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

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

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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Keywords

  • Testicular microlithiasis
  • Testis microcalcification
  • Germ cell tumour
  • Ultrasound