From the Guidelines
The initial test for a hypoechoic mass suggestive of testicular cancer is a scrotal ultrasound with Doppler imaging, as recommended by the most recent guidelines 1. This non-invasive imaging study should be performed promptly when a testicular mass is suspected, as it can distinguish between malignant and benign conditions with high sensitivity. The key points to consider when evaluating a hypoechoic mass suggestive of testicular cancer include:
- The use of high-frequency (>10 MHz) testicular ultrasound to confirm the presence of a testicular mass 1
- The evaluation of the echogenicity, vascularity, and size of the mass, with most testicular cancers appearing as hypoechoic lesions with increased blood flow
- The importance of prompt referral to a urologist once a suspicious mass is identified on ultrasound If the ultrasound confirms a suspicious mass, the next steps include:
- Blood tests for tumor markers (alpha-fetoprotein, human chorionic gonadotropin, and lactate dehydrogenase) 1
- A CT scan of the abdomen and pelvis to assess for metastatic disease It's essential to note that the definitive diagnosis requires an inguinal orchiectomy (surgical removal of the affected testicle), which serves as both a diagnostic and therapeutic procedure 1. Needle biopsy is contraindicated due to the risk of tumor seeding along the needle tract. The most recent guidelines emphasize the importance of prompt evaluation and treatment of testicular cancer, with a focus on minimizing morbidity and mortality while optimizing quality of life 1.
From the Research
Initial Test for Hypoechoic Mass Suggestive of Testicular Cancer
- The initial test for a hypoechoic mass suggestive of testicular cancer involves ultrasound examination of the scrotum 2, 3, 4.
- Ultrasound characteristics such as the presence of microliths, macrocalcifications, and hypoechoic areas surrounding the nodule may indicate malignancy 2.
- Colour Doppler US remains the basic examination for characterization of testicular lesions 2.
- The role of newer imaging modalities such as MRI, sonoelastography, and contrast-enhanced ultrasound in characterization is evolving 2.
Biochemical Markers
- Biochemical markers such as human chorionic gonadotropin, alpha-fetoprotein, and lactate dehydrogenase play a crucial role in the diagnosis, staging, and surveillance of testicular cancer 5, 6.
- These markers are helpful in determining the effectiveness of therapy and in monitoring treatment response 5, 6.
- However, they have limited value in the differential diagnosis of scrotal masses 5.
Differential Diagnosis
- Avascular hypoechoic testicular lesions can be benign or malignant, and their cause can be determined by sonographic and clinical features 4.
- Benign lesions such as epidermoid cysts can have characteristic sonographic appearances, including an onion-ring appearance and avascularity on Doppler sonography 3.
- The presence of poorly defined margins and focal calcification within the lesion may indicate malignancy 4.