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Appropriateness Criteria

Reference Study Type Patients/Events Study Objective(Purpose of Study) Study Results Study Quality
1. Crawford P, Crop JA. Evaluation of scrotal masses. [Review]. Am Fam Physician. 89(9):723-7, 2014 May 01. Review/Other-Dx N/A To provide a review of various scrotal masses and different approaches used to evaluate them. No results stated in abstract. 4
2. Schmoll HJ, Jordan K, Huddart R, et al. Testicular seminoma: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol. 21 Suppl 5:v140-6, 2010 May. Review/Other-Dx N/A Clinical practice guidelines for diagnosis, treatment and follow-up of testicular seminoma. No results stated in abstract. 4
3. Schmoll HJ, Jordan K, Huddart R, et al. Testicular non-seminoma: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol. 21 Suppl 5:v147-54, 2010 May. Review/Other-Dx N/A Clinical practice guidelines for diagnosis, treatment and follow-up of testicular non-seminoma. No results stated in abstract. 4
4. Mittal PK, Abdalla AS, Chatterjee A, et al. Spectrum of Extratesticular and Testicular Pathologic Conditions at Scrotal MR Imaging. [Review]. Radiographics. 38(3):806-830, 2018 May-Jun. Review/Other-Dx N/A To discuss the anatomy and MR imaging features of testicular and extratesticular neoplastic and nonneoplastic conditions and describes relevant MR imaging techniques. No results stated in abstract. 4
5. Albers P, Albrecht W, Algaba F, et al. EAU guidelines on testicular cancer: 2011 update. [Review]. Eur Urol. 60(2):304-19, 2011 Aug. Review/Other-Dx N/A To summarize the main conclusions from the EAU guidelines on the management of testicular cancer. No results stated in abstract. 4
6. Goldberg H, Klaassen Z, Chandrasekar T, Fleshner N, Hamilton RJ, Jewett MAS. Germ Cell Testicular Tumors-Contemporary Diagnosis, Staging and Management of Localized and Advanced disease. [Review]. Urology. 125:8-19, 2019 03. Review/Other-Dx N/A To discuss the diagnosis, staging and management of localized and advanced germ cell testicular tumors. No results stated in politics. 4
7. Moch H, Cubilla AL, Humphrey PA, Reuter VE, Ulbright TM. The 2016 WHO Classification of Tumours of the Urinary System and Male Genital Organs-Part A: Renal, Penile, and Testicular Tumours. [Review]. Eur Urol. 70(1):93-105, 2016 07. Review/Other-Dx N/A To summarize the most significant differences between the newly published classification and the prior version for renal, penile, and testicular tumours. No results stated in abstract. 4
8. Honecker F, Aparicio J, Berney D, et al. ESMO Consensus Conference on testicular germ cell cancer: diagnosis, treatment and follow-up. Annals of Oncology. 29(8):1658-1686, 2018 08 01. Review/Other-Dx N/A To discuss recommendations on topics relating to testicular cancer that are not covered in detail in the current ESMO Clinical Practice Guidelines (CPGs) and where the available level of evidence is insufficient. No results stated in abstract. 4
9. Wang SQ, Ren FY, Wang JH, et al. Diagnostic value of multislice spiral computed tomography (CT) combined with CT angiography for intra-abdominal undescended testis secondary seminomas. Cancer Imaging. 19(1):24, 2019 May 16. Review/Other-Dx 9 patients To discuss the diagnostic value of multislice spiral tomography (CT) combined with CT angiography (CTA) technology in intra-abdominal undescended testis secondary seminoma cases. The tumors in all nine patients were mainly solid, and the average CT value was 38.4 ± 3.4 HU. Low-density areas of various sizes were visible in the tumors, and calcifications were detected in two patients. The tumors in eight patients had a complete capsule, which pressed on the surrounding structures. In one patient, the tumor had an incomplete capsule, which invaded the surrounding structures. Some of the solid tumors showed progressive and slight enhancement on the CT-enhanced scans. The values in the arterial phase, venous phase, and delayed phase were 46.3 ± 5.1 (40-55 HU), 57.3 ± 7.3HU (48-68 HU), and 65.1 ± 7.2HU (56-77 HU), respectively, with an average increase rate of 27.0 ± 7.2 HU. No enhancement was found in low-density areas on the CTA scans, and the supply arteries of the tumors in the nine patients all originated from the abdominal aortic wall 2-3 cm below the renal ostia. These arteries became thickened and tortuous when near the tumors, and there were no branching vessels. In eight patients, the supply arteries of the tumors originated from the posterior tumor and ended inside the tumor, and they originated from anterior of the tumor in one patient. Testicular venous drainage was detected in three patients, and lymph node metastasis in the abdominal aorta detected in two cases. 4
10. Aoun F, Slaoui A, Naoum E, et al. Testicular microlithiasis: Systematic review and Clinical guidelines. Prog Urol. 29(10):465-473, 2019 Sep. Review/Other-Dx N/A To give clinical guidelines based on the evidence in the literature. No results stated in abstract. 4
11. Stephenson A, Eggener SE, Bass EB, et al. Diagnosis and Treatment of Early Stage Testicular Cancer: AUA Guideline. J Urol. 202(2):272-281, 2019 08. Review/Other-Tx N/A To provide a useful reference (guideline) on the effective evidence-based treatment of early stage testicular cancer. No results stated in abstract. 4
12. Richenberg J, Belfield J, Ramchandani P, et al. Testicular microlithiasis imaging and follow-up: guidelines of the ESUR scrotal imaging subcommittee. European Radiology. 25(2):323-30, 2015 Feb. Review/Other-Dx N/A To produce guidelines on imaging and follow-up in testicular microlithiasis (TML). No results stated in abstract. 4
13. Aparicio J, Terrasa J, Duran I, et al. SEOM clinical guidelines for the management of germ cell testicular cancer (2016). Clin Transl Oncol. 18(12):1187-1196, 2016 Dec. Review/Other-Tx N/A To define current ‘‘state-of-the-art’’ in the treatment of this malignancy using the methodology of evidence-based medicine. No results stated in abstract. 4
14. Wang CL, Aryal B, Oto A, et al. ACR Appropriateness Criteria® Acute Onset of Scrotal Pain-Without Trauma, Without Antecedent Mass. J Am Coll Radiol 2019;16:S38-S43. Review/Other-Dx N/A Evidence-based guidelines to assist referring physicians and other providers in making the most appropriate imaging or treatment decision for acute onset of scrotal pain-without trauma, without antecedent mass. No results stated in abstract. 4
15. American College of Radiology. ACR Appropriateness Criteria®: Staging of Testicular Malignancy. Available at: https://acsearch.acr.org/docs/69375/Narrative/. Review/Other-Tx N/A Evidence-based guidelines to assist referring physicians and other providers in making the most appropriate imaging or treatment decision for a specific clinical condition. No abstract available. 4
16. Lock G, Schmidt C, Helmich F, Stolle E, Dieckmann KP. Early experience with contrast-enhanced ultrasound in the diagnosis of testicular masses: a feasibility study. Urology. 77(5):1049-53, 2011 May. Observational-Dx 51 patients To evaluate the feasibility of contrast-enhanced ultrasound (CEUS) in the diagnosis of testicular masses. In 50/51 patients, bubbles of the contrast media were clearly visualized in the testicles 21 ± 5.5 seconds after injection. Of the patients, 43 had a neoplastic lesion, histologically (29 seminoma, 9 nonseminomatous testicular tumor, 4 Leydig cell tumor, and 1 non-Hodgkin lymphoma). In 39 of 51 patients (76.5%), testicular masses showed a clear early hyperenhancement compared with the surrounding tissue. Of these 39 masses, 38 proved to be neoplastic; 1 patient had focal suppurative epididymo-orchitis. Hyperenhancement of a testicular lesion had a positive predictive value of 97.4% (95% CI = 84.9-99.9%) for neoplasia. Hyperenhancement was not found in 7 of 8 lesions proved to be nonneoplastic (1 epidermoid cyst, 3 necrosis/atrophy, 1 incarcerated inguinal hernia, 1 hematoma, and 1 tubular ectasia of the rete testis). 3
17. Valentino M, Bertolotto M, Derchi L, et al. Role of contrast enhanced ultrasound in acute scrotal diseases. Eur Radiol. 21(9):1831-40, 2011 Sep. Observational-Dx 50 patients To evaluate the efficacy of contrast-enhanced US in patients with acute scrotal pain not defined at US with color Doppler. 23 patients had a final diagnosis of testicular tumor, 3 abscess, 8 focal infarction, 7 trauma, 3 testicular torsion, 1 hematoma. 5 patients were negative. 35 patients were operated (23 testicular tumors, 6 trauma, 3 testicular torsion, 1 abscess, 1 focal infarction, and 1 hematoma) and 15 underwent medical treatment or were discharged. US provided a definitive diagnosis in 34/50 as compared to the 48/50 patients diagnosed at contrast-enhanced US. Sensitivity and specificity were 76% and 45% for US and 96% and 100% for contrast-enhanced US, respectively. 3
18. Moschouris H, Stamatiou K. Re: Lock et al.: Early experience with contrast-enhanced ultrasound in the diagnosis of testicular masses: a feasibility study (Urology 2011;77:1049-1053). Urology. 78(2):480-1; author reply 481, 2011 Aug. Review/Other-Dx N/A To address a report on contrast-enhanced ultrasonography (CEUS) in the diagnosis of testicular masses. No results stated in abstract. 4
19. Bertolotto M, Derchi LE, Sidhu PS, et al. Acute segmental testicular infarction at contrast-enhanced ultrasound: early features and changes during follow-up. AJR Am J Roentgenol. 196(4):834-41, 2011 Apr. Observational-Dx 20 men To assess whether contrast-enhanced US is useful for characterization of acute segmental testicular infarction. 14/16 lesions examined within 24 hours were oval, and 2 were wedge shaped. 8 lesions were isoechoic to the testis, 6 were hypoechoic, and 2 had mixed echogenicity. 12 lesions were avascular and 4 were hypovascular at color Doppler examination. Contrast-enhanced US showed avascular parenchymal lobules in all cases and without perilesional rim enhancement in 12/13 studies. 2 to 17 days after the symptoms appeared, contrast-enhanced US showed avascular lobules in all cases and perilesional rim enhancement in 8 examinations. After 1 month or more, contrast-enhanced US depicted intralesional vascular spots in 12/14 infarcts. Perilesional enhancement was absent. 4
20. Lung PF, Jaffer OS, Sellars ME, Sriprasad S, Kooiman GG, Sidhu PS. Contrast-enhanced ultrasound in the evaluation of focal testicular complications secondary to epididymitis. AJR. American Journal of Roentgenology. 199(3):W345-54, 2012 Sep. Review/Other-Dx 14 patients The purpose of this study is to determine the effectiveness of contrast-enhanced ultrasound in evaluating incidental focal testicular lesions in epididymitis. Over 28 months, 16 focal testicular lesions (median lesion size, 24 mm; range, 14-48 mm) in 14 patients (median age, 49 years; range, 18-81 years) were examined. Lesions were oval (n = 14), wedge shaped (n = 1), or involved the entire testis (n = 1). Lesions were isoechoic (n = 1), hypoechoic (n = 4), or of mixed echogenicity (n = 11). Color Doppler ultrasound flow was not clearly depicted in 13 lesions but was present in three lesions, with contrast-enhanced ultrasound concordant with color Doppler ultrasound, showing unequivocal absence of vascularity and increased flow, respectively. In the avascular lesions, rim enhancement (n = 6), vascular projections (n = 4), and irregular (n = 10) and smooth (n = 2) borders were documented. The observers identified infarction (n = 9), abscess (n = 4), orchitis (n = 1), and tumor (n = 2). Histologic examination (seven lesions in five patients) confirmed infarction, abscess formation, and seminoma; follow-up ultrasound confirmed resolution for eight patients. 4
21. Huang DY, Sidhu PS. Focal testicular lesions: colour Doppler ultrasound, contrast-enhanced ultrasound and tissue elastography as adjuvants to the diagnosis. [Review]. British Journal of Radiology. 85 Spec No 1:S41-53, 2012 Nov. Review/Other-Dx N/A To illustrate the potential of different and newer ultrasound techniques beyond conventional B-mode imaging, including colour Doppler ultrasound, contrast-enhanced ultrasound (CEUS) and tissue elastography, in the characterisation of both benign and malignant intratesticular lesions. No results stated in abstract. 4
22. Lerchbaumer MH, Auer TA, Marticorena GS, et al. Diagnostic performance of contrast-enhanced ultrasound (CEUS) in testicular pathologies: Single-center results. Clinical Hemorheology & Microcirculation. 73(2):347-357, 2019. Observational-Dx 45 patients To evaluate the diagnostic performance of contrast-enhanced ultrasound (CEUS) in the assessment of unclear testicular pathologies. Overall 19 patients presented with a neoplastic lesion, whereas 14 were malignant. Matched to the histopathological report and clinical follow up, CEUS represented a sensitivity of 93% (95% -CI, 69-99), a specificity of 94% (95% -CI, 80-98), a positive predictive value (PPV) of 87% (95% -CI, 62-96) and a negative predictive value (NPV) of 97% (95% -CI, 83-99). 3
23. Drudi FM, Maghella F, Martino G, et al. Detection of small testicular masses in monorchid patients using US, CPDUS, CEUS and US-guided biopsy. Journal of Ultrasound. 19(1):25-8, 2016 Mar. Review/Other-Dx 18 patients To assess the role of US imaging in the detection of small testicular masses in monorchid patients after orchiectomy for malignant neoplasm, and in guiding surgery to reach the target and also to differentiate lesions which presented vascular activity within the mass. All patients underwent CPDUS; 12/19 lesions showed blood flow while 7/19 showed absence of blood flow. At CEUS, 16/19 lesions showed enhancement and subsequent histological examination revealed that 8 were seminomas and 3 were Leydig cell tumors. In 5/19 cases CEUS showed the presence of lesions (focal inflammatory lesions) and in 3/19 cases CEUS was negative. 4
24. Zeng B, Chen F, Qiu S, et al. Application of Quasistatic Ultrasound Elastography for Examination of Scrotal Lesions. Journal of Ultrasound in Medicine. 35(2):253-61, 2016 Feb. Review/Other-Dx 1073 patients To investigate the value of applying quasistatic ultrasound elastography for examination of scrotal lesions, to investigate the features of normal testes on quasistatic elastography, and to establish whether testicular and epididymal lesions had specific quasistatic elastographic features. Quasistatic elastography did not reveal any testicular or epididymal abnormalities in 625 cases. Seven cases showed testicular torsion; 3 cases showed testicular space-occupying lesions (1 case each of a testicular teratoma, testicular seminoma, and testicular endodermal sinus tumor); 176 cases showed epididymal lesions (138 cases of caudal epididymal inflammatory masses, 37 cases of caput epididymal cysts, and 1 case of an epididymal lymphangioma); and 262 cases showed varicocele. The normal testicular elastographic appearance showed a 3-ring structure: red surrounding bands with a blue edge region and a green central area. The stiffness in cases of testicular torsion, testicular space-occupying lesions, and epididymal lesions was increased, whereas caput epididymal cysts of different diameters appeared either as green, blue-green-red, or "scooped out." Elastographic results for patients with varicocele were not different from those for normal testes. 4
25. Pedersen MR, Sloth Osther PJ, Nissen HD, Vedsted P, Moller H, Rafaelsen SR. Elastography and diffusion-weighted MRI in patients with testicular microlithiasis, normal testicular tissue, and testicular cancer: an observational study. Acta Radiologica. 60(4):535-541, 2019 Apr. Observational-Dx 132 patients with testicular microlithiasis (n = 53), or normal testicular tissue (n = 53), or suspected for testicular cancer (n = 26). To evaluate ultrasound elastography in combination with the apparent diffusion coefficient measurements in diffusion weighted (DW) magnetic resonance imaging (MRI) in testicles. No clinically relevant difference in velocity stiffness was found between normal and testicles with microlithiasis. There was a significant difference in stiffness between patients with testicular microlithiasis (0.78 m/s), normal testicular tissue (0.77 m/s), and patients with testicular cancer (1.95 m/s) ( P = 0.001). Similarly, there was a statistically significant difference in MRI diffusion values between patients with testicular microlithiasis (0.978 × 10-3 mm2 s-1), normal testicular tissue (0.929 × 10-3 mm2 s-1), and testicular cancers (0.743 × 10-3 mm2 s-1) ( P < 0.01). 2
26. Konstantatou E, Fang C, Romanos O, et al. Evaluation of Intratesticular Lesions With Strain Elastography Using Strain Ratio and Color Map Visual Grading: Differentiation of Neoplastic and Nonneoplastic Lesions. Journal of Ultrasound in Medicine. 38(1):223-232, 2019 Jan. Observational-Dx 86 patients To investigate the role of strain elastography using calculated strain ratio and visual elastography score in differentiating nonneoplastic, benign, and malignant neoplastic intratesticular lesions. Thirty-one of 86 (36.0%) intratesticular malignant neoplasms, 17 of 86 (19.8%) benign neoplasms, and 38 of 86 (44.2%) nonneoplastic lesions were confirmed with histology (n = 52) or follow-up sonography (n = 34); 89.5% of intratesticular lesions were heterogeneous or hypoechoic on gray scale, with no difference between benign and malignant. Sensitivity, specificity, positive and negative likelihood ratio for nonneoplasm versus neoplasm were documented: color Doppler: 68.8%, 97.4%, 26.5, 0.32; visual elastography score: 81.3%, 57.9%, 1.93, 0.32; strain ratio: 68.8%, 81.6%, 3.73, 0.38. Neoplastic lesions showed a higher strain ratio than nonneoplastic lesions (P < .001), with strong correlation between median strain ratio and visual elastography score (Spearman's coefficient, 0.693; P < .001). Strain ratio is a significantly better assessment than visual elastography score for malignant lesions (P = .025). Logistic regression analysis revealed significant associations between size (P = .001), hypervascularity (P < .001), and malignancy. 3
27. Marcon J, Trottmann M, Rubenthaler J, Stief CG, Reiser MF, Clevert DA. Shear wave elastography of the testes in a healthy study collective - Differences in standard values between ARFI and VTIQ techniques. Clinical Hemorheology & Microcirculation. 64(4):721-728, 2016. Observational-Dx 20 volunteers To determine whether there is a statistically significant difference between shear wave velocity values of both techniques (ARFI and VTIQ) in a healthy collective. We measured a mean shear wave velocity of 0.81 m/s using ARFI and 1.07 m/s with VTIQ.Shear wave velocities determined by VTIQ were all significantly higher than values gained in the ARFI mode. (p < 0.001 to p = 0.007). Values were between 0.22 and 0.29 m/s higher, when the examination was performed using VTIQ. 3
28. Marcon J, Trottmann M, Rubenthaler J, et al. Three-dimensional vs. two-dimensional shear-wave elastography of the testes - preliminary study on a healthy collective. Clinical Hemorheology & Microcirculation. 64(3):447-456, 2016. Observational-Dx 32 healthy volunteers To evaluate the feasibility of 3D SWE and to compare 2D and 3D SWE standard values in the testes of healthy subjects. Mean SWV values were 1.05 m/s for the 2D SWE and 1.12 m/s for the 3D SWE.Comparisons of local areas delivered no statistically significant differences (p = 0.11 to p = 0.66), except for the region in the central portion in the superior part of the coronal plane (p = 0.03). Testicular volume was significanty higher by a mean of 1.72 ml when measured with 3D SWE (p = 0.001). 3
29. Aigner F, De Zordo T, Pallwein-Prettner L, et al. Real-time sonoelastography for the evaluation of testicular lesions. Radiology. 263(2):584-9, 2012 May. Observational-Dx 50 patients To evaluate the feasibility of using real-time sonoelastography (RTE) for the differentiation and characterization of testicular lesions. hirty-four of the 50 lesions (68%) were testicular tumors and 16 (32%) were of nontumorous origin. RTE showed the presence of hard lesions in all cases of testicular tumors and three cases of nontumorous lesions. Four lesions with an uncertain diagnosis when tested with gray-scale US and color and/or power Doppler US alone were soft at RTE and showed nontumorous character at follow-up. RTE showed a sensitivity of 100%, a specificity of 81%, a negative predictive value of 100%, a positive predictive value of 92%, and an accuracy of 94% in the diagnosis of testicular tumors. 2
30. Rocher L, Criton A, Gennisson JL, et al. Characterization of Testicular Masses in Adults: Performance of Combined Quantitative Shear Wave Elastography and Conventional Ultrasound. Ultrasound in Medicine & Biology. 45(3):720-731, 2019 03. Observational-Dx 89 testicular focal masses The purpose of this study was to evaluate the performance of combined information provided by conventional B-mode, CDUS and SWE for the characterization of testicular masses. Thirty-seven malignant tumors (MTs), 12 burned out tumors (BOTs), 28 Leydig cell tumors (LCTs), 2 dermoid cysts and other benign lesions were included. MTs + BOTs exhibited more microliths and macrocalcifications compared with benign lesions (p < 10 4). LCTs manifested mostly a dominant peripheral vascularization pattern compared with other lesions. MTs + BOTs were stiffer compared with benign lesions (p < 2 £10 4) but with a moderate area under the receiver operating characteristic curve (AUROC) of 80%. By focusing on LCTs versus MTs + BOTs, diagnostic performance led to an AUROC of 89% for the best stiffness parameter. For combined conventional US and SWE, the diagnostic performance to differentiate all benign lesions versus MTs + BOTs and LCTs versus MTs + BOTs increased to AUROCs of 93% and 98%, respectively. 2
31. Pastore AL, Palleschi G, Maceroni P, et al. Correlation between semiquantitative sonoelastography and immunohistochemistry in the evaluation of testicular focal lesions. Cancer Imaging. 14:29, 2014 Oct 08. Review/Other-Dx 30 patients To evaluate focal lesions of the testes with diameters of <10 mm using sonoelastography, B-mode sonography (US), and colour Doppler ultrasonography (CDU). Analyses of the strain fields obtained using semiquantitative sonoelastography yielded different values for the masses and the surrounding tissues, which led to significant increases in the strain ratios. Sonoelastography upheld all of the diagnoses that were suspected when the patients were physically examined, when the serum markers were analysed, and after the patients had undergone US and CDU. Histopathological examinations confirmed the neoplastic characteristics of these masses. A significant inverse correlation was determined between the sonoelastographic strain ratio and the VI (Pearson correlation coefficient, r, = - 0.93; P < 0.001). 4
32. Rizvi SA, Ahmad I, Siddiqui MA, Zaheer S, Ahmad K. Role of color Doppler ultrasonography in evaluation of scrotal swellings: pattern of disease in 120 patients with review of literature. [Review]. Urology Journal. 8(1):60-5, 2011Winter. Observational-Dx 122 patients To determine the value of color Doppler ultrasonography (CDUS) as a routine investigational method for diagnosis of scrotal pathologies. The final diagnoses were epididymitis or epididymo-orchitis (46), hydrocele (26), varicocele (16), testicular malignancy (16), orchitis (6), testicular torsion (4), spermatic cord injury (2), hematocele (2), and pyocele (2). Color Doppler ultrasonography accurately diagnosed all cases of epididymitis or epididymo-orchitis, spermatic cord injury, testicular torsion, varicocele, and hydrocele (sensitivity 100% and specificity 100%). Of 16 subjects diagnosed as testicular malignancy on CDUS, only 14 were subsequently found to have malignancy. Two cases of orchitis were wrongly diagnosed as malignancy. Similarly, of 6 patients diagnosed as orchitis, 1 was found to have seminoma (sensitivity 87.5% and specificity 66.7%). Overall sensitivity of CDUS in diagnosing scrotal diseases was 98% while specificity was 66.7%. 3
33. Dudea SM, Ciurea A, Chiorean A, Botar-Jid C. Doppler applications in testicular and scrotal disease. [Review]. Medical Ultrasonography. 12(1):43-51, 2010 Mar. Review/Other-Dx N/A To review the current knowledge on the use of Doppler ultrasound in disease of the testis and scrotal contents. No results stated in abstract. 4
34. Schroder C, Lock G, Schmidt C, Loning T, Dieckmann KP. Real-Time Elastography and Contrast-Enhanced Ultrasonography in the Evaluation of Testicular Masses: A Comparative Prospective Study. Ultrasound in Medicine & Biology. 42(8):1807-15, 2016 08. Observational-Dx 67 patients To investigate the usefulness of contrast-enhanced ultrasound (CEUS) and real-time elastography (RTE) for the characterization of testicular masses by comparing pre-operative ultrasound findings with post-operative histology. For RTE, elasticity score (ES), difference of elasticity score (D-ES), strain ratio (SR) and size quotient (Qsize) were evaluated. Histopathologically, 54/68 testicular lesions were neoplastic (47 malignant, 7 benign). Descriptive statistics revealed the following results (neoplastic vs. non-neoplastic) for sensitivity, specificity, positive predictive value, negative predictive value and accuracy, respectively: B-mode, 100%, 43%, 87%, 100%, 88%; CCDS 81%, 86%, 96%, 55%, 82%; CEUS 93%, 85%, 96%, 73%, 91%; ES 98%, 25%, 85%, 75%, 85%; D-ES 98%, 50%, 90%, 83%, 89%; SR 90%, 45%, 86%, 56%, 81%; and Qsize 57%, 83%, 94%, 28%, 61%. B-mode with CCDS remains the standard for assessing testicular masses. In characterization of testicular lesions, CEUS clearly outperformed all other modalities. 3
35. Montgomery JS, Bloom DA. The diagnosis and management of scrotal masses. [Review]. Med Clin North Am. 95(1):235-44, 2011 Jan. Review/Other-Dx N/A To review the diagnosis and treatment of benign and malignant scrotal masses of children and adults according to anatomic location (scrotal wall, paratesticular, testicular, and spermatic cord). No results stated in abstract. 4
36. Weatherspoon K, Polansky S, Catanzano T. Ultrasound Emergencies of the Male Pelvis. [Review]. Semin Ultrasound CT MR. 38(4):327-344, 2017 Aug. Review/Other-Dx N/A To review the role of imaging as well as the key characteristic imaging findings of these injuries to direct the appropriate management. No results stated in abstract. 4
37. Patel HD, Ramos M, Gupta M, et al. Magnetic Resonance Imaging to Differentiate the Histology of Testicular Masses: A Systematic Review of Studies With Pathologic Confirmation. Urology. 135:4-10, 2020 Jan. Review/Other-Dx 9 studies including 217 patients. To evaluate magnetic resonance imaging (MRI) as a potential adjunct for diagnosis of testicular masses. No results stated in abstract. 4
38. Tsili AC, Argyropoulou MI, Giannakis D, Sofikitis N, Tsampoulas K. MRI in the characterization and local staging of testicular neoplasms. AJR. American Journal of Roentgenology. 194(3):682-9, 2010 Mar. Observational-Dx 33 patients Prospective study to assess the role of MRI in the preoperative characterization and local staging of testicular neoplasms. Histologic examination revealed 36 intratesticular lesions, 28 (78%) of which were malignant and 8 benign. Thirteen malignant testicular tumors (46%) were confined within the testis, 12 (43%) had invaded the testicular tunicae or epididymis, and 3 (11%) had invaded the spermatic cord. The sensitivity and specificity of MRI in differentiating benign from malignant intratesticular lesions were 100% (95% CI, 87.9%-100%) and 87.5% (95% CI, 52.9%-97.7%). The rate of correspondence between MRI and histologic diagnosis in the local staging of testicular tumors was 92.8% (26/28). MRI is a good diagnostic tool for the evaluation of testicular disease. It is highly accurate in the preoperative characterization and local staging of testicular neoplasms. 2
39. Tsili AC, Bertolotto M, Turgut AT, et al. MRI of the scrotum: Recommendations of the ESUR Scrotal and Penile Imaging Working Group. [Review]. European Radiology. 28(1):31-43, 2018 Jan. Review/Other-Dx N/A To present recommendations for magnetic resonance imaging (MRI) of the scrotum. No results stated in abstract. 4
40. Tsili AC, Argyropoulou MI, Astrakas LG, et al. Dynamic contrast-enhanced subtraction MRI for characterizing intratesticular mass lesions. AJR. American Journal of Roentgenology. 200(3):578-85, 2013 Mar. Observational-Dx 44 patients To analyze the enhancement patterns of various intratesticular mass lesions at dynamic contrast-enhanced subtraction MRI and assess the value of the technique in distinguishing between benign and malignant lesions. Normal testes enhanced homogeneously with a type I curve. Most benign intratesticular lesions showed inhomogeneous or homogeneous contrast enhancement and a type II curve. Testicular carcinomas showed heterogeneous contrast enhancement with a type III curve. The relative percentages of maximum time to peak proved the most important discriminating factor in differentiating malignant from benign intratesticular masses (p < 0.001). A strong association (p < 0.001) was found between the type of time–signal intensity curve and the final diagnosis. Specifically, the type I curve was found in all normal cases (100%), a type II curve was found in 63.6% of benign cases, and a type III curve was found in all cases (100%) of malignancy. Logistic regression analysis revealed that relative maximum time is the only independent predictor of malignancy (regression coefficient, –0.103; likelihood ratio, 29.2; p < 0.001; adjusted odds ratio, 0.902; 95% CI, 0.850–0.957). 3
41. Thomas LJ, Brooks MA, Stephenson AJ. The Role of Imaging in the Diagnosis, Staging, Response to Treatment, and Surveillance of Patients with Germ Cell Tumors of the Testis. [Review]. Urologic Clinics of North America. 46(3):315-331, 2019 Aug. Review/Other-Dx N/A To review the indications for imaging and performance characteristics of modalities in the diagnosis, staging, surveillance, and follow-up of patients with GCTs. No results stated in abstract. 4
42. McDonald MW, Reed AB, Tran PT, Evans LA. Testicular tumor ultrasound characteristics and association with histopathology. Urologia Internationalis. 89(2):196-202, 2012. Observational-Dx 107 patients To develop knowledge of ultrasound characteristics of germ cell testicular neoplasms, associate these characteristics with histopathologic tumor types, and lay a foundation for study of ultrasound findings in benign versus malignant testicular lesions. 55 patients had seminoma (1 bilateral) and 52 non-seminoma. Ultrasound images of seminoma were more often hypoechoic, homogeneous, and lobulated than those of non-seminoma (p < 0.001). Images of non-seminoma were more often heterogeneous and cystic (p < 0.001). There was no difference in tumor size, multiplicity, presence of calcium or lesion margination. Testicular microlithiasis was more common in seminoma (p < 0.02). The combined findings of hypoechoic and homogeneous echo texture had a positive predictive value of 0.843 (95% CI 0.743–0.943) for seminoma, with a sensitivity of 0.768 (95% CI 0.658–0.878) and specificity of 0.846 (95% CI 0.748–0.944). The absence of either hypoechoic or homogeneous echo texture had a negative predictive value for seminoma (or, viewed alternatively, a positive predictive value for non-seminoma) of 0.772 (95% CI 0.664–0.880). The presence of cysts on ultrasound examination had a positive predictive value of 0.938 (95% CI 0.855–1.0) for non-seminoma, with sensitivity 0.577 (95% CI 0.443–0.711) and specificity 0.964 (95% CI 0.810–1.0). 3
43. Oldenburg J, Fossa SD, Nuver J, et al. Testicular seminoma and non-seminoma: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol. 24 Suppl 6:vi125-32, 2013 Oct. Review/Other-Dx N/A To provide guidance for diagnosis, treatment and follow-up of testicular seminoma and non-seminoma. No results stated in abstract. 4
44. Sommers D, Winter T. Ultrasonography evaluation of scrotal masses. [Review]. Radiol Clin North Am. 52(6):1265-81, 2014 Nov. Review/Other-Dx N/A To review the anatomy and sonographic findings of scrotal masses. No results stated in abstract. 4
45. Shtricker A, Silver D, Sorin E, et al. The value of testicular ultrasound in the prediction of the type and size of testicular tumors. International Braz J Urol. 41(4):655-60, 2015 Jul-Aug. Observational-Dx 85 patients To assess the ultrasound capability to distinguish benign from malignant disease and to estimate the tumor size as compared to pathological measurements. Sonographic lesions were at least 20% smaller than the pathologically determined dimensions in 21 (25%) patients. The ability of US in estimating the size of malignant tumors was 71%, compared to 100% of benign tumors (p=0.03), with no significant difference between SGCT and NSGCT. Necrosis was more frequent in malignant tumors (p=0.03); hypoechogeneity and fibrosis were more frequent in SGCT than in NSGCT (p=0.002 and 0.04 respectively). 3
46. Carkaci S, Ozkan E, Lane D, Yang WT. Scrotal sonography revisited. [Review] [56 refs]. Journal of Clinical Ultrasound. 38(1):21-37, 2010 Jan. Review/Other-Dx N/A To review the various scrotal and extrascrotal pathologic conditions, including acute scrotum, pediatric and adult testicular and extratesticular scrotal neoplasms, traumatic lesions, and miscellaneous other scrotal lesions. No results stated in abstract. 4
47. Bertolotto M, Muca M, Curro F, Bucci S, Rocher L, Cova MA. Multiparametric US for scrotal diseases. [Review]. Abdom Radiol. 43(4):899-917, 2018 04. Review/Other-Dx N/A To review the application of multiparametric US for scrotal pathologies. No results stated in abstract. 4
48. Dieckmann KP, Frey U, Lock G. Contemporary diagnostic work-up of testicular germ cell tumours. [Review]. Nat Rev Urol. 10(12):703-12, 2013 Dec. Review/Other-Dx N/A To review the diagnostic work-up of testicular masses. No results stated in abstract. 4
49. Wasnik AP, Maturen KE, Shah S, Pandya A, Rubin JM, Platt JF. Scrotal pearls and pitfalls: ultrasound findings of benign scrotal lesions. [Review]. Ultrasound Quarterly. 28(4):281-91, 2012 Dec. Review/Other-Dx N/A To discuss the pathophysiology and ultrasound findings of a variety of non-neoplastic scrotal lesions, both intratesticular and extratesticular. No results stated in abstracts. 4
50. Mirochnik B, Bhargava P, Dighe MK, Kanth N. Ultrasound evaluation of scrotal pathology. [Review]. Radiologic Clinics of North America. 50(2):317-32, vi, 2012 Mar. Review/Other-Dx N/A To review extratesticular and intratesticular lesions presenting as a palpable mass and other conditions commonly seen. No results stated in abstract. 4
51. Philips S, Nagar A, Dighe M, Vikram R, Sunnapwar A, Prasad S. Benign non-cystic scrotal tumors and pseudotumors. [Review]. Acta Radiol. 53(1):102-11, 2012 Feb 01. Review/Other-Dx N/A To review the cross-sectional imaging features of benign, non-cystic, intra- and extratesticular lesions. No results stated in abstract. 4
52. American College of Radiology. ACR Appropriateness Criteria® Radiation Dose Assessment Introduction. Available at: https://www.acr.org/-/media/ACR/Files/Appropriateness-Criteria/RadiationDoseAssessmentIntro.pdf. Review/Other-Dx N/A To provide evidence-based guidelines on exposure of patients to ionizing radiation. No abstract available. 4
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