What is the best initial test for a suspected testicular mass?

What is the best initial test for a suspected testicular mass?

• A. Scrotal ultrasound
• B. CT chest/abdomen/pelvis
• C. Serum AFP and beta-hCG
• D. Testicular biopsy

Answer: (A)

Scrotal ultrasound is the best initial test. It’s quick, noninvasive, and highly sensitive for detecting and characterizing a testicular mass. It helps distinguish whether the lesion is intratesticular or extratesticular and, with Doppler, shows blood flow to assess vascularity. Intratesticular solid masses in adults are most concerning for malignancy, so early imaging guides urgent management decisions, typically toward surgical planning. Serum tumor markers like AFP and beta-hCG are helpful for classifying and staging suspected germ cell tumors, but they don’t replace imaging as the first step. CT imaging of the chest/abdomen/pelvis is used for staging if cancer is diagnosed, not for initial evaluation. Testicular biopsy is generally avoided due to the risk of tumor seeding and disruption of lymphatic drainage, which can affect staging and treatment.

Scrotal ultrasound is the best initial test. It’s quick, noninvasive, and highly sensitive for detecting and characterizing a testicular mass. It helps distinguish whether the lesion is intratesticular or extratesticular and, with Doppler, shows blood flow to assess vascularity. Intratesticular solid masses in adults are most concerning for malignancy, so early imaging guides urgent management decisions, typically toward surgical planning.

Serum tumor markers like AFP and beta-hCG are helpful for classifying and staging suspected germ cell tumors, but they don’t replace imaging as the first step. CT imaging of the chest/abdomen/pelvis is used for staging if cancer is diagnosed, not for initial evaluation. Testicular biopsy is generally avoided due to the risk of tumor seeding and disruption of lymphatic drainage, which can affect staging and treatment.