Diagnostic Value Of Imaging Diagnosis Of Testicular Germ Cell Tumors In Children

Part one Diagnostic value of ultrasonography for testicular germ cell tumors in childrenObjective To investigate the diagnostic value of color Doppler ultrasound in testicular germ cell tumor(TGCT)in children.Methods Retrospectively analyzed the ultrasonographic features of 92 children with TGCT confirmed by surgery and pathology.According to pathological diagnosis,they were divided into benign tumor group and malignant tumor group.Logistic regression analysis was used to analyze the risk factors of testicular malignant tumors,and ROC was used to analyze the diagnostic efficacy of independent ultrasonographic features of testicular tumors for benign and malignant tumors.Results There were 64 benign testicular tumors(69.6%)and 28 malignant testicular tumors(30.4%).The most common benign TGCT was teratoma in children,followed by epidermoid cyst.The most common malignant TGCT was yolk sac tumor in children;The maximum diameter of the benign tumor group was smaller than that of the malignant tumor group [(1.69±0.73)cm vs(2.81±1.16)cm,P=0.000],and the difference was statistically significant(P=0.000).In terms of sonographic features,benign tumors were mainly inhomogeneous,malignant tumors were more homogeneous(P=0.000),benign tumors had more calcification and cystic areas than malignant tumors(P=0.000),and benign tumors had lower blood flow classification than malignant tumors(P=0.000).Logistic regression analysis indicated that flow grade was the independent prognostic factors for malignant tumor.By using Alder grade of 2 or above as threshold,the sensitivity,specificity and accuracy were 92.9%、98.4%and 96.7% respectively.Conclusions The sonographic features vary between benign and malignant TGCT in children.Blood flow is the independent factors for predicting malignant tumor.Color Doppler ultrasonography is an important method for differential diagnosis of TGCT in children.Part two CT diagnostic value of testicular germ cell tumors in childrenObjective To explore the differential diagnosis value of CT in children with testicular germ cell tumors(TGCT).Methods Retrospective analysis of clinical data,laboratory examination and CT featur es of 57 children with TGCT(size,border,shape,mass density,calcification,cystic d egeneration,steatosis,blood supply artery and degree of enhancement).According to th e pathological results,the patients were divided into benign tumor group and malignan t tumor group.The tumor size,CT features and diagnostic accuracy were compared b etween the benign and malignant tumor groups.Results Among 57 children with TGCT,40 cases(70.2%)were benign tumors,17 cases(29.8%)were malignant tumors,the most common benign tumors were teratomas and the most common malignant tumors were yolk sac tumors.The difference was statistically significant(P=0.005);In terms of CT features,non-uniform density was common in benign tumors(26/40,65.0%)and homogeneous density was predominant in malignant tumors(12/17,70.6%).The difference was statistically significant(P=0.014).Benign tumor group had more calcification and steatosis than malignant tumor group;malignant tumor had more uniform tumor density and larger blood supply artery than benign tumor group,the difference was statistically significant(all P<0.05);the enhancement intensity of malignant tumor group was higher than that of benign tumor group(all P<0.05).Comparing with pathological results,the coincidence rate of CT diagnosis was 84.2%(48/57).There was no significant difference between benign and malignant tumors(P=0.802).The clinical stages of 17 malignant tumors were stage I 14 cases(88.2%),stage III 2 cases(11.8%)and stage IV 1 case(5.9%),CT showed tumor hemorrhage and necrosis in 5 cases(29.4%),retroperitoneal lymph node metastasis in 2 cases(11.8%)and right lung and left renal hilar metastasis in 1 case(5.9%).The follow-up time ranged from 6 months to 63 months.All the patients survial without tumor exist,The overall survival rate was 100%.Logistic regression analysis showed that tumor feeding artery enlargement was an independent risk factor for predicting tumor benignity and malignancy.The sensitivity,specificity and accuracy of tumor feeding artery enlargement in diagnosing childhood malignant TGCT were 70.6%,97.5% and 89.5% respectively.Conclusions CT examination of TGCT in children has specificity,and tumor feeding artery enlargement is an independent risk factor for predicting benign and malignant TGCT in children.CT examination can preliminarily judge the benign or malignant tumor and clinical stages of TGCT in children,and provide a basis for clinical selection of surgical methods.Part three MRI diagnostic value of testicular germ cell tumors in childrenObjective To investigate the diagnostic value of MRI in children with testicular germ cell tumors(TGCT).Methods The clinical data,MRI findings and pathological findings of 63 children with TGCT were retrospectively analyzed.The patients were divided into benign tumor group and malignant tumor group according to pathological diagnosis.The location,size,border,shape,signal characteristics,cystic and fatty changes,thickening and enhancement of the spermatic cord on the affected side,and the diagnostic accuracy of benign and malignant tumors were compared.Results 63 children with TGCT,45(71.4%)were benign tumors,including teratoma in 23 cases(51.1%),epidermoid cysts in 16 cases(35.6%),dermoid cysts in 6 cases(13.3%),18(28.6%)were malignant tumors,including 16 cases of yolk sac tumor(88.9%)and 2 cases of mixed germ cell tumor(11.1%).In benign tumor group,mixed signal(20/45,44.4%)and high signal(16/45,35.6%)were predominant on T2 WI,low signal(28/45,62.2%)and high signal(16/41,39%)were predominant on DWI,and high signal were predominant in malignant tumor group both on T2 WI and DWI.There were significant differences in T2 WI and DWI between benign and malignant tumor groups(P=0.002,0.000).There were more cystic degeneration and steatosis in benign tumor group than in malignant tumor group(P < 0.05),more thickened spermatic cord t in malignant tumor group han in benign tumor group,and the degree of enhancement in malignant tumor group was higher than that in benign tumor group(all P=0.000).Compared with pathological results,the coincidence rate of MRI diagnosis of benign tumors was 93.3%,and that of malignant tumors was 88.9%.There was no significant difference in the coincidence rate of MRI in diagnosis of benign and malignant TGCT in children(P=0.941).Conclusions MRI evaluation of benign and malignant TGCT in children has differences in T2 WI,DWI,cystic and steatosis of tumor,thickening of the affected spermatic cord and enhancement degree.MRI can provide auxiliary diagnostic information when ultrasound diagnosis of TGCT is not clear.Part four Comparative study of ultrasonography,CT and MRI in diagnosis of testicular germ cell tumors in childrenObjective To investigate the diagnostic value of ultrasonography,CT and MRI in testicular germ cell tumor(TGCT)in children.Methods Retrospective analysis of 92 cases of TGCT confirmed by surgery and pathology in our hospital from March 2013 to July 2018,one or more imaging examinations including ultrasound,CT and MRI were performed before operation.Bland-Altman diagram was used to analyze the consistency of ultrasound,CT and MRI in assessing the size of TGCT tumors in children,and kappa test was used to evaluate the consistency of imaging features of TGCT in children.The diagnostic efficacy of ultrasound,ultrasound combined with CT and ultrasound combined with MRI in children was compared.Results All three imaging examinations can accurately assess the size of TGCT in children.Ultrasound showed a mean difference of tumor maximum diameter of `d=-0.15 cm,a standard deviation of Sd =0.28 cm,a 95% consistency limit of(-0.69~0.39 cm),and 95.7%(88/92)within the consistency limit.CT showed a mean difference of tumor maximum diameter of `d=0.01 cm,a standard deviation of Sd =0.47 cm,a 95% consistency limit of(-0.90~0.93 cm)and 96.5%(55/57)within the consistency limit.MRI showed a mean difference of tumor maximum diameter `d =-0.12 cm,the standard deviation Sd =0.26 cm,a 95% consistency limit of(-0.63~0.40 cm),and 96.8%(61/63)within the consistency limit.In terms of imaging features,the three imaging methods were consistent with pathological findings(all P < 0.05).MRI had the best sensitivity(90.5%)in evaluating tumor cystic degeneration.CT was more sensitive than ultrasound in evaluating tumor calcification(83.3% vs 69.8%.MRI was more sensitive in evaluating tumor steatosis.The sensitivity was higher than that of CT(85.7% vs 75%).The accuracy of ultrasound,CT and MRI in differentiating benign and malignant TGCT in children was 95.7%,94.7% and 93.7%,respectively.Compared with pathological results,the consistency of the three methods in differentiating benign and malignant TGCT in children was excellent(kappa=0.897,0.872,0.844).The coincidence rate of ultrasonic diagnosis of TGCT was 72.8%.The coincidence rate of ultrasound combined with CT,ultrasound combined with MRI was 87.7% and 90.5% respectively,the difference was statistically significant(P= 0.031,0.007).Conclusions Ultrasound,CT and MRI have higher diagnostic and differential value for TGCT in children.Ultrasound combined with CT,Ultrasound combined with MRI can improve the diagnostic coincidence rate of TGCT in children,and provide the basis for clinical selection of surgical procedures.