MRI Head MRI of the head, without and with GBCAs, is recommended during the initial staging of testicular cancer if the patient is symptomatic or has high-risk features (eg, hCG >5000 IU/L, extensive lung metastases, choriocarcinoma, nonpulmonary visceral metastases, or alpha-fetoprotein [AFP] >10,000 ng/mL) [8-11]. Radiography Chest Studies have shown that chest radiography is beneficial during the initial staging of testicular cancer, assessing for pulmonary metastases [48,49]. For nonseminoma testicular cancer, a slight advantage for chest CT has been noted compared with chest radiography [48,51], and chest CT is useful during the initial staging of nonseminoma testicular cancer by the NCCN and European Association of Urology guidelines [8,9]. US Abdomen and Retroperitoneum US of the abdomen and retroperitoneum to detect retroperitoneal lymph node metastases is less accurate and reproducible than CT, MRI, or PET/CT [50]. US Scrotum Scrotal US is frequently used and should always be the initial imaging modality in assessing patients with scrotal masses. Scrotal US should always be performed during the initial workup of a scrotal mass before orchiectomy to localize the tumor, plan surgery, and clear the contralateral testicle of disease [40]. After initial triage and orchiectomy, scrotal US does not have a role in the initial staging or restaging of men with testicular cancer diagnosis established by orchiectomy unless there is concern for contralateral tumor or equivocal clinical examination [8]. Variant 3: Surveillance of stage IA and IB pure seminoma testicular cancer. Diagnosed by orchiectomy. No clinical suspicion of recurrence. Bone Scan Whole Body Bone metastases from testicular cancer are uncommon. In one study, bone scan was able to detect metastases to the iliac bones ipsilateral to the testicular tumor before they were detectable by CT [12].
Staging and Surveillance of Testicular Cancer. MRI Head MRI of the head, without and with GBCAs, is recommended during the initial staging of testicular cancer if the patient is symptomatic or has high-risk features (eg, hCG >5000 IU/L, extensive lung metastases, choriocarcinoma, nonpulmonary visceral metastases, or alpha-fetoprotein [AFP] >10,000 ng/mL) [8-11]. Radiography Chest Studies have shown that chest radiography is beneficial during the initial staging of testicular cancer, assessing for pulmonary metastases [48,49]. For nonseminoma testicular cancer, a slight advantage for chest CT has been noted compared with chest radiography [48,51], and chest CT is useful during the initial staging of nonseminoma testicular cancer by the NCCN and European Association of Urology guidelines [8,9]. US Abdomen and Retroperitoneum US of the abdomen and retroperitoneum to detect retroperitoneal lymph node metastases is less accurate and reproducible than CT, MRI, or PET/CT [50]. US Scrotum Scrotal US is frequently used and should always be the initial imaging modality in assessing patients with scrotal masses. Scrotal US should always be performed during the initial workup of a scrotal mass before orchiectomy to localize the tumor, plan surgery, and clear the contralateral testicle of disease [40]. After initial triage and orchiectomy, scrotal US does not have a role in the initial staging or restaging of men with testicular cancer diagnosis established by orchiectomy unless there is concern for contralateral tumor or equivocal clinical examination [8]. Variant 3: Surveillance of stage IA and IB pure seminoma testicular cancer. Diagnosed by orchiectomy. No clinical suspicion of recurrence. Bone Scan Whole Body Bone metastases from testicular cancer are uncommon. In one study, bone scan was able to detect metastases to the iliac bones ipsilateral to the testicular tumor before they were detectable by CT [12].