Testicular Microlithiasis

Objectives Testicular microlithiasis (TM) is characterized on sonography by multiple microprecipitates in the testes. The correlation between TM and testicular malignancies is variable. The purpose of this study was to review our 10‐year experience regarding the prevalence of TM and its association with testicular malignancies. Methods This was a retrospective study in which 3254 testicular sonographic examinations over a 10‐year period identified 137 patients with TM. Testicular microlithiasis was divided into 2 groups: classic TM (CTM; ≥ 5 calcifications per image) and limited TM (<5 calcifications/image). A control population without TM was also randomly selected during the same period. Associations with testicular cancers and other findings were then noted and compared between the TM and control groups. Results One hundred thirty‐seven (4.6%) of the 2957 individual patients with scrotal sonographic examinations had TM; 8 (5.8%) of the 137 patients with TM had testicular cancer, whereas 1 (0.73%) of the 137 patients without TM had primary testicular cancer ( P = .04). There were 9 testicular neoplasms in 8 patients, all of whom had CTM. Thirty patients with TM and no malignancy were followed for an average of 19 months (range, 1–90 months; SD, 19.7 months); none had tumor development. Conclusions We found a strong association between TM and testicular malignancy. We think that the most prudent use of resources for early detection of malignancy would be to have all patients with CTM perform testicular self‐examinations, and follow‐up sonography should be limited to a subgroup of patients with CTM and other associated risk factors.