Ultrasonography of intratesticular lesions: its role in clinical management.

Ultrasound is the primary imaging modality in the investigation of patients with symptoms related to the scrotum, and is pivotal to the diagnosis of suspected testicular malignancy. This retrospective study analysed the results of testicular ultrasound at a large teaching hospital over a five year period. We wished to examine the clinical consequences for patients in whom ultrasound findings were suspicious of testicular cancer, and the accuracy of the ultrasound diagnosis. Real time ultrasound examinations were performed, providing multiplanar imaging of the testis and para testicular tissues. Over a five year period 661 examinations were carried out. An intratesticular lesion was identified in 44 patients; nineteen of these patients were shown to have testicular malignancy following tissue diagnosis. When ultrasound was used to identify testicular malignancy in those patients with an intratesticular lesion, it had a sensitivity of 94.7% and a specificity of 59.1%. A tissue diagnosis was obtained in 93% of those patients thought likely to have a testicular malignancy on sonographic assessment, and in 40% of those in whom a diagnosis of malignancy was possible, but less likely. Our study shows that this modality can be used to aid the clinician in deciding which patients should undergo orchidectomy, invasive biopsy or clinical surveillance.