Role of Ultrasound in Benign and Malignant Testicular Lesions Keeping Histopathology as Gold Standard
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Abstract
Background: Testicular lesions include a heterogeneous spectrum of benign and malignant conditions, and accurate preoperative differentiation is essential to guide timely management while avoiding unnecessary invasive intervention. Grayscale ultrasound provides morphological assessment, whereas color Doppler ultrasound evaluates lesion vascularity; however, histopathology remains the definitive diagnostic standard. Objective: To evaluate the diagnostic performance of combined grayscale and color Doppler ultrasound in differentiating benign from malignant testicular lesions using histopathological examination as the gold standard. Methods: This diagnostic-accuracy cross-sectional observational study was conducted at Cancer Care Hospital & Research Center and Chughtai Lab, Lahore, over four months. Seventy-five male patients aged 18–60 years with clinically or radiologically detected testicular lesions were included. Ultrasound features including lesion type, echogenicity, margins, vascularity, vascular pattern, lesion size, and resistive index were recorded. Final ultrasound diagnosis was compared with histopathological diagnosis obtained through biopsy or orchiectomy. Sensitivity, specificity, predictive values, diagnostic accuracy, and Cohen’s kappa were calculated. Results: Histopathology confirmed 45 benign and 30 malignant lesions. Ultrasound correctly identified 28 malignant and 43 benign lesions, with 2 false-positive and 2 false-negative cases. Sensitivity was 93.3%, specificity 95.6%, positive predictive value 93.3%, negative predictive value 95.6%, and diagnostic accuracy 94.7%. Cohen’s kappa was 0.860, indicating excellent agreement. Hypoechogenicity, ill-defined margins, vascularity, and central or chaotic vascular patterns were strongly associated with malignancy. Conclusion: Combined grayscale and color Doppler ultrasound demonstrated excellent diagnostic performance for differentiating benign and malignant testicular lesions and may serve as an effective first-line imaging modality, particularly in resource-limited settings, while histopathology remains essential for definitive diagnosis
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