Surveillance of indeterminate small testis masses (STMs): A 10-year single centre experience and recommendations for excision
BAUS ePoster online library. Wardak S. 06/21/21; 319078; p4-1
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Mr. Shafiullah Wardak
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Abstract
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Introduction:
There is no standardised pathway for the management of indeterminate STMs. We analysed the imaging surveillance outcomes to propose a management pathway for STMs.
Methods:
A retrospective analysis of STMs (≤ 2cm) over a 10-year period was performed. Each case was discussed at a specialist Testis MDT. Parameters included lesions size, sonographic characteristics, imaging surveillance interval and excisional biopsy outcomes.
Results:
A total of 161 patients with a median age of 38 years (range:17-76) and median lesion size of 4mm (range:1.5-20) were included. The median imaging interval was 3 months (range:0-12), the median number of scans was 3 (range:1-10) and the median surveillance time was 6 months (range:0-24).
91 patients (56.5%) were discharged, and none represented with malignancy. 37 (23%) were still under surveillance at the time of analysis and 33 (20.5%) proceeded to excisional biopsy of which 9 (27%) showed malignancy or ITGCN, 7 of which were seminomas. This gives an overall malignancy rate of 5.6%. Indications for biopsy included, change in lesion, patient choice and elevated tumour markers. All 7 malignant biopsies were in patients with change in lesion characteristics.
Conclusions:
This study shows that imaging surveillance of STMs is safe and effective. It avoids unnecessary biopsy or orchidectomy and ensures that the lesions that change are biopsied. It is reassuring that only lesions with sonographic changes on serial scanning harboured malignancy.
Based on our data, we recommend at least 3 surveillance scans, 3 to 6 months apart, and performing excisional biopsy of the lesions that change.
There is no standardised pathway for the management of indeterminate STMs. We analysed the imaging surveillance outcomes to propose a management pathway for STMs.
Methods:
A retrospective analysis of STMs (≤ 2cm) over a 10-year period was performed. Each case was discussed at a specialist Testis MDT. Parameters included lesions size, sonographic characteristics, imaging surveillance interval and excisional biopsy outcomes.
Results:
A total of 161 patients with a median age of 38 years (range:17-76) and median lesion size of 4mm (range:1.5-20) were included. The median imaging interval was 3 months (range:0-12), the median number of scans was 3 (range:1-10) and the median surveillance time was 6 months (range:0-24).
91 patients (56.5%) were discharged, and none represented with malignancy. 37 (23%) were still under surveillance at the time of analysis and 33 (20.5%) proceeded to excisional biopsy of which 9 (27%) showed malignancy or ITGCN, 7 of which were seminomas. This gives an overall malignancy rate of 5.6%. Indications for biopsy included, change in lesion, patient choice and elevated tumour markers. All 7 malignant biopsies were in patients with change in lesion characteristics.
Conclusions:
This study shows that imaging surveillance of STMs is safe and effective. It avoids unnecessary biopsy or orchidectomy and ensures that the lesions that change are biopsied. It is reassuring that only lesions with sonographic changes on serial scanning harboured malignancy.
Based on our data, we recommend at least 3 surveillance scans, 3 to 6 months apart, and performing excisional biopsy of the lesions that change.
Introduction:
There is no standardised pathway for the management of indeterminate STMs. We analysed the imaging surveillance outcomes to propose a management pathway for STMs.
Methods:
A retrospective analysis of STMs (≤ 2cm) over a 10-year period was performed. Each case was discussed at a specialist Testis MDT. Parameters included lesions size, sonographic characteristics, imaging surveillance interval and excisional biopsy outcomes.
Results:
A total of 161 patients with a median age of 38 years (range:17-76) and median lesion size of 4mm (range:1.5-20) were included. The median imaging interval was 3 months (range:0-12), the median number of scans was 3 (range:1-10) and the median surveillance time was 6 months (range:0-24).
91 patients (56.5%) were discharged, and none represented with malignancy. 37 (23%) were still under surveillance at the time of analysis and 33 (20.5%) proceeded to excisional biopsy of which 9 (27%) showed malignancy or ITGCN, 7 of which were seminomas. This gives an overall malignancy rate of 5.6%. Indications for biopsy included, change in lesion, patient choice and elevated tumour markers. All 7 malignant biopsies were in patients with change in lesion characteristics.
Conclusions:
This study shows that imaging surveillance of STMs is safe and effective. It avoids unnecessary biopsy or orchidectomy and ensures that the lesions that change are biopsied. It is reassuring that only lesions with sonographic changes on serial scanning harboured malignancy.
Based on our data, we recommend at least 3 surveillance scans, 3 to 6 months apart, and performing excisional biopsy of the lesions that change.
There is no standardised pathway for the management of indeterminate STMs. We analysed the imaging surveillance outcomes to propose a management pathway for STMs.
Methods:
A retrospective analysis of STMs (≤ 2cm) over a 10-year period was performed. Each case was discussed at a specialist Testis MDT. Parameters included lesions size, sonographic characteristics, imaging surveillance interval and excisional biopsy outcomes.
Results:
A total of 161 patients with a median age of 38 years (range:17-76) and median lesion size of 4mm (range:1.5-20) were included. The median imaging interval was 3 months (range:0-12), the median number of scans was 3 (range:1-10) and the median surveillance time was 6 months (range:0-24).
91 patients (56.5%) were discharged, and none represented with malignancy. 37 (23%) were still under surveillance at the time of analysis and 33 (20.5%) proceeded to excisional biopsy of which 9 (27%) showed malignancy or ITGCN, 7 of which were seminomas. This gives an overall malignancy rate of 5.6%. Indications for biopsy included, change in lesion, patient choice and elevated tumour markers. All 7 malignant biopsies were in patients with change in lesion characteristics.
Conclusions:
This study shows that imaging surveillance of STMs is safe and effective. It avoids unnecessary biopsy or orchidectomy and ensures that the lesions that change are biopsied. It is reassuring that only lesions with sonographic changes on serial scanning harboured malignancy.
Based on our data, we recommend at least 3 surveillance scans, 3 to 6 months apart, and performing excisional biopsy of the lesions that change.
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