PMID- 25641474
OWN - NLM
STAT- MEDLINE
DCOM- 20150601
LR  - 20220309
IS  - 1124-3562 (Print)
IS  - 1124-3562 (Linking)
VI  - 86
IP  - 4
DP  - 2014 Dec 30
TI  - Diagnostic ultrasound-guided excisional testicular biopsy for small (< 1 cm) 
      incidental nodules. A single institution experience.
PG  - 373-7
LID - 10.4081/aiua.2014.4.373 [doi]
AB  - 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.
FAU - Fabiani, Andrea
AU  - Fabiani A
AD  - Surgery Dpt, Section of Urology, ASUR Marche Area Vasta 3, Macerata Hospital, 
      Macerata. andreadoc1@libero.it.
FAU - Filosa, Alessandra
AU  - Filosa A
FAU - Fioretti, Fabrizio
AU  - Fioretti F
FAU - Servi, Lucilla
AU  - Servi L
FAU - Piergallina, Mara
AU  - Piergallina M
FAU - Ciccotti, Giovanni
AU  - Ciccotti G
FAU - Maurelli, Valentina
AU  - Maurelli V
FAU - Talle, Matteo
AU  - Talle M
FAU - Mammana, Gabriele
AU  - Mammana G
LA  - eng
PT  - Evaluation Study
PT  - Journal Article
DEP - 20141230
PL  - Italy
TA  - Arch Ital Urol Androl
JT  - Archivio italiano di urologia, andrologia : organo ufficiale [di] Societa 
      italiana di ecografia urologica e nefrologica
JID - 9308247
SB  - IM
MH  - Adolescent
MH  - Adult
MH  - Humans
MH  - Image-Guided Biopsy/methods
MH  - Male
MH  - Scrotum/diagnostic imaging
MH  - Testicular Diseases/*diagnostic imaging/*pathology
MH  - Testis/*diagnostic imaging/*pathology
MH  - *Ultrasonography, Interventional
MH  - Young Adult
EDAT- 2015/02/03 06:00
MHDA- 2015/06/02 06:00
CRDT- 2015/02/03 06:00
PHST- 2015/01/23 00:00 [received]
PHST- 2015/01/23 00:00 [accepted]
PHST- 2015/02/03 06:00 [entrez]
PHST- 2015/02/03 06:00 [pubmed]
PHST- 2015/06/02 06:00 [medline]
AID - 10.4081/aiua.2014.4.373 [doi]
PST - epublish
SO  - Arch Ital Urol Androl. 2014 Dec 30;86(4):373-7. doi: 10.4081/aiua.2014.4.373.