Diagnostic ultrasound-guided excisional testicular biopsy for small (< 1 cm) incidental nodules. A single institution experience
Introduction and objectives: The widespread use of scrotal ultrasound (SUS) has led to a marked increase in the number of incidentally detected testicular lesions. A small incidental nodule (STN) has defined as a non palpable (< 10 mm), asymptomatic solid lesion with normal levels of oncologi...
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PAGEPress Publications
2014-12-01
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| Series: | Archivio Italiano di Urologia e Andrologia |
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| Online Access: | http://www.pagepressjournals.org/index.php/aiua/article/view/5054 |
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| author | Andrea Fabiani Alessandra Filosa Fabrizio Fioretti Lucilla Servi Mara Piergallina Giovanni Ciccotti Valentina Maurelli Matteo Tallè Gabriele Mammana |
| author_facet | Andrea Fabiani Alessandra Filosa Fabrizio Fioretti Lucilla Servi Mara Piergallina Giovanni Ciccotti Valentina Maurelli Matteo Tallè Gabriele Mammana |
| author_sort | Andrea Fabiani |
| collection | DOAJ |
| description | Introduction and objectives: The widespread use of scrotal ultrasound (SUS) has led to a marked increase in the number of incidentally detected testicular lesions. A small incidental nodule (STN) has defined as a non palpable (< 10 mm), asymptomatic solid lesion with normal levels of oncological testicular markers. Nowadays the lack of agreement on the topic causes managing problems to andrologists. We present our experience consisting in 8 cases of STN discovered by SUS performed for different clinical indications. Matherial and methods: We retrieved from our ultrasonographic files the clinical information about 717 patients evaluated for andrological problems. Patients with STN underwent to a complete clinical history and physical examination as well as oncological testicular markers measurement and ormonal assessment and then received a diagnostic ultrasound guided excisional biopsy (DEB). Surgical approach was performed through an inguinal incision. Using the coordinates previously obtained from preoperative SUS, STN was localized by intraoperative SUS. The lesion was enucleated and sent to the Pathology department for frozen section examination (FSE). Biopsies of affected testis (TB) were also performed. Post-excision ultrasound has been used to confirm the complete removal of the nodule. Whether pathological findings were benign, testis sparing surgery (TSS) was performed. Immediate radical orchidectomy (IRO) was performed if FSE and TB findings suggested a malignant lesion. Results: STNs were discovered in 8 patients (1,1%). Very small lesions (< 5 mm) were detected in 50% of cases. We performed four IRO and four DEB with consequent TSS. In one case we performed a delayed radical orchidectomy (DRO). At FSE pathologist reported 3 Leydig cell tumor and 3 seminoma and an inflammatory regressive lesion in one case. FSE on TB reported intratesticular neoplasia (TIN) in three cases. In one case nodule wasn’t sent to FSE. We observed a concordance between FSE and definitive pathologic report in six cases (75%). Conclusions: The management of STN is still a challenge for the surgical andrologist. A correct diagnosis has a crucial role in making the best treatment and patients outcome. Ultrasound guided excisional biopsy and the close collaboration with a dedicated pathologist are very useful in reducing errors. |
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| spelling | doaj.art-829f50cde0ba4d669f1549ecf46481f62022-12-21T20:01:59ZengPAGEPress PublicationsArchivio Italiano di Urologia e Andrologia1124-35622282-41972014-12-0186437337710.4081/aiua.2014.4.3734184Diagnostic ultrasound-guided excisional testicular biopsy for small (< 1 cm) incidental nodules. A single institution experienceAndrea Fabiani0Alessandra Filosa1Fabrizio Fioretti2Lucilla Servi3Mara Piergallina4Giovanni Ciccotti5Valentina Maurelli6Matteo Tallè7Gabriele Mammana8Surgery Dpt, Section of Urology, ASUR Marche Area Vasta 3, Macerata Hospital, MacerataSection of Pathological Anatomy, Department of Clinical Pathology, Area Vasta 3, ASUR Marche, Macerata Hospital, MacerataSurgery Dpt, Section of Urology, ASUR Marche Area Vasta 3, Macerata Hospital, MacerataSurgery Dpt, Section of Urology, ASUR Marche Area Vasta 3, Macerata Hospital, MacerataSurgery Dpt, Section of Urology, ASUR Marche Area Vasta 3, Macerata Hospital, MacerataSurgery Dpt, Section of Urology, ASUR Marche Area Vasta 3, Macerata Hospital, MacerataSurgery Dpt, Section of Urology, ASUR Marche Area Vasta 3, Macerata Hospital, MacerataSurgery Dpt, Section of Urology, ASUR Marche Area Vasta 3, Macerata Hospital, MacerataSurgery Dpt, Section of Urology, ASUR Marche Area Vasta 3, Macerata Hospital, MacerataIntroduction and objectives: The widespread use of scrotal ultrasound (SUS) has led to a marked increase in the number of incidentally detected testicular lesions. A small incidental nodule (STN) has defined as a non palpable (< 10 mm), asymptomatic solid lesion with normal levels of oncological testicular markers. Nowadays the lack of agreement on the topic causes managing problems to andrologists. We present our experience consisting in 8 cases of STN discovered by SUS performed for different clinical indications. Matherial and methods: We retrieved from our ultrasonographic files the clinical information about 717 patients evaluated for andrological problems. Patients with STN underwent to a complete clinical history and physical examination as well as oncological testicular markers measurement and ormonal assessment and then received a diagnostic ultrasound guided excisional biopsy (DEB). Surgical approach was performed through an inguinal incision. Using the coordinates previously obtained from preoperative SUS, STN was localized by intraoperative SUS. The lesion was enucleated and sent to the Pathology department for frozen section examination (FSE). Biopsies of affected testis (TB) were also performed. Post-excision ultrasound has been used to confirm the complete removal of the nodule. Whether pathological findings were benign, testis sparing surgery (TSS) was performed. Immediate radical orchidectomy (IRO) was performed if FSE and TB findings suggested a malignant lesion. Results: STNs were discovered in 8 patients (1,1%). Very small lesions (< 5 mm) were detected in 50% of cases. We performed four IRO and four DEB with consequent TSS. In one case we performed a delayed radical orchidectomy (DRO). At FSE pathologist reported 3 Leydig cell tumor and 3 seminoma and an inflammatory regressive lesion in one case. FSE on TB reported intratesticular neoplasia (TIN) in three cases. In one case nodule wasn’t sent to FSE. We observed a concordance between FSE and definitive pathologic report in six cases (75%). Conclusions: The management of STN is still a challenge for the surgical andrologist. A correct diagnosis has a crucial role in making the best treatment and patients outcome. Ultrasound guided excisional biopsy and the close collaboration with a dedicated pathologist are very useful in reducing errors.http://www.pagepressjournals.org/index.php/aiua/article/view/5054Scrotal ultrasoundSmall testicular nodulesSeminomaLeydig cell tumorIntratesticular neoplasia |
| spellingShingle | Andrea Fabiani Alessandra Filosa Fabrizio Fioretti Lucilla Servi Mara Piergallina Giovanni Ciccotti Valentina Maurelli Matteo Tallè Gabriele Mammana Diagnostic ultrasound-guided excisional testicular biopsy for small (< 1 cm) incidental nodules. A single institution experience Archivio Italiano di Urologia e Andrologia Scrotal ultrasound Small testicular nodules Seminoma Leydig cell tumor Intratesticular neoplasia |
| title | Diagnostic ultrasound-guided excisional testicular biopsy for small (< 1 cm) incidental nodules. A single institution experience |
| title_full | Diagnostic ultrasound-guided excisional testicular biopsy for small (< 1 cm) incidental nodules. A single institution experience |
| title_fullStr | Diagnostic ultrasound-guided excisional testicular biopsy for small (< 1 cm) incidental nodules. A single institution experience |
| title_full_unstemmed | Diagnostic ultrasound-guided excisional testicular biopsy for small (< 1 cm) incidental nodules. A single institution experience |
| title_short | Diagnostic ultrasound-guided excisional testicular biopsy for small (< 1 cm) incidental nodules. A single institution experience |
| title_sort | diagnostic ultrasound guided excisional testicular biopsy for small 1 cm incidental nodules a single institution experience |
| topic | Scrotal ultrasound Small testicular nodules Seminoma Leydig cell tumor Intratesticular neoplasia |
| url | http://www.pagepressjournals.org/index.php/aiua/article/view/5054 |
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