Biopsy of Testicular Cancer Does Not Increase Risk of Spread
A scrotal approach to biopsy should be strictly avoided as it is associated with higher local recurrence rates, but proper inguinal orchiectomy—the standard surgical approach—does not increase the risk of cancer spread. 1
Standard Surgical Approach
The key distinction is the surgical technique used:
- Radical inguinal orchiectomy with division of the spermatic cord at the internal inguinal ring is the standard initial intervention for suspected testicular cancer and does not promote tumor spread 1
- Scrotal violation (scrotal incision for biopsy or surgery) must be avoided, as this approach is associated with higher local recurrence rates 1
- The tumor-bearing testis should be resected through an inguinal incision with the spermatic cord divided at the internal inguinal ring level 1
When Biopsy Is Appropriate
Biopsy has specific, limited indications in testicular cancer management:
- Extragonadal presentations: Trucut biopsy or mediastinoscopy is needed when patients present with retroperitoneal or mediastinal primary tumors 1
- Contralateral testis biopsy: This is performed to detect germ cell neoplasia in situ (GCNIS), not to diagnose the primary cancer itself 1
- Frozen section analysis: May be considered intraoperatively for uncertain testicular masses to differentiate benign from malignant lesions, allowing for potential testis-sparing surgery 1
Contralateral Biopsy Safety Profile
When discussing testicular biopsy safety (for contralateral GCNIS detection):
- Surgical complications occur in only 2.78% of cases, with most managed conservatively 2
- Only 0.64% require repeat surgery, and testicular loss is extremely rare 2
- Imaging abnormalities (hematoma, edema) appear in 33-45% one week post-biopsy but resolve in 96% of cases by 18 months 2
- Testicular biopsy is safe when vascular anatomy is respected during surgery 2
Critical Caveat
The concern about "spreading" testicular cancer relates specifically to scrotal approach violations, not to properly performed inguinal orchiectomy or appropriately indicated biopsies. The inguinal approach maintains anatomic barriers and respects lymphatic drainage patterns, preventing tumor seeding that can occur with scrotal incisions 1.