NEW YORK (Reuters Health) – Ultrasound surveillance is a safe alternative to immediate resection for small testicular masses discovered incidentally, Canadian researchers report.

Small testicular masses are occasionally revealed by scrotal ultrasound exams during evaluations of male infertility, and the management of these masses is controversial, the authors say. Ultrasound surveillance has been proposed as an alternative to surgical excision.

In the April issue of the Journal of Urology, Dr. Kirk C. Lo and colleagues from the University of Toronto report their experience. Between 2001 and 2008, they evaluated 4418 new patients, 46 of whom had hypoechoic testicular masses 1 cm or less in maximum dimension. Twenty-eight of the men had solitary lesions.

None of the masses was palpable. In 22 patients, tumor markers were negative. Staging abdominal CT performed in 11 patients was negative as well.

Thirty-eight of the 46 patients had serial ultrasound surveillance only (at 1 month and then every 3 months for at least 6 months), 3 had immediate surgery, and 5 had surgery after initial ultrasound surveillance.

The reasons for surgery included interval growth in 2 patients and patient choice in the remaining 6 cases.

Pathologists identified one case as pure seminoma (in a patient with interval growth); the remaining diagnoses included 3 Leydig cell tumors, 2 cases of Leydig cell hyperplasia, and 1 hyalinized fibrotic nodule. One patient did not receive a pathological diagnosis.

Vascular flow on ultrasound was significantly more common in men who had surgery (7/8) than in those who did not (2/38), and initial and maximum size of the dominant lesions were significantly greater in the surgery patients.

Among the 38 men who did not have surgery, the mean change in mass size was 0.5 mm per year.

The median follow-up time for the entire cohort, including the men who had surgery, was 123 days. The researchers don’t specify how long they followed the men who received serial ultrasound without surgery. But, they note, “Since the doubling time for a germ cell malignancy is reported to be as rapid as 10 to 30 days, the volume of a testis tumor should have increased by more than 8-fold in 3 months.”

“Based on this study and a review of the literature, we now offer active surveillance with ultrasound monitoring to men who have the finding of a small testicular mass on ultrasound,” they conclude.

Reference:

J Urol 2010;183:1373-1377.