The 2021 NCCN guidelines, however, do provide an option for chest radiography for stage I pure seminoma testicular cancer patients undergoing surveillance if clinically indicated [8]. 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 does not have a role in the restaging of men with testicular cancer diagnosis established by orchiectomy unless there is concern for contralateral tumor or equivocal clinical examination [8]. 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 4: Surveillance of stage IA and IB nonseminoma 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]. CT Abdomen and Pelvis CT is the reference standard imaging test used for assessing the retroperitoneum for the presence of metastatic lymphadenopathy. CT is rapid, reproducible, and provides excellent imaging assessment of the para-aortic and paracaval regions [13-15]. Challenges related to CT are that many young men have little retroperitoneal fat, which may be an impediment for readers interpreting the study, and that CT cannot detect metastatic disease in lymph nodes of normal size. Additionally, inflammatory lymph nodes cannot be differentiated from those that are enlarged from metastases [16].
Staging and Surveillance of Testicular Cancer. The 2021 NCCN guidelines, however, do provide an option for chest radiography for stage I pure seminoma testicular cancer patients undergoing surveillance if clinically indicated [8]. 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 does not have a role in the restaging of men with testicular cancer diagnosis established by orchiectomy unless there is concern for contralateral tumor or equivocal clinical examination [8]. 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 4: Surveillance of stage IA and IB nonseminoma 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]. CT Abdomen and Pelvis CT is the reference standard imaging test used for assessing the retroperitoneum for the presence of metastatic lymphadenopathy. CT is rapid, reproducible, and provides excellent imaging assessment of the para-aortic and paracaval regions [13-15]. Challenges related to CT are that many young men have little retroperitoneal fat, which may be an impediment for readers interpreting the study, and that CT cannot detect metastatic disease in lymph nodes of normal size. Additionally, inflammatory lymph nodes cannot be differentiated from those that are enlarged from metastases [16].