INTRODUCTION: The purpose of this retrospective study was to determine the accuracy of repeat sonographic tests for intrascrotal pathologies that were performed when the first ultrasound (US) report was inconclusive. We also examined the consistency of the first and final diagnoses and the effect on management procedures.
METHODS: In 2008, 3049 sonograms were performed for scrotal pathology. A total of 70 sonograms (2.3%) were inconclusive and a second US was requested; these became the database for the present study. We recorded the patient's age, presenting symptoms, time span between US sessions, grade of the US operator, US results, and final histopathological or clinical diagnosis. We also examined whether or not the follow-up US led to a change in management.
RESULTS: The mean age of patients was 46 years (range, 6-85 years) at the time of the original US. Indications for the second US were pain (n = 30), the presence of an indistinct swelling (n = 19), a discrete lump (n = 11), or a combination of these (n = 10). Overall, 66 patients (94.3%) had benign pathology; 4 patients were diagnosed with cancer following histopathology tests that were conducted because of abnormal tumor markers. In 22 patients (31%) there were appreciable differences between the first and subsequent diagnoses; in 48 patients (69%) there was no appreciable difference. For 45 patients (64.3%), the follow-up US did not alter the management plan; only 2 of these patients had a change from the initial diagnosis. However, 25 patients (35.7%) had an alteration in their management after the follow-up US; 20 of these patients had a different diagnosis following the repeated US. Of the 70 patients, 61 (87%) were managed conservatively; 9 patients received surgery.
CONCLUSIONS: A second scrotal US can be an effective diagnostic tool if a prior US is inconclusive, particularly if the condition is benign. Repeat US has minimal value in detecting malignant testicular pathologies.
Pejman Kheirandish, Sohayl Mukhtar, Rhana Zakri, Nitin Shrotri, Rajeshwar Krishnan
Submitted: December 10, 2010
Accepted for Publication: January 26, 2011
KEYWORDS: Repeat scrotal ultrasound; Equivocal report.
CORRESPONDENCE: Mr Pejman Kheirandish, Department of Urology (Jasmin Ward), Newham University Hospital, Glen Road, Plaistow, London, E13 8SL, United Kingdom ( ).
CITATION: UroToday Int J. 2011 Apr;4(2):art26.
doi: 10.3834/uij.1944-5784.2011.04.08