Testicular Cancer

Preliminary Diagnosis: Testicular Cancer

I. What imaging technique is first-line for this diagnosis?

Ultrasound of the scrotum and bilateral testicles.

II. Describe the advantages and disadvantages of this technique for diagnosing testicular cancer.

Advantages

• Highly portable and does not expose patients to ionizing radiation.

• Details the velocity and direction of vascular flow.

• May help guide percutaneous biopsy.

• Offers moderate sensitivity and specificity in characterizing the surrounding soft tissues.

• Details the local extent and infiltration of the primary tumor and distant metastatic disease.

Disadvantages

• Highly operator dependent.

III. What are the contraindications for the first-line imaging technique?

No specific contraindications to ultrasound exist.

IV. What alternative imaging techniques are available?

• CT imaging with IV contrast.

• MR imaging with IV contrast.

• PET/CT imaging.

V. Describe the advantages and disadvantages of the alternative techniques for diagnosing testicular cancer.

CT imaging with IV contrast

Advantages

• Offers exquisite detail of the surrounding soft tissues, osseous structures, and vasculature.

• Highly sensitive and specific in detailing the local extent and infiltration of the primary neoplasm and may detail any surrounding suspicious distant metastatic disease.

• May help guide percutaneous biopsy, treatment, and therapy.

Disadvantages

• Exposes patients to ionizing radiation.

• Less sensitive and specific in detailing primary and distant metastatic disease compared to PET/CT imaging.

MR imaging with IV contrast

Advantages

• Does not expose patients to ionizing radiation.

• Better details the surrounding soft tissues than other imaging modalities.

Disadvantages

• Expensive.

• Time consuming.

• Offers limited evaluation of the surrounding osseous structures.

• May be subject to motion and susceptibility weighted artifact, degrading image quality.

PET/CT imaging

Advantages

• Highly sensitive and specific in detecting local testicular neoplastic disease and detailing distant metastatic disease.

• Gold standard in staging neoplasm, which directs treatment.

• Offers exquisite anatomical and functional detail of the surrounding soft tissues, vasculature, and osseous structures.

Disadvantages

• May be subject to motion artifact and further imaging artifact secondary to blood glucose, movement, and many more false positives and negatives.

• Exposes patients to ionizing radiation.

VI. What are the contraindications for the alternative imaging techniques?

CT imaging with IV contrast

• May be contraindicated in pregnant patients.

• May be contraindicated in patients with renal failure or contrast allergy.

MR imaging with IV contrast

• May be contraindicated in patients with non MR compatible hardware.

PET/CT imaging

• May be contraindicated in pregnant patients and those that are breast feeding.