Multiparametric Ultrasound Findings of Testicular Sarcoidosis

17 men with testicular sarcoidosis had tiny, stable nodules that mimicked cancer on ultrasound

Journal: Journal of Ultrasound in Medicine | Published: 2026-02-06 | Type: Retrospective case series | PMID: 41645844 Authors: Liu Huahui, Abudalo Razan, Salahia Ghali, Yusuf Gibran T, Huang Dean Y, Sidhu Paul S (King's College Hospital, London and University Hospital of Wales, Cardiff) Funding/COI: Not listed

Summary

This is a 16-year retrospective chart review from a single UK hospital describing what testicular sarcoidosis looks like on four different ultrasound techniques combined (greyscale, color Doppler, contrast-enhanced ultrasound, and strain elastography). Across 17 men, the lesions were consistently small, hypoechoic, poorly vascularized, and stable over years of follow-up, a pattern the authors argue can be distinguished from testicular cancer without resorting to surgery. The paper is descriptive: it catalogs an imaging appearance rather than testing a diagnostic algorithm against an alternative.

Claims

• 17 men (mean age 42.1-43.1 years, reported inconsistently between abstract and results) had testicular sarcoidosis confirmed by biopsy or clinical criteria
• Lesions were small (mean 4.3 ± 1.8 mm), solid, hypoechoic, and well-defined in 100% of cases
• Multifocal in 76.5% of patients, bilateral in 52.9%
• No/low internal vascularity on Doppler in 82.4% of lesions (47.1% avascular, 35.3% hypovascular)
• No contrast enhancement in 62.5% of 16 evaluable lesions
• Intermediate or soft elasticity on strain elastography in 80% of 15 evaluable lesions (53.3% intermediate, 26.7% soft)
• 76.5% of lesions were stable in size and appearance on follow-up imaging (6 months to 10 years, median 3 years)

Study Quality

This is a retrospective, single-institution case series with no comparison group. The diagnostic criteria were mixed: only 3 of 17 patients (17.6%) had testicular tissue biopsied; 9 (52.9%) were diagnosed from biopsies of other organs (lung, lymph node, skin), and 5 (29.4%) had no tissue diagnosis at all, relying instead on clinical assessment plus "typical" imaging and stable follow-up. That last group is circular: patients were included partly because their scans looked like the pattern the study then reports as characteristic. Elastography and CEUS data were also incomplete (15/17 and 16/17 lesions respectively), and the paper doesn't report inter-observer agreement statistics despite noting three different radiologists performed the scans, only that they "agreed without need for further evaluation."

There is no control arm of testicular malignancies or other benign lesions scanned with the same four-modality protocol, so the claim that this pattern "differs meaningfully" from cancer rests on the authors' prior knowledge of tumor imaging literature, not a head-to-head comparison in this dataset. With an n of 17 and no denominator of how many testicular sarcoidosis cases were missed, sensitivity and specificity cannot be calculated.

Red Flags

• No control group of malignant or other benign testicular lesions imaged with the same protocol
• Nearly a third of the cohort (29.4%) diagnosed without any tissue confirmation, using imaging appearance as part of the inclusion criteria itself
• No funding or conflict-of-interest disclosure provided
• Inconsistent mean age reported between abstract (42.1) and results (43.1)
• Missing elastography (2 lesions) and CEUS data (1 lesion) not accounted for in denominators
• No inter-observer reliability statistics despite three different operators and four ultrasound systems

Strengths

• Longest follow-up reported for this rare condition (up to 10 years, median 3)
• Multiparametric approach (four modalities) rather than relying on greyscale alone
• Clear reporting of diagnostic pathway per patient (biopsy site or clinical criteria)
• Addresses a real clinical problem: avoiding unnecessary orchidectomy for a benign mimic

Verdict

This is a useful catalog of what a rare condition looks like on ultrasound, not evidence that ultrasound can reliably rule out cancer in these patients. With no comparator group, a circular diagnostic criterion applied to nearly a third of the cohort, and no reported test performance statistics, the paper describes an imaging pattern rather than validates a diagnostic strategy. Worth reading if you want to know what testicular sarcoidosis looks like on multiparametric ultrasound; not sufficient on its own to change how equivocal testicular lesions get worked up.