Is contralateral testicular biopsy warranted at the time of orchidectomy?

Summary 

Objective

Previous studies have suggested that biopsy of the contralateral testis at the time of radical inguinal orchidectomy for unilateral testicular cancer should be performed to exclude intra tubular germ cell neoplasia (ITGCN). This practice has become routine in many urology departments. We reviewed the histological outcome of contralateral testis biopsy in patients with testis cancer to determine if it was appropriate to routinely continue this practice.

Methods

The medical records of all men presenting to our institution with testicular cancer between 1998 and 2006 were retrospectively reviewed. The histological diagnosis following inguinal orchidectomy and the outcome of contralateral testis biopsy (where this had been performed) were recorded. The median duration of follow-up was 56 months and the incidence of metachronous tumours during this period was noted.

Results

There were 193 consecutive cases of testicular cancer (seminoma, n=108; nonseminatous germ cell tumour [NSGCT], n=73; non-GCT, n=8; lymphoma, n=4). Nine patients had a history of maldescent, 12 had microlithiasis and 9 had atrophic testes. One hundred and fifty-one men had contralateral testis biopsies, but there were no cases of ITGCN, regardless of original tumour type or stage. Four patients (all with initial seminomas) developed metachronous tumours, 3 were seminomas and 1 was a mixed GCT. In 3 of the 4 cases, the previous contralateral testis biopsy was normal while the fourth patient was not biopsied at the time of his initial surgery. There were 4 (3%) cases of haematoma following contralateral testis biopsy.

Conclusion

Contralateral testis biopsy was unhelpful in predicting metachronous tumour occurrence, carries a small risk of morbidity and should not be routinely performed in men undergoing orchidectomy for testicular cancer.

Abbreviations: NSGCT, nonseminomatous germ cell tumour, GCT, germ cell tumour, ITGCN, intra tubular germ cell neoplasia, CIS, carcinoma in situ

Keywords: Testicular cancer, Contralateral biopsy, Histology, Metachronous tumour