New research from King's enhancing the ability to detect testicular tumours at an early stage and also avoid unneccessary surgery for benign testicular problems.
| The "King's criss-cross" sign in testicular cacner |
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High frequency Colour Doppler Ultrasound of focal testicular lesion: Crossing vessels (Criss-Cross) pattern identifies primary malignant tumours. Introduction: Ultrasound probe technological developments have improved both B-mode and colour Doppler imaging, allowing more detailed evaluation of intra testicular lesions. We have evaluated the vascularity of intra testicular lesions in order to identify patterns of malignant vascularity. Materials and Methods: Over a 24- month period, 2032 consecutive patients underwent scrotal ultrasound. They were examined with a 15L8w multifrequency (8-13 MHz) linear array probe (Acuson, CA). If a focal testicular lesion was identified, the abnormality was re-examined with the colour Doppler mode (7-14MHz). The ultrasound diagnosis of the abnormality was correlated with histology. Results: A total of 43 focal abnormalities were identified. There were 31 testicular tumours, 3 arteriovenous malformations, 4 testicular infarcts and 2epididymal abscesses and 3 were manifestations of ‘two-tone’testis. Twenty- seven patients had primary testicular cancers (seminoma and teratoma). Of these, 26 patients demonstrated disordered ‘criss-cross’ pattern of vascularity (‘criss-sross’ sign). The four testicular tumours which did not show this vascular pattern had the following histological diagnoses: Leydig cell tumour and secondaries (adenocarcinoma of prostate=1; myeloid leukemia =2). For the diagnosis of common testicular tumour (seminoma and teratoma) the vascular sign has a sensitivity and specificity of 100%. Conclusion: The presence of the ‘criss-cross’ vascular pattern allows confident diagnosis of primary testicular tumours, although not differentiating seminomas from teratomas. With the improvement of probe technology, vascularity of testicular tumour proves to be an important differentiating feature.
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