BJU international · 2026
Comparative accuracy of imaging modalities for differentiating malignant small testicular masses.
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Dua Yajat, Maheshwari Anusha, Perera Marlon, Murphy Declan, Lawrentschuk Nathan, Sathianathen Niranjan
Аннотация
OBJECTIVES: To synthesise evidence comparing the diagnostic performance of imaging modalities in differentiating malignant from benign small testicular masses.
PATIENTS AND METHODS: A Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA)-compliant search of PubMed, Scopus, Cochrane and Web of Science databases up to 6 May 2026 identified 11 studies comprising 707 patients with small testicular masses (predominantly <2 cm) who underwent imaging prior to a histopathological or, where unavailable, a mixed clinical/radiological follow-up reference standard. Diagnostic accuracy measures for six modalities (brightness-mode [B-Mode] ultrasonography [US], colour doppler US [CDUS], contrast-enhanced US [CEUS], magnetic resonance imaging [MRI], strain elastography [SE] and strain ratio [SR]) were synthesised using a Bayesian bivariate hierarchical summary receiver operating characteristic model.
RESULTS: The CEUS demonstrated the most reliable discriminatory ability with a pooled sensitivity of 91% and pooled specificity of 81%, yielding the highest diagnostic odds ratio of 46. B-Mode US remains a valid screening test with the highest sensitivity of 96% but a specificity of only 39%. CDUS showed a pooled sensitivity of 69% and a specificity of 81%. MRI had a pooled sensitivity of 91% and a specificity of 38%. SE demonstrated a pooled sensitivity of 87% and a specificity of 56%. Finally, SR reported the lowest sensitivity at 74% and a specificity of 50%. CEUS demonstrated significantly higher specificity than B-Mode US (ratio 1.9, 95% posterior interval [PI] 1.2-4.4) and MRI (ratio 1.8, 95% PI 1.0-5.2).
CONCLUSION: The CEUS demonstrates the highest combined sensitivity and specificity for differentiating benign from malignant testicular masses, significantly outperforming conventional B-Mode US and MRI in specificity. CEUS represents a compelling decision-making tool to support testis-sparing strategies and reduce unnecessary orchidectomies for indeterminate small testicular masses.
PATIENTS AND METHODS: A Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA)-compliant search of PubMed, Scopus, Cochrane and Web of Science databases up to 6 May 2026 identified 11 studies comprising 707 patients with small testicular masses (predominantly <2 cm) who underwent imaging prior to a histopathological or, where unavailable, a mixed clinical/radiological follow-up reference standard. Diagnostic accuracy measures for six modalities (brightness-mode [B-Mode] ultrasonography [US], colour doppler US [CDUS], contrast-enhanced US [CEUS], magnetic resonance imaging [MRI], strain elastography [SE] and strain ratio [SR]) were synthesised using a Bayesian bivariate hierarchical summary receiver operating characteristic model.
RESULTS: The CEUS demonstrated the most reliable discriminatory ability with a pooled sensitivity of 91% and pooled specificity of 81%, yielding the highest diagnostic odds ratio of 46. B-Mode US remains a valid screening test with the highest sensitivity of 96% but a specificity of only 39%. CDUS showed a pooled sensitivity of 69% and a specificity of 81%. MRI had a pooled sensitivity of 91% and a specificity of 38%. SE demonstrated a pooled sensitivity of 87% and a specificity of 56%. Finally, SR reported the lowest sensitivity at 74% and a specificity of 50%. CEUS demonstrated significantly higher specificity than B-Mode US (ratio 1.9, 95% posterior interval [PI] 1.2-4.4) and MRI (ratio 1.8, 95% PI 1.0-5.2).
CONCLUSION: The CEUS demonstrates the highest combined sensitivity and specificity for differentiating benign from malignant testicular masses, significantly outperforming conventional B-Mode US and MRI in specificity. CEUS represents a compelling decision-making tool to support testis-sparing strategies and reduce unnecessary orchidectomies for indeterminate small testicular masses.