to evaluate possible predictors factors of testicular cancer (TC) in patients undergoing testicular sparing surgery (TSS).

a retrospective analysis of all patients undergoing TSS for small testicular mass (STM) in five centers was performed. All patients with one solitary lesion ≤ 2cm at pre-operative ultrasound (US) were enrolled in the study. TSS consists in the enucleation of tumor for frozen section examination (FSE). Immediate radical orchiectomy (RO) was performed in all cases of malignancy at FSE; otherwise testes were spared. Univariate and multivariate analysis were performed and receiver operator characteristic curves (ROC) were produced to evaluate preoperative factors predicting TC.

Overall 147 patients were included in the study. No patient had elevated serum tumor markers. Overall 21/147 (14%) of the patients presented TC. On multivariate analysis preoperative US diameter of the lesion is a predictor of malignancy (OR: 6.62; CI: 2.26-19.39, p= 0.01). On ROC analysis diameter of the lesion presented an AUC of 0,75 (CI: 0.63-0.86, p= 0.01) for the prediction of TC. At the best cut-off of 0.85 the diameter of the lesion presented a sensitivity of 81%, specificity of 58%, positive predictive value of 24%, negative predictive value of 95%.

Our study confirms that STM are often benign and do not always require RO. Preoperative US can assess lesion size and the smaller is the nodule the less likely it is malignant. A stepwise approach to STM, which includes tumorectomy, FSE and RO or TSS according to the FSE results, is therefore suggested.

The Journal of urology. 2019 Oct 03 [Epub ahead of print]

Giorgio Gentile, Michele Rizzo, Lorenzo Bianchi, Marco Falcone, Donato Dente, Mario Cilletti, Alessandro Franceschelli, Valerio Vagnoni, Marco Garofalo, Riccardo Schiavina, Eugenio Brunocilla, Francesco Claps, Giovanni Liguori, Carlo Trombetta, Massimiliano Timpano, Luigi Rolle, Angelo Porreca, Costantino Leonardo, Cosimo De Nunzio, Fulvio Colombo, Giorgio Franco

Andrology-Unit, University Hospital S.Orsola-Malpighi, Bologna, Italy., Department of Urology, University of Trieste, Hospital of Cattinara, Trieste, Italy., Department of Urology, University of Bologna, Bologna, Italy., Department of Urology, University of Turin, Hospital Molinette, Italy., Department of Urology, Abano Terme Hospital, AbanoTerme, Padua, Italy., Department of Urology, Sapienza University of Rome, Italy.