Diagnostic Imaging Pathways - Scrotal Mass
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This pathway provides guidance on the imaging of adult male patients with a scrotal mass.
Date reviewed: January 2012
Date of next review: January 2015
Published: August 2012
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|SYMBOL||RRL||EFFECTIVE DOSE RANGE|
|Minimal||< 1 millisieverts|
- Ultrasound can be used to differentiate between intra and extra testicular masses. It is also useful in differentiating solid from cystic masses
- A painless testicular mass on ultrasound requires further investigation, as a malignancy is highly likely
- Initial staging modalities include a CT of the abdomen and plain chest radiographs
Computed Tomography (CT)
- Abdominal CT is the imaging modality of choice for staging of patients with testicular cancer
- Allows assessment of the retroperitoneum for the presence of metastatic disease
- Accuracy ranges between 73-97% with false-negative rates of 23-44% ,,
- Chest CT is indicated when ,,,
- Abdominal CT is positive
- Tumour markers are persistently elevated
- Chest radiography findings are suspicious of pulmonary metastases
- Limitations - inability to detect metastatic disease in normal sized lymph nodes, and difficult interpretation in young men with paucity of retroperitoneal fat
- To confirm a clinical diagnosis of tumour and to assess contralateral testis
- To assess clinically solid scrotal masses
- To assess an impalpable testis within a hydrocoele
- To confirm a borderline clinical diagnosis of varicocoele in appropriate patients
- Used to differentiate between intra- and extra-testicular masses and can differentiate fluid filled lesions (eg hydrocoele, spermatocoele, haematocoele etc.) from solid intra-testicular tumours when clinical evaluation is in doubt
- 98% sensitivity and specificity for diagnosis of intra-scrotal neoplasia
- Limitations - hypervascularity of large tumours can be difficult to distinguish from that of inflammatory lesions ,
Plain Chest Radiograph (CXR)
References are graded from Level I to V according to the Oxford Centre for Evidence-Based Medicine, Levels of Evidence. Download the document
- Adeyoju AB, Collins GN, Pollard AJ, et al. A prospective evaluation of scrotal ultrasonography in clinical practice. BJU Int. 2000;86:87-8. (Level II evidence). View the reference
- Lau MWM, Taylor PM, Payne SR. The indications for scrotal ultrasound. Br J Radiol. 1999;72:833-7. (Level III evidence)
- Guthrie JA, Fowler RC. Ultrasound diagnosis of testicular tumours presenting as epididymal disease. Clin Radiol. 1992;46:397-400. (Level II evidence). View the reference
- Horstman WG, Melson GL, Middleton WD, et al. Testicular tumours: findings with colour Doppler US. Radiology. 1992;185(3):733-7. (Level IV evidence)
- Mazzu D, Jeffery Jr RB, Ralls PW. Lymphoma and leukemia involving the testicles: findings on gray-scale and colour Doppler sonography. AJR Am J Roentgenol. 1994;164:645-7. (Level IV evidence)
- Gatti JM, Stephenson RA. Staging of testis cancer: combining serum markers, histologic parameters, and radiographic imaging. Urol Clin North Am. 1998;25(3):397-403. (Review article)
- Richie JP, Garnick MB, Finberg H. Computerised tomography: how accurate for abdominal staging of testis tumours? J Urol. 1982;127:715-7. (Level II/III evidence)
- Moul JW. Proper staging techniques in testicular cancer. Tech Urol. 1995;1:126-32. (Review article)
- Samuelson L, Frostberg L, Olson A. Accuracy of radiological staging procedures in nonseminomatous testis cancer compared with findings from surgical exploration and histopathological studies of extirpated tissue. Br J Radiol. 1986;59:131-4. (Level III evidence)
- See WA, Hoxie L. Chest staging in testis cancer patients: imaging modality selection based upon risk assessment as determined by abdominal CT scan results. J Urol. 1993;150:874-8. (Level III evidence)
- Fernandez EB, Colon E, McLeod DG, et al. Efficacy of radiographic chest imaging in patients with testicular cancer. Urology. 1994;44:243-9. (Level III evidence)
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