Carcinoma-in-situ of the Testis—Is Ultrasound of the Testes Useful as a Screening Method?

Testicular germ cell cancer is preceded by a pre-invasive stage called carcinoma-in-situ (CIS). The majority, if not all cases of CIS will progress into invasive cancer. Today, the only reliable way of diagnosing CIS is by performing open testicular biopsy. There is an ongoing search for non-invasive techniques for diagnosing early testicular neoplasia. The possibility of using ultrasound of the testis as a screening procedure has been investigated, and this review focuses on the available literature on the subject. It is clearly demonstrated that an abnormal echopattern seen by ultrasound of the testis is suspicious of CIS. The normal echopattern is slightly irregular. The abnormal patterns consist of either a very irregular echopattern or a pattern with bright echogenic points also named microlithiasis or micro-calcifications. The abnormal pattern is found in only 2–5% of men from the general population. The risk of CIS with a normal echopattern, even in a high risk group, is estimated to be below 3%. The risk of CIS with the abnormal echopattern is 6–48% and relates to the degree of microlithiasis and the underlying disease. Our conclusion is that ultrasound is a valuable tool in the examination of men with an increased risk of testicular cancer to detect pre-malignant stages, but large follow-up studies of men from general population are needed in order to find out whether it can be recommended as a general screening method.