{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,10]],"date-time":"2026-10-10T08:48:55Z","timestamp":1791622135323,"version":"4.3.4"},"reference-count":35,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,10,10]],"date-time":"2026-10-10T00:00:00Z","timestamp":1791590400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,10,10]],"date-time":"2026-10-10T00:00:00Z","timestamp":1791590400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["bjui-journals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["BJU International"],"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>To synthesise evidence comparing the diagnostic performance of imaging modalities in differentiating malignant from benign small testicular masses.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Patients and Methods<\/jats:title>\n                    <jats:p>A Preferred Reporting Items for Systematic Reviews and Meta\u2010Analyses (PRISMA)\u2010compliant search of PubMed, Scopus, Cochrane and Web of Science databases up to 6 May 2026 identified 11 studies comprising 707 patients with small testicular masses (predominantly &lt;2\u2009cm) who underwent imaging prior to a histopathological or, where unavailable, a mixed clinical\/radiological follow\u2010up reference standard. Diagnostic accuracy measures for six modalities (brightness\u2010mode [B\u2010Mode] ultrasonography [US], colour doppler US [CDUS], contrast\u2010enhanced US [CEUS], magnetic resonance imaging [MRI], strain elastography [SE] and strain ratio [SR]) were synthesised using a Bayesian bivariate hierarchical summary receiver operating characteristic model.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The CEUS demonstrated the most reliable discriminatory ability with a pooled sensitivity of 91% and pooled specificity of 81%, yielding the highest diagnostic odds ratio of 46. B\u2010Mode US remains a valid screening test with the highest sensitivity of 96% but a specificity of only 39%. CDUS showed a pooled sensitivity of 69% and a specificity of 81%. MRI had a pooled sensitivity of 91% and a specificity of 38%. SE demonstrated a pooled sensitivity of 87% and a specificity of 56%. Finally, SR reported the lowest sensitivity at 74% and a specificity of 50%. CEUS demonstrated significantly higher specificity than B\u2010Mode US (ratio 1.9, 95% posterior interval [PI] 1.2\u20134.4) and MRI (ratio 1.8, 95% PI 1.0\u20135.2).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The CEUS demonstrates the highest combined sensitivity and specificity for differentiating benign from malignant testicular masses, significantly outperforming conventional B\u2010Mode US and MRI in specificity. CEUS represents a compelling decision\u2010making tool to support testis\u2010sparing strategies and reduce unnecessary orchidectomies for indeterminate small testicular masses.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/bju.70492","type":"journal-article","created":{"date-parts":[[2026,10,10]],"date-time":"2026-10-10T08:09:55Z","timestamp":1791619795000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Comparative accuracy of imaging modalities for differentiating malignant small testicular masses"],"prefix":"10.1111","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8490-1743","authenticated-orcid":false,"given":"Yajat","family":"Dua","sequence":"first","affiliation":[{"name":"Department of Urology Royal Melbourne Hospital  Parkville Victoria Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-2075-1438","authenticated-orcid":false,"given":"Anusha","family":"Maheshwari","sequence":"additional","affiliation":[{"name":"Department of Urology Royal Melbourne Hospital  Parkville Victoria Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1138-6389","authenticated-orcid":false,"given":"Marlon","family":"Perera","sequence":"additional","affiliation":[{"name":"Department of Genitourinary Oncology Peter MacCallum Cancer Centre  Parkville Victoria Australia"},{"name":"Department of Surgery University of Melbourne  Parkville Victoria Australia"},{"name":"The Sir Peter MacCallum Department of Oncology University of Melbourne  Parkville Victoria Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7500-5899","authenticated-orcid":false,"given":"Declan","family":"Murphy","sequence":"additional","affiliation":[{"name":"Department of Genitourinary Oncology Peter MacCallum Cancer Centre  Parkville Victoria Australia"},{"name":"Department of Surgery University of Melbourne  Parkville Victoria Australia"},{"name":"The Sir Peter MacCallum Department of Oncology University of Melbourne  Parkville Victoria Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8553-5618","authenticated-orcid":false,"given":"Nathan","family":"Lawrentschuk","sequence":"additional","affiliation":[{"name":"Department of Urology Royal Melbourne Hospital  Parkville Victoria Australia"},{"name":"Department of Genitourinary Oncology Peter MacCallum Cancer Centre  Parkville Victoria Australia"},{"name":"Department of Surgery University of Melbourne  Parkville Victoria Australia"},{"name":"The Sir Peter MacCallum Department of Oncology University of Melbourne  Parkville Victoria Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3710-014X","authenticated-orcid":false,"given":"Niranjan","family":"Sathianathen","sequence":"additional","affiliation":[{"name":"Department of Urology Royal Melbourne Hospital  Parkville Victoria Australia"},{"name":"Department of Surgery University of Melbourne  Parkville Victoria Australia"},{"name":"The Sir Peter MacCallum Department of Oncology University of Melbourne  Parkville Victoria Australia"},{"name":"Department of Urology Austin Health  Heidelberg Victoria Australia"},{"name":"School of Medicine Deakin University  Ballarat Victoria Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,10,10]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"crossref","first-page":"481","DOI":"10.1016\/j.juro.2017.08.004","article-title":"Prevalence and management of incidental small testicular masses discovered on ultrasonographic evaluation of male infertility","volume":"199","author":"Bieniek JM","year":"2018","journal-title":"J Urol"},{"key":"e_1_2_9_3_1","doi-asserted-by":"crossref","first-page":"2787","DOI":"10.1016\/j.ultrasmedbio.2021.05.022","article-title":"Incidental findings and how to manage them: testis\u2014a WFUMB position paper","volume":"47","author":"Lewicki A","year":"2021","journal-title":"Ultrasound Med Biol"},{"key":"e_1_2_9_4_1","doi-asserted-by":"crossref","first-page":"522","DOI":"10.1016\/j.clgc.2013.04.033","article-title":"Can testis\u2010sparing surgery for small testicular masses be considered a valid alternative to radical orchiectomy? 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