The objective of this study was to assess whether scrotal ultrasound scan is necessary in patients with clinically suspected benign testis pathology.

Between January 2012 and December 2013 a total of 3297 men with a median age of 37 years (range 16–60 years) underwent a scrotal ultrasound scan performed by a mixture of radiographers and radiologists. Of these, 1378/3297 (42%) with a median age of 36 years (range 16–60 years) were included in our study; 1919 (58%) were excluded, as they were thought to have an infective, malignant or traumatic testis.

Twenty-six out of 1378 (1.9%) had a sinister scrotal ultrasound scan and were referred to the urology multidisciplinary team. Of these, 17/26 (65%) with a median age of 32 years (range 19–59 years) were still regarded as having a malignant pathology and underwent an orchidectomy. Histology revealed a malignant pathology in 14/17 (82%) with a median age of 32 years (range 23–52 years). Overall, 17/1378 (1.2%) had an unexpected suspicious scrotal ultrasound scan supported at the multidisciplinary team review, with 14/1378 (1%) having a confirmed malignant pathology.

Our large retrospective study has demonstrated that 1% of men with clinically benign testis lesion will actually have an underlying unsuspected malignant pathology. Therefore, scrotal ultrasound scan should be considered in all men presenting with a testis lesion.