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Testicular microlithiasis imaging and follow-up: guidelines of the ESUR scrotal imaging subcommittee

  • Ultrasound
  • Published:
European Radiology Aims and scope Submit manuscript

Abstract

Objectives

The subcommittee on scrotal imaging, appointed by the board of the European Society of Urogenital Radiology (ESUR), have produced guidelines on imaging and follow-up in testicular microlithiasis (TML).

Methods

The authors and a superintendent university librarian independently performed a computer-assisted literature search of medical databases: MEDLINE and EMBASE. A further parallel literature search was made for the genetic conditions Klinefelter’s syndrome and McCune-Albright syndrome.

Results

Proposed guidelines are: follow-up is not advised in patients with isolated TML in the absence of risk factors (see Key Points below); annual ultrasound (US) is advised for patients with risk factors, up to the age of 55; if TML is found with a testicular mass, urgent referral to a specialist centre is advised.

Conclusion

Consensus opinion of the scrotal subcommittee of the ESUR is that the presence of TML alone in the absence of other risk factors is not an indication for regular scrotal US, further US screening or biopsy. US is recommended in the follow-up of patients at risk, where risk factors other than microlithiasis are present. Risk factors are discussed and the literature and recommended guidelines are presented in this article.

Key Points

• Follow up advised only in patients with TML and additional risk factors.

• Annual US advised for patients with risk factors up to age 55.

• If TML is found with testicular mass, urgent specialist referral advised.

• Risk factors – personal/ family history of GCT, maldescent, orchidopexy, testicular atrophy.

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Acknowledgments

The scientific guarantor of this publication is Jonathan Richenberg. The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article. The authors state that this work has not received any funding. No complex statistical methods were necessary for this paper. Institutional review board approval was not required because not applicable. Methodology: prospective/retrospective

Author information

Authors and Affiliations

  1. Royal Sussex County Hospital Brighton and Brighton and Sussex Medical School, Brighton, Sussex, UK

    Jonathan Richenberg

  2. Royal Liverpool University Hospital, Prescot Street, Liverpool, L7 8XP, UK

    Jane Belfield

  3. Perelman School of Medicine of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA, 19104, USA

    Parvati Ramchandani

  4. Hôpitaux Universitaires Paris Sud, APHP, site Bicêtre, Ecole doctorale Biosigne, ED 419, 78 Avenue du General Leclerc, 94270, Le Kremlin Bicêtre, France

    Laurence Rocher

  5. Plymouth Hospitals NHS Trust, Plymouth, UK

    Simon Freeman

  6. University of Ioannina, Pl. Pargis, 2, Ionnina, 45332, Greece

    Athina C. Tsili

  7. Royal Sussex County Hospital, Eastern Road, Brighton, BN2 5BE, UK

    Faye Cuthbert

  8. Medical University of Gdansk, ul Debinki 7, Gdansk, Poland

    Michal Studniarek

  9. Uco di Radiologia Dell ‘Universita’ di Trieste, Strada di Fiume 447, Trieste, Italy

    Michele Bertolotto

  10. Department of Radiology, Ankara Training and Research Hospital, 06590, Ankara, Turkey

    Ahmet Tuncay Turgut

  11. Department of Imaging Sciences, University of Rochester School of Medicine and Dentistry, 601 Elmwood Ave, Box 648, Rochester, NY, USA

    Vikram Dogra

  12. Universita di Genova, Largo R. Benzi, 8, Genova, Italy

    Lorenzo E. Derchi

Authors
  1. Jonathan Richenberg
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  2. Jane Belfield
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  3. Parvati Ramchandani
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Corresponding author

Correspondence to Jonathan Richenberg.

Appendices

Appendix 1

Patient leaflet for testicular microlithiasis

What is testicular microlithiasis?

Small lumps of calcium lie in the small tubes within the testicle. There must be at least 5 such calcifications in one (or both) testicles before the label testicular microlithiasis (TML) is applied. TML is seen in about 2 or 3 men in every hundred.

How is TML detected?

The calcium lumps cannot be felt and they do NOT cause discomfort. They can only be seen on ultrasound. In other words, TML was discovered incidentally during your ultrasound scan of the testes.

Why is TML important?

At the end of the 1990s, there was some concern that TML might lead to cancer of the testicle. Since then, many studies across the world have looked at TML. They have NOT confirmed the initial worries.

There is no evidence that TML on its own leads to cancer.

What should I do?

Like every man, including men who do not have TML, you should practice monthly self-examination of the testicles. If you are uncertain about how to do this, please ask your doctor. Nothing else is required. You do not need regular ultrasound scans. The calcium in the testicles is not related to your diet or to any sexual or other activity.

What should I do if I feel a new lump during self-examination?

Please contact your family doctor or specialist. Your family doctor or specialist will examine you and if thought appropriate will refer you on for a specialist opinion. It is likely that you will be referred also for an urgent ultrasound scan. This will be usually at the hospital where the initial scan was performed.

Appendix 2

Checklist to be completed in men discovered to have TML

If you discover a patient has TML during ultrasound scanning, risk factors for developing GCT should be ascertained.

Risk factor

Comments

Yes >=5 ML per FoV

Yes Diffuse

No TML i.e. no FoV contains 5 or more microliths

Maldescent

Ask patient for relevant history

Annual US

Annual US

Discharge

Orchidopexy

Ask patient for relevant history

Annual US

Annual US

Discharge

Previous GCT

Likely to have orchidectomy so this should be easy to ascertain. If there is any doubt, ask the patient

Annual US

Annual US

Discharge

Genetic disease

Ask patient for relevant history

Repeat US at 6 and 12 months, D/C if no nodule >3mm

Refer

Discharge

Family history of GCT

Ask patient for relevant history

Encourage self-examination and offer open access

Encourage self-examination and offer open access

Discharge

Atrophic testis

Should be noted during the ultrasound examination

Annual US

Annual US

Discharge

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Richenberg, J., Belfield, J., Ramchandani, P. et al. Testicular microlithiasis imaging and follow-up: guidelines of the ESUR scrotal imaging subcommittee. Eur Radiol 25, 323–330 (2015). https://doi.org/10.1007/s00330-014-3437-x

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