Determining an Approach to Small Testicular Masses by Examining Scrotal Doppler Ultrasonography and Serum Tumor Markers

Objective: In our study, we retrospectively analyzed the pathology results of radical orchiectomy operations performed in our clinic and to correlate preoperative color Doppler ultrasonography (CDUSG) findings with small-testicular masses (SmTM) with negative serum tumor markers (STM). Materials and Methods: Male patients (n=98) who underwent radical orchiectomy between January 2010 and January 2021 to treat intratesticular solid lesions that were detected via CDUSG were evaluated retrospectively. All patients were evaluated in terms of age, atrophic testis, echogenicity, size of tumoral lesions, testicular palpability, preoperative STM and postoperative pathology results. Results: Expression of at least one STM was elevated in 58 (59.2%) patients preoperatively. STM elevation continued to occur in 25 (25.5%) patients postoperatively; furthermore, 81 (82.7%) patients presented with malignant pathology. The mean age of patients was 39.47±15.20 years, whereas the mean age of patients with benign pathology was higher than patients with malignant pathology (p=0.008). The mean size of malignant lesions was significantly greater than that of benign lesions (5.4 vs 3.5 cm; p=0.033). Statistically elevated STM, lower age, heterogeneity in CDUSG, and large lesion size were found as parameters predicting malignancy. Although lesions in 9 (45%) of 20 STM-negative patients with a lesion smaller than 3 cm were benign, benign pathology was detected in 6 (75%) of 8 STM-negative patients with a lesion smaller than 1.5 cm. Conclusion: CDUSG plays an important role in detecting small non-palpable masses. Especially in STM-negative patients with a SmTM, CDUSG can reasonably guide the decision-making phase although it cannot provide definitive diagnosis. Radical orchiectomy, which is the traditional approach for all solid testicular lesions, leads to unnecessary treatment in patients with benign lesions, so testicular-sparing surgery should be preferred in STM-negative non-palpable SmTMs because the risk of cancer is low.