MRI on the ball

MRI proves to be a good diagnostic tool for testicular cancer and could spare some men unnecessary surgery.

Athina Tsili, Maria Argyropoulou, and Konstantine Tsampoulas of the Department of Clinical Radiology, and colleagues Dimitrios Giannakis and Nikolaos Sofikitis in the Department of Urology, at the University Hospital of Ioannina, Ioannina, in Greece, have demonstrated that non-invasive MRI can be used to evaluate the staging, or progression, of testicular cancer. They report details in the March issue of the American Journal of Roentgenology.

A man's risk of testicular cancer is roughly 1 in 250 (about 0.4%) over his lifetime. It is most common among males aged 15 to 40 years, but afflicts those in their mid-twenties more. Testicular cancer has one of the highest cure rates of all types of cancer: with a cure being possible in essentially all cases if the disease has not spread to other parts of the body. Even for those cases, which are relatively rare, malignancy can be treated with chemotherapy at a success rate of more than 85 percent.

The researchers point out that the primary goal in evaluating a palpable scrotal mass is to determine its location. Most solid, intratesticular masses are considered to be malignant but to avoid unnecessary surfical removal of the testicle, it is essential that imaging features of various benign intratesticular mass lesions, including orchitis, haemorrhage, ischaemia and infarction, fibrosis, be excluded as a diagnosis.

"Medical imaging plays an important role in the investigation of testicular masses," explains Tsili, who is lead author of the study. "Sonography, although the primary imaging technique for the evaluation of scrotal contents, does not always allow confident characterization of the nature of a testicular mass. The purpose of our study was to assess the role of MRI in the preoperative characterization and local staging of testicular masses."

The team looked at 33 patients prior to surgery; the patients were referred following detection of a testicular lump confirmed clinically and sonographically. Conventional histological examination revealed 28 malignant and 8 benign lesions. Of those 36 lesions, 1.5-T MRI with intravenous gadolinium chelate as contrast agent correctly identified all 28 malignant lesions and 7 or 8 benign lesions, the researchers explain. "A possible diagnosis of benign lesion based on MRI features may improve patient care and decrease the number of unnecessary surgical procedures," says Tsili.

The team adds that in 12 patients the cancer had invaded the testicular tunicae or epididymis, and in three it had entered the spermatic cord. "The rate of correspondence between MRI and histologic diagnosis in the local staging of testicular tumours was 92.8% (26/28)," the team adds.

 "Although organ-sparing surgery is not generally indicated in the care of patients with testicular masses," the researchers point out, they do suggest that in certain circumstances, where a lesion may be suspected as benign and normal preoperative testosterone levels are measured, preoperative imaging evaluation of the local stage of disease is mandatory.

They do concede, however, that there are limitations to the present research. "First, our sample included only a small number of benign testicular lesions," they explain, "It is known, however, that malignant intratesticular lesions greatly outnumber benign ones." They add that a comparison of the diagnostic performances of sonography versus MRI is now needed given that no direct evaluation of the results of those two techniques was performed in this research. Nevertheless, they say that MRI is an efficient diagnostic tool for the evaluation of testicular masses. "It is accurate in the preoperative differentiation of benign and malignant intratesticular masses, facilitating accurate estimation of the local extent of disease in patients with malignant tumour," the team concludes.

The views represented in this article are solely those of the author and do not necessarily represent those of John Wiley and Sons, Ltd.