和1例精母细胞瘤呈不均匀增强，内部有坏死。根据CEUS非坏死区域诊断非生殖细胞肿瘤的敏感度、特异度、阳性预测值、阴性预测值及准确率分别为90.0%、100.0%、100.0%、75.0%和92.3%。与常规超声相比，差异具有统计学意义（P=0.039）。
结论
50岁以上患者的原发性睾丸肿瘤主要为淋巴瘤，CEUS在生殖细胞肿瘤和非生殖细胞肿瘤之间有显著差异。与常规超声相比，CEUS能更准确地区分睾丸生殖细胞肿瘤和非生殖细胞肿瘤。术前超声检查对准确诊断具有重要意义，并可指导临床治疗。
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