The presence of more than 5 calcifications per image field on ultrasound, with each calcification < 2 mm, and normal testicular shape or volume.
5 % prevalence in an asymptomatic screened population of healthy young men.
But, high rates of co-existing microlithiasis on ultrasounds showing testicular cancer.
It was once believed that microlithiasis was a possible precursor to testicular cancer, however a prospective study now suggests the risk of developing a germ cell tumour is comparable to the normal population.
- < 2 % (1/68) of those found with microlithiasis developed GCT within 5 years
AUA 2019 guideline
“Testicular microlithiasis in the absence of solid mass and risk factors for developing a GCT does not confer an increased risk of malignant neoplasm and does not require further evaluation”
In practice:
- Assess for risk factors – cryptorchidism, atrophic testes, known infertility, family history – these men may benefit from surveillance and follow up
- If no risk factors – reassurance that no link has been proven, and regular routine follow up is not recommended
- Encourage self examination and re-assessment if any palpable abnormality develops