The Real-Time Elastography (RTE) Increases the Diagnostic Accuracy of Testicular Focal Lesions

Alfredo D'Andrea; Michele Scialpi; Sabrina Gravante; Michelle Magli; Fabrizio Urraro; Andrea Izzo; Vitaliano Ferrone; Alfonso Reginelli; Corrado Malaspina; Lucia Manganaro; Antonio Rotondo; Irene Piscioli; Teresa Pusiol; Luca Roncati

doi:10.5455/ajdi.20170702112314

Abstract
Objective: The aim of our research has been to evaluate the usefulness of real-time ultrasound elastography (RTE) in the differential diagnosis between benign and malignant non-palpable and palpable testicular lesions in children and adults.
Methods: B-mode ultrasonography (US), color/power Doppler and RTE of 54 patients with 54 unilateral testicular lesions were retrospective investigated. The imaging results were supported by histopathological examination in all cases. On RTE the value of tissue rigidity was reported in a chromatic scale and categorized in three patterns: soft (red), medium (green) and hard (blue). Results: Among the 54 testicular lesions, 35 measured more than 2 cm in diameter (32 malignant and 3 benignant tumors) while 19 less than 2 cm (9 malignant and 10 benignant lesions). In the group of the 41 proved malignant tumors, RTE demonstrated hard pattern in 32 cases. Immature teratomas exhibited a mixed pattern likely related to their heterogeneous content. In the testicular lesions diagnosis, RTE showed a 78% sensitivity, an 85% specificity, a 94% positive predictive value, a 55% negative predictive value and an 80% accuracy in differentiating malignant from benignant lesions. The integration of US with color/power Doppler and RTE showed a diagnostic accuracy of 100% and 90%, respectively.
Conclusion: Integrated with conventional ultrasound methods, RTE increases the diagnostic accuracy of US and color/power Doppler in the differential diagnosis between benignant and malignant testicular lesions.

Key words: real-time ultrasound elastography (RTE); ultrasound (US); color/power Doppler; testis; testicular lesions.