Testicular microlithiasis and its relation to testicular cancer on ultrasound findings of symptomatic men.

Abstract

We reviewed testicular microlithiasis (TM) on scrotal ultrasound in relation to the incidence of testicular neoplasm in males 17 to 45 years old with scrotal symptoms. We reviewed the radiographic and medical records of males age 4 weeks to 84 years with symptomatic complaint of scrotal pain or swelling between September 1998 and April 2002. Subgroup analysis was performed on 160 male patients between 17 and 45 years old since they were at higher risk for testicular carcinoma. TM was found in 12 patients (8%) and concomitant testicular neoplasm was found in 4 (33%) symptomatic individuals age 17 to 45. In the 148 (93%) patients without testicular microlithiasis, concomitant testicular neoplasm was found in 2 individuals (2%). Statistical analysis revealed a relative risk of testicular neoplasm in the presence of TM to be 36.5 (CI 4.2-429.6) in our symptomatic population. Sensitivity and specificity were 0.67 and 0.95, respectively. Symptomatic patients with TM exhibited an incidence of testicular neoplasm greater than that of the general population. An algorithm for the surveillance of patients with TM should be developed. The fact that our patient population was symptomatic at referral preselected toward a higher incidence of TM and testicular neoplasm compared to accepted incidence in the general population. Further investigation will require a multicenter trial to generate an adequate patient pool due to the low incidence of TM and testicular malignancy.