Real-time tissue elastography for testicular lesion assessment.

Objectives: To assess the ability of Real-time Elastography (RTE) to differentiate malignant from benign testicular lesions.

Methods: In 88 testicles ultrasound identified 144 lesions, which were examined by RTE. Elasticity images of the lesions were assigned the colour-coded score of Itoh (Radiology 2006), according to the distribution of strain induced by light compression. RTE findings were analysed considering shape (nodular/pseudo-nodular), size (<5 mm, 6-10 mm, >11 mm) and score (SC1-5) of the lesions.

Results: 93.7% of all benign lesions showed a complete elastic pattern (SC1). 92.9% of benign nodules <5 mm and 100% of the pseudonodules showed a nearly complete elastic pattern (mainly SC1). 87.5% of malignant nodules showed a stiff pattern (SC4-5). RTE gave 87.5% sensitivity, 98.2% specificity, 93.3% positive predictive value, 96.4% negative predictive value and 95.8% accuracy in differentiating malignant from benign lesions.

Conclusions: RTE is a useful technique in assessing small testicular nodules and pseudo-nodules. This is relevant in clinical practice allowing expectant management in RTE selected cases. The role of RTE seems less relevant for larger lesions because most of them are malignant at clinical and ultrasound assessment, limiting RTE to simply confirmation role.

Key Points: An emerging role for Elastography in allowing surveillance for small testicular lesions. Elastography can better differentiate benign from malignant testicular lesions. Follow up can be reduced for elastic testicular lesions at Elastography.