The value of contrast-enhanced ultrasonography in the diagnosis of primary testicular non-neoplastic and neoplastic lesions in adults

Background: Different pathological types of testicular tumors are treated differently. For example, malignant germ cell tumors require radical orchiectomy, benign tumors only require mass enucleation and segmental infarction does not require treatment. Contrast-enhanced ultrasonography (CEUS) can more sensitively display tumor microvessels, thereby distinguishing between benign and malignant tumors. Methods: : This was a retrospective analysis of 35 patients with primary testicular non-neoplastic and neoplastic confirmed by pathology in our hospital from February 2017 to February 2022. Conventional ultrasonography and CEUS of primary testicular non-neoplastic lesions and neoplastic lesions of different pathological types in adults were retrospectively analyzed and their diagnostic values were compared with the pathological results. Results: : The sensitivity, specificity, positive predictive value, negative predictive value and accuracy rates for conventional ultrasound in the diagnosis of benign testicular tumors based on "onion skin-like" echo (epidermoid cysts) and peripheral annular blood flow were 30.8%, 100.0%, 100.0%, 71.9% and 75.0%, respectively. According to CEUS without enhancement (non-neoplastic lesions and epidermoid cysts) and uniform high enhancement with fast forward and slow backward (SLCT), the sensitivity, specificity, positive predictive value, negative predictive value and accuracy rates for diagnosing benign testicular tumors were 100.0%, 100.0%, 100.0%, 100.0% and 100.0%, respectively. Compared with conventional ultrasound, the difference was statistically significant (P=0.004). Conclusions: CEUS could accurately distinguish between benign and malignant testicular tumors and also diagnosed specific pathological types (such as testicular focal infarction, epidermoid cysts, spermatocytic tumors, SLTC and lymphoma). Different pathological types of testicular tumors had different treatment options; thus, accurate preoperative diagnosis was of great significance and could guide the selection of appropriate treatment options.