Ultrasonographic evaluation and clinical correlation of intratesticular lesions: a series of 39 cases

OBJECTIVE: To assess the accuracy, specificity and sensitivity of ultrasonography (US) for diagnosing testicular tumours. PATIENTS AND METHODS: Ultrasonography of the scrotum was performed in 39 patients (mean age 20.3 years, range 3-61) referred to the hospital because of pain, tenderness, appearance of a mass in the scrotum or swelling of the scrotum after trauma. RESULTS: Intratesticular lesions were detected by US in 35 patients and four had no suspicious findings after surgical exploration of the scrotum based solely on clinical findings. In five patients the findings on US were compatible with neoplasm, but at surgery or follow-up, no tumour was found. In one case, the US findings suggested inflammation, but on exploration 3 weeks later, an embryonal cell carcinoma was found. CONCLUSIONS: While very sensitive in differentiating an intra-from an extratesticular lesion, and in ruling out a testicular tumour (sensitivity 96.6%), the US examination is less specific (specificity 44.4%) as the US pattern of different benign process may be similar to those of tumours. The positive predictive value (85.3%) and the accuracy (84.6%) imply that when an intratesticular lesion is detected on US, even when there is no clinical suspicion of neoplasm, exploration of the scrotum is indicated.