Diagnostic Accuracy of Ultrasound in Differentiating Benign and Malignant Testicular Tumors Using Computed Tomography as the Gold Standard

Abstract

Background: Testicular tumors represent a small but clinically significant proportion of male malignancies, predominantly affecting adolescents and young adults in whom early and accurate diagnosis is essential for optimal outcomes. Ultrasonography is widely used as the first-line imaging modality for evaluating testicular masses; however, variability in its specificity necessitates validation of its diagnostic performance against a reliable reference comparator in routine clinical practice. Objective: To evaluate the diagnostic accuracy of ultrasonography in differentiating benign and malignant testicular tumors using contrast-enhanced computed tomography as the reference comparator. Methods: This cross-sectional observational study was conducted at a tertiary diagnostic center in Islamabad over nine months and included 59 male patients aged 16–45 years with clinically suspected testicular masses. All participants underwent standardized gray-scale and color Doppler ultrasonography followed by contrast-enhanced computed tomography. Ultrasonographic findings were classified as benign or malignant based on predefined imaging criteria and compared with CT-based classification. Diagnostic performance metrics, including sensitivity, specificity, positive predictive value, negative predictive value, and overall accuracy, were calculated with 95% confidence intervals. Results: The mean age of participants was 31.27 ± 7.07 years. Ultrasonography classified 50.8% of lesions as malignant, while CT identified 55.9% as malignant. Compared with CT, ultrasonography demonstrated a sensitivity of 80.76% (95% CI: 67.5–91.1), specificity of 75.75% (95% CI: 61.1–87.0), positive predictive value of 72.41% (95% CI: 58.3–83.9), negative predictive value of 83.33% (95% CI: 70.4–92.1), and overall diagnostic accuracy of 77.96% (95% CI: 69.8–85.4). Conclusion: Ultrasonography showed high sensitivity and acceptable specificity for differentiating benign and malignant testicular tumors when compared with computed tomography, supporting its role as a reliable first-line imaging modality. Computed tomography remains valuable for confirmation and staging in indeterminate or suspicious cases.