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Radiologie up2date 2025; 25(01): 37-55
DOI: 10.1055/a-2415-4877
Urogenitale Radiologie

Die Bildgebung von Hodentumoren - Diagnostik, Staging und Nachsorge

Imaging of testicular tumors – diagnosis, staging and aftercare
Luca Funk∗
,
Uwe Bieri
,
Daniel Hausmann
,
Gerd Stuckmann
,
Lukas Hefermehl
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Hodenkrebs betrifft hauptsächlich jüngere Männer und ist damit eine Herausforderung für Diagnostik und Therapie. Mit steigenden Heilungsraten dank Fortschritten in der Bildgebung und Behandlung rückt die Verbesserung des Stagings und der minimalinvasiven Nachsorge in den Fokus. Dieser Beitrag gibt einen Überblick über die diagnostischen Verfahren, legt besonderen Wert auf strahlungsarme Techniken und informiert über die Leitlinien zur Nachsorge.

Abstract

Testicular cancer primarily affects younger men, presenting a unique challenge for diagnosis and treatment. With increasing cure rates due to advances in imaging and therapy, the focus is shifting towards optimizing staging and minimally invasive follow-up care. Our latest article provides a comprehensive overview of state-of-the-art diagnostic techniques, emphasizes low-radiation approaches, and highlights the latest guidelines for follow-up care to ensure long-term quality of life for patients.

Kernaussagen

  • Die Bildgebung mittels Ultraschall ist entscheidend für die initiale Diagnose von Hodentumoren und ermöglicht die Unterscheidung zwischen intra- und extratestikulären Läsionen sowie die Beurteilung des kontralateralen Hodens.

  • Moderne Schnittbildverfahren wie CT und MRT spielen eine zentrale Rolle im Staging bei Hodentumoren, um das Ausmaß der Erkrankung zu bestimmen und Metastasen nachzuweisen.

  • Die MRT bietet bei unklaren sonografischen Befunden eine höhere Sensitivität und Spezifität in der Beurteilung von Hodentumoren, ist aber aufgrund der höheren Kosten und spezifischer Indikationen (z. B. unklare Sonografiebefunde, Bestimmung der lokalen Ausbreitung zur Planung hodenerhaltender Operationen, Abgrenzung zwischen paratestikulären und intratestikulären Läsionen) begrenzt.

  • Für die spezifische Beurteilung von Residualmassen nach Chemotherapie bei Hodentumoren zeigt die FDG-PET/CT eine überlegene Sensitivität und Spezifität gegenüber der CT allein, besonders bei Residualtumoren über 3 cm.

  • Die Abdomensonografie hat ihre Bedeutung in der Nachsorge von Hodentumoren in Niedrig-Risiko-Situationen, wobei sie die Schnittbildgebung ersetzen kann, um eine unnötige Strahlenexposition zu vermeiden.

  • Die MRT des Schädels sollte bei Patienten mit schlechter Prognose sowie bei Vorliegen neurologischer Symptome oder exzessiver β‑hCG-Wert-Erhöhung ergänzend zum Staging eingesetzt werden.

  • Die genaue Interpretation von Serumtumormarkern in Kombination mit bildgebenden Verfahren liefert wertvolle Informationen zum Tumorstadium, Therapieansprechen und zur Früherkennung von Rezidiven.

Schlüsselwörter

Hodentumor - Diagnostik - Staging - Urologie - Nachsorge

Keywords

testicular tumor - diagnosis - staging - urology - follow-up care


Publication History

Article published online:
27 February 2025

© 2025. Thieme. All rights reserved.

Georg Thieme Verlag KG
Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany

 

  • Literatur

  • 1 Shah YB, Goldberg H, Hu B. et al. Metastatic Testicular Cancer Patterns and Predictors: A Contemporary Population-based SEER Analysis. Urology 2023; 180: 182-189
    CrossrefPubMedSearch in Google Scholar
  • 2 Nigam M, Aschebrook-Kilfoy B, Shikanov S. et al. Increasing incidence of testicular cancer in the United States and Europe between 1992 and 2009. World J Urol 2015; 33: 623-631
    CrossrefPubMedSearch in Google Scholar
  • 3 Harland SJ, Cook PA, Fosså SD. et al. Risk factors for carcinoma in situ of the contralateral testis in patients with testicular cancer. An interim report. Eur Urol 1993; 23: 115-119
    CrossrefPubMedSearch in Google Scholar
  • 4 Cook MB, Akre O, Forman D. et al. A systematic review and meta-analysis of perinatal variables in relation to the risk of testicular cancer—experiences of the son. Int J Epidemiol 2010; 39: 1605-1618
    CrossrefPubMedSearch in Google Scholar
  • 5 Latif T, Kold Jensen T, Mehlsen J. et al. Semen Quality as a Predictor of Subsequent Morbidity: A Danish Cohort Study of 4,712 Men With Long-Term Follow-up. Am J Epidemiol 2017; 186: 910-917
    CrossrefPubMedSearch in Google Scholar
  • 6 Moul JW. Timely Diagnosis of Testicular Cancer. Urol Clin North Am 2007; 34: 109-117
    CrossrefPubMedSearch in Google Scholar
  • 7 Moch H, Amin MB, Berney DM. et al. The 2022 World Health Organization Classification of Tumours of the Urinary System and Male Genital Organs—Part A: Renal, Penile, and Testicular Tumours. Eur Urol 2022; 82: 458-468
    CrossrefPubMedSearch in Google Scholar
  • 8 Smith ZL, Werntz RP, Eggener SE. Testicular Cancer. Med Clin North Am 2018; 102: 251-264
    CrossrefPubMedSearch in Google Scholar
  • 9 Patrikidou A, Cazzaniga W, Berney D. et al. European Association of Urology Guidelines on Testicular Cancer: 2023 Update. Eur Urol 2023; 84: 289-301
    CrossrefPubMedSearch in Google Scholar
  • 10 Hale GR, Teplitsky S, Truong H. et al. Lymph node imaging in testicular cancer. Transl Androl Urol 2018; 7: 864-874
    CrossrefPubMedSearch in Google Scholar
  • 11 Leitlinienprogramm Onkologie. S3-Leitlinie Diagnostik, Therapie und Nachsorge der Keimzelltumoren des Hodens. Version 1.1. 2020 Accessed November 21, 2024 at: https://www.leitlinienprogramm-onkologie.de/fileadmin/user_upload/Downloads/Leitlinien/Hodentumoren/LL_Hodentumoren_Langversion_1.1.pdf
    PubMedSearch in Google Scholar
  • 12 Necas M, Muthupalaniappaan M, Barnard C. Ultrasound morphological patterns of testicular tumours, correlation with histopathology. J Med Radiat Sci 2021; 68: 21-27
    CrossrefPubMedSearch in Google Scholar
  • 13 Rebik K, Wagner JM, Middleton W. Scrotal Ultrasound. Radiol Clin North Am 2019; 57: 635-648
    CrossrefPubMedSearch in Google Scholar
  • 14 Coret A, Leibovitch I, Heyman Z. et al. Ultrasonographic evaluation and clinical correlation of intratesticular lesions: a series of 39 cases. Br J Urol 1995; 76: 216-219
    CrossrefPubMedSearch in Google Scholar
  • 15 Kennedy PT, Elliott JM, Rice PF. et al. Ultrasonography of intratesticular lesions: its role in clinical management. Ulster Med J 1999; 68: 54-58
    PubMedSearch in Google Scholar
  • 16 Chavarriaga J, Hamilton R. Small Testicular Masses: Contemporary Diagnostic and Treatment Strategies, Future Directions, and Knowledge Gaps. Urol Oncol 2023; 41: 331-339
    CrossrefPubMedSearch in Google Scholar
  • 17 Ager M, Donegan S, Boeri L. et al. Radiological features characterising indeterminate testes masses: a systematic review and meta-analysis. BJU Int 2023; 131: 288-300
    CrossrefPubMedSearch in Google Scholar
  • 18 Tsili AC, Argyropoulou MI, Giannakis D. et al. MRI in the Characterization and Local Staging of Testicular Neoplasms. Am J Roentgenol 2010; 194: 682-689
    CrossrefPubMedSearch in Google Scholar
  • 19 Tsili AC, Argyropoulou MI, Dolciami M. et al. When to ask for an MRI of the scrotum. Andrology 2021; 9: 1395-1409
    CrossrefPubMedSearch in Google Scholar
  • 20 Dotzauer R, Salamat A, Nabar ND. et al. The timing of initial imaging in testicular cancer: impact on radiological findings and clinical decision making. Minerva Urol Nephrol 2022; 74: 72-76
    CrossrefPubMedSearch in Google Scholar
  • 21 Busch J, Schmidt S, Albers P. et al. Can magnetic resonance imaging replace conventional computerized tomography for follow-up of patients with testicular cancer? A systematic review. World J Urol 2022; 40: 2843-2852
    CrossrefPubMedSearch in Google Scholar
  • 22 Kreydin EI, Barrisford GW, Feldman AS. et al. Testicular Cancer: What the Radiologist Needs to Know. AJR Am J Roentgenol 2013; 200: 1215-1225
    CrossrefPubMedSearch in Google Scholar
  • 23 Pasoglou V, Van Nieuwenhove S, Van Damme J. et al. Whole Body MRI in the Detection of Lymph Node Metastases in Patients with Testicular Germ Cell Cancer. Life (Basel) 2022; 12: 212
    CrossrefPubMedSearch in Google Scholar
  • 24 Feldman DR, Lorch A, Kramar A. et al. Brain Metastases in Patients With Germ Cell Tumors: Prognostic Factors and Treatment Options—An Analysis From the Global Germ Cell Cancer Group. J Clin Oncol 2016; 34: 345-351
    CrossrefPubMedSearch in Google Scholar
  • 25 de Wit M, Brenner W, Hartmann M. et al. [18F]-FDG-PET in clinical stage I/II non-seminomatous germ cell tumours: results of the German multicentre trial. Ann Oncol 2008; 19: 1619-1623
    CrossrefPubMedSearch in Google Scholar
  • 26 Yacoub JH, Oto A, Allen BC. et al. ACR Appropriateness Criteria Staging of Testicular Malignancy. J Am Coll Radiol 2016; 13: 1203-1209
    CrossrefPubMedSearch in Google Scholar
  • 27 Germà-Lluch J. Clinical Pattern and Therapeutic Results Achieved in 1490 Patients with Germ-Cell Tumours of the Testis: the Experience of the Spanish Germ-Cell Cancer Group (GG). Eur Urol 2002; 42: 553-563
    CrossrefPubMedSearch in Google Scholar
  • 28 Dieckmann K-P, Simonsen-Richter H, Kulejewski M. et al. Serum Tumour Markers in Testicular Germ Cell Tumours: Frequencies of Elevated Levels and Extents of Marker Elevation Are Significantly Associated with Clinical Parameters and with Response to Treatment. Biomed Res Int 2019; 2019: 1-22
    CrossrefPubMedSearch in Google Scholar
  • 29 Nason GJ, Aditya I, Leao R. et al. Partial orchiectomy: The Princess Margaret cancer centre experience. Urol Oncol 2020; 38: 605.e19-605.e24
    CrossrefPubMedSearch in Google Scholar
  • 30 Pfannenberg AC, Oechsle K, Bokemeyer C. et al. The role of [18F] FDG-PET, CT/MRI and tumor marker kinetics in the evaluation of postchemotherapy residual masses in metastatic germ cell tumors – prospects for management. World J Urol 2004; 22: 132-139
    CrossrefPubMedSearch in Google Scholar
  • 31 Treglia G, Sadeghi R, Annunziata S. et al. Diagnostic Performance of Fluorine-18-Fluorodeoxyglucose Positron Emission Tomography in the Postchemotherapy Management of Patients with Seminoma: Systematic Review and Meta-Analysis. Biomed Res Int 2014; 2014: 1-11
    CrossrefPubMedSearch in Google Scholar
  • 32 Daneshmand S, Albers P, Fosså SD. et al. Contemporary Management of Postchemotherapy Testis Cancer. Eur Urol 2012; 62: 867-876
    CrossrefPubMedSearch in Google Scholar
  • 33 Hendry WF, Norman AR, Dearnaley DP. et al. Metastatic nonseminomatous germ cell tumors of the testis. Cancer 2002; 94: 1668-1676
    CrossrefPubMedSearch in Google Scholar
  • 34 Ehrlich Y, Brames MJ, Beck SDW. et al. Long-Term Follow-Up of Cisplatin Combination Chemotherapy in Patients With Disseminated Nonseminomatous Germ Cell Tumors: Is a Postchemotherapy Retroperitoneal Lymph Node Dissection Needed After Complete Remission?. J Clin Oncol 2010; 28: 531-536
    CrossrefPubMedSearch in Google Scholar
  • 35 Scavuzzo A, Santana Ríos ZA, Noverón NR. et al. Growing Teratoma Syndrome. Case Rep Urol 2014; 2014: 139425
    CrossrefPubMedSearch in Google Scholar
  • 36 Saoud RM, Andolfi C, Aizen J. et al. Impact of Non–guideline-directed Care on Quality of Life in Testicular Cancer Survivors. Eur Urol Focus 2021; 7: 1137-1142
    CrossrefPubMedSearch in Google Scholar
  • 37 Smith-Bindman R. Radiation Dose Associated With Common Computed Tomography Examinations and the Associated Lifetime Attributable Risk of Cancer. Arch Intern Med 2009; 169: 2078
    CrossrefPubMedSearch in Google Scholar
  • 38 Helbling D, Stenner F, Rothermundt C. et al. Interdisciplinary evidence-based recommendations for the follow-up of testicular cancer patients: a joint effort. Swiss Med Wkly 2010; 26: 356-369
    CrossrefPubMedSearch in Google Scholar
  • 39 De La Pena H, Sharma A, Glicksman C. et al. No longer any role for routine follow-up chest x-rays in men with stage I germ cell cancer. Eur J Cancer 2017; 84: 354-359
    CrossrefPubMedSearch in Google Scholar
  • 40 Sohaib SA, Koh DM, Barbachano Y. et al. Prospective assessment of MRI for imaging retroperitoneal metastases from testicular germ cell tumours. Clin Radiol 2009; 64: 362-367
    CrossrefPubMedSearch in Google Scholar
  • 41 Joffe JK, Cafferty FH, Murphy L. et al. Imaging Modality and Frequency in Surveillance of Stage I Seminoma Testicular Cancer: Results From a Randomized, Phase III, Noninferiority Trial (TRISST). J Clin Oncol 2022; 40: 2468-2478
    CrossrefPubMedSearch in Google Scholar