Abstract
Objective
Ultrasound surveillance of patients with testicular microlithiasis (TM) has been advocated following the reported association with testicular cancer. The aim of this study was to assess the evidence base supporting such surveillance.
Methods
Formal literature review identified cohort studies comprising at least 15 patients followed up for at least 24 months. Combining an institutional audit with the identified studies in a pooled analysis the incidence of new cancers during the surveillance period was evaluated.
Results
Literature review identified eight studies. Our institutional audit comprised 2,656 men referred for scrotal ultrasound. Fifty-one men (1.92 %) with TM were identified, none of whom developed testicular cancer (mean follow-up: 33.3 months). In a combined population of 389 men testicular cancer developed in 4. Excluding 3 who had additional risk factors, only 1 of 386 developed testicular cancer during follow-up (95 % CI 0.05–1.45 %).
Conclusions
Ultrasound surveillance is unlikely to benefit patients with TM in the absence of other risk factors. In the presence of additional risk factors (previous testicular cancer, a history of maldescent or testicular atrophy) patients are likely to be under surveillance; nonetheless monthly self-examination should be encouraged, and open access to ultrasound and formal annual surveillance should be offered.
Key Points
• The literature reports a high association between testicular microlithiasis and testicular cancer.
• Our study and meta-analysis suggest no causal link between microlithiasis and cancer.
• In the absence of additional risk factors surveillance is not advocated.
• In the presence of additional risk factors surveillance is recommended.
• Such surveillance is primarily aimed at engaging patients in regular follow-up.
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References
De Jong BW, De Gouveia Brazao CA, Stoop H et al (2004) Raman spectroscopic analysis identifies testicular microlithiasis as intratubular hydroxyapatite. J Urol 171:92–96
Kim B, Winter TC, Ryu JA (2003) Testicular microlithiasis: Clinical significance and review of the literature. Eur Radiol 13:2567–2576
Renshaw AA (1998) Testicular calcifications: Incidence, histology and proposed pathological criteria for testicular microlithiasis. J Urol 160:1625–1628
Drut R, Monica R (2002) Testicular microlithiasis: Histologic and immunohistochemical findings in 11 pediatric cases. Pediatr Dev Pathol 5:544–550
Howlett DC, Marchbank ND, Sallomi DF (2000) Pictorial review. Ultrasound of the testis. Clin Radiol 55:595–601
Bennett HF, Middleton WD, Bullock AO, Teefey SA (2001) Testicular microlithiasis: US follow-up. Radiology 218:359–363
Backus ML, Mack LA, Middleton WD, King BF, Winter TC 3rd, True LD (1994) Testicular microlithiasis: Imaging appearances and pathologic correlation. Radiology 192:781–785
Derogee M, Bevers RF, Prins HJ, Jonges TG, Elbers FH, Boon TA (2001) Testicular microlithiasis, a premalignant condition: Prevalence, histopathologic findings, and relation to testicular tumor. Urology 57:1133–1137
Bach AM, Hann LE, Hadar O et al (2001) Testicular microlithiasis: What is its association with testicular cancer? Radiology 220:70–75
Byrne A, Al-Agha G, Torreggiani WC, et al (2003) Does testicular microlithiasis matter? (multiple letters). Clinical Radiology 58
Middleton WD, Teefey SA, Santillan CS (2002) Testicular microlithiasis: Prospective analysis of prevalence and associated tumor. Radiology 224:425–428
Otite U, Webb JAW, Oliver RTD, Badenoch DF, Nargund VH (2001) Testicular microlithiasis: Is it a benign condition with malignant potential? Eur Urol 40:538–542
Skyrme RJ, Fenn NJ, Jones AR, Bowsher WG (2000) Testicular microlithiasis in a UK population: Its incidence, associations and follow-up. BJU Int 86:482–485
Miller FN, Sidhu PS (2002) Does testicular microlithiasis matter? A review. Clin Radiol 57:883–890
Cast JEI, Nelson WM, Early AS et al (2000) Testicular microlithiasis: Prevalence and tumor risk in a population referred for scrotal sonography. Am J Roentgenol 175:1703–1706
Ganem JP, Workman KR, Shaban SF (1999) Testicular microlithiasis is associated with testicular pathology. Urology 53:209–213
Leenen AS, Riebel TW (2002) Testicular microlithiasis in children: Sonographic features and clinical implications. Pediatr Radiol 32:575–579
Berger A, Brabrand K (1998) Testicular microlithiasis—a possibly premalignant condition. Report of five cases and a review of the literature. Acta Radiol 39:583–586
Ihara H, Maruyama T, Kondo N, Shima H, Uematsu K (2003) Testicular microlithiasis: report of 14 cases. Hinyokika Kiyo 49:575–578
Miller RL, Wissman R, White S, Ragosin R (1996) Testicular microlithiasis: a benign condition with a malignant association. J Clin Ultrasound 24:197–202
Pourbagher MA, Kilinc F, Guvel S, Pourbagher A, Egilmez T, Ozkardes H (2005) Follow-up of testicular microlithiasis for subsequent testicular cancer development. Urol Int 74:108–112
Ahmad I, Krishna NS, Clark R, Nairn R, Al-Saffar N (2007) Testicular microlithiasis: Prevalence and risk of concurrent and interval development of testicular tumor in a referred population. Int Urol Nephrol 39:1177–1181
DeCastro BJ, Peterson AC, Costabile RA (2008) A 5-year followup study of asymptomatic men with testicular microlithiasis. J Urol 179:1420–1423
Ou SM, Lee SS, Tang SH et al (2007) Testicular microlithiasis in Taiwanese men. Arch Androl 53:339–344
Sakamoto H, Shichizyou T, Saito K et al (2006) Testicular microlithiasis identified ultrasonographically in Japanese adult patients: Prevalence and associated conditions. Urology 68:636–641
Von Eckardstein S, Tsakmakidis G, Kamischke A, Rolf C, Nieschlag E (2001) Sonographic testicular microlithiasis as an indicator of premalignant conditions in normal and infertile men. J Androl 22:818–824
Kosan M, Gonulalan U, Ugurlu O, Oztekin V, Akdemir O, Adsan O (2007) Testicular microlithiasis in patients with scrotal symptoms and its relationship to testicular tumors. Urology 70:1184–1186
Lam DL, Gerscovich EO, Kuo MC, McGahan JP (2007) Testicular microlithiasis: Our experience of 10 years. J Ultrasound Med 26:867–873
Serter S, Gumus B, Unlu M et al (2006) Prevalence of testicular microlithiasis in an asymptomatic population. Scand J Urol Nephrol 40:212–214
Hobarth K, Susani M, Szabo N, Kratzik C (1992) Incidence of testicular microlithiasis. Urology 40:464–467
Janzen DL, Mathieson JR, Marsh JI et al (1992) Testicular microlithiasis: Sonographic and clinical features. AJR 158:1057–1060
Peterson AC, Bauman JM, Light DE, McMann LP, Costabile RA (2001) The prevalence of testicular microlithiasis in an asymptomatic population of men 18 to 35 years old. J Urol 166:2061–2064
von der Maase H, Rorth M, Walbom-Jorgensen S et al (1986) Carcinoma in situ of contralateral testis in patients with testicular germ cell cancer: Study of 27 cases in 500 patients. Br Med J (Clin Res Ed) 293:1398–1401
Skakkebaek NE, Berthelsen JG, Muller J (1982) Carcinoma-in-situ of the undescended testis. Urol Clin North Am 9:377–385
Guzman Martinez-Valls PL, Hita VG, Fernandez AT, Minana LB, Martinez DF, Sanchez GF (2003) Significance and management of testicular microlithiasis. Arch Esp Urol 56:472–477
Nistal M, Paniagua R, Diez-Pardo JA (1979) Testicular microlithiasis in 2 children with bilateral cryptorchidism. J Urol 121:535–537
Patel MD, Olcott EW, Kerschmann RL, Callen PW, Gooding GA (1993) Sonographically detected testicular microlithiasis and testicular carcinoma. J Clin Ultrasound 21:447–452
Bieger RC, Passarge E, McAdams AJ (1965) Testicular intratubular bodies. J Clin Endocrinol Metab 25:1340–1346
Rashid HH, Cos LR, Weinberg E, Messing EM (2004) Testicular microlithiasis: A review and its association with testicular cancer. Urol Oncol: Semin Orig Inv 22:285–289
Acknowledgements
A thank you to Prof. Ken Miles, who was involved and provided advice in the early stages of this document.
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Richenberg, J., Brejt, N. Testicular microlithiasis: is there a need for surveillance in the absence of other risk factors?. Eur Radiol 22, 2540–2546 (2012). https://doi.org/10.1007/s00330-012-2520-4
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DOI: https://doi.org/10.1007/s00330-012-2520-4