睾丸癌

首要检查。

敏感性接近100%。[22]Ilic D, Misso ML. Screening for testicular cancer. Cochrane Database Syst Rev. 2011;(2):CD007853.http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD007853.pub2/fullhttp://www.ncbi.nlm.nih.gov/pubmed/21328302?tool=bestpractice.com

在诊断流程中早期进行。

如果超声无法确认肿块并且高度可疑（例如异常肿瘤标志物），下一步可进行盆腔和腹部CT扫描。

睾丸肿物

用来评估睾丸外转移。

用于疗效随访评估和监测复发的常规步骤。

增大的淋巴结

在使用超灵敏探针的情况下，对于50岁以下男性上限参考值是0.7 U/L。

在所有的绒毛膜癌患者中均升高。

5%-10%的单纯精原细胞瘤患者中会升高。[34]Sturgeon CM, Duffy MJ, Stenman UH, et al. National Academy of Clinical Biochemistry laboratory medicine practice guidelines for use of tumor markers in testicular, prostate, colorectal, breast, and ovarian cancers. Clin Chem. 2008;54:e11-e79.http://www.clinchem.org/cgi/content/full/54/12/e11http://www.ncbi.nlm.nih.gov/pubmed/19042984?tool=bestpractice.com

＞0.7 U/L

半衰期是5-7天，当肿瘤切除后25-35天内水平会恢复正常。

在胚胎癌、畸胎瘤、卵黄囊肿瘤或混合肿瘤中会出现升高。

单纯的绒毛膜癌和精原细胞瘤与升高的AFP并不相关。

＞25 μg/L (＞25 ng/mL)

在50%的患者中升高。[34]Sturgeon CM, Duffy MJ, Stenman UH, et al. National Academy of Clinical Biochemistry laboratory medicine practice guidelines for use of tumor markers in testicular, prostate, colorectal, breast, and ovarian cancers. Clin Chem. 2008;54:e11-e79.http://www.clinchem.org/cgi/content/full/54/12/e11http://www.ncbi.nlm.nih.gov/pubmed/19042984?tool=bestpractice.com[35]Stenman UH, Lamerz R, Looijenga LH. Tumor markers in testicular cancers. In: The National Academy of Clinical Biochemistry. Laboratory medicine practice guidelines: use of tumor markers in testicular, prostate, colorectal, breast and ovarian cancers. 2009. http://www.aacc.org/ (last accessed 8 September 2016).https://www.aacc.org/~/media/practice-guidelines/major-tumor-markers/tumormarkersmajor10.pdf?la=en

但是，假阳性率高，并且主要用于评估肿瘤负担。

在10%的非精原细胞瘤患者中是唯一升高的肿瘤标志物。[34]Sturgeon CM, Duffy MJ, Stenman UH, et al. National Academy of Clinical Biochemistry laboratory medicine practice guidelines for use of tumor markers in testicular, prostate, colorectal, breast, and ovarian cancers. Clin Chem. 2008;54:e11-e79.http://www.clinchem.org/cgi/content/full/54/12/e11http://www.ncbi.nlm.nih.gov/pubmed/19042984?tool=bestpractice.com[35]Stenman UH, Lamerz R, Looijenga LH. Tumor markers in testicular cancers. In: The National Academy of Clinical Biochemistry. Laboratory medicine practice guidelines: use of tumor markers in testicular, prostate, colorectal, breast and ovarian cancers. 2009. http://www.aacc.org/ (last accessed 8 September 2016).https://www.aacc.org/~/media/practice-guidelines/major-tumor-markers/tumormarkersmajor10.pdf?la=en

＞25 U/L

对正确的分期是必须的。

纵隔和肺部肿块提示转移

根据使用不同的特殊探针，正常值范围不同。

在40%的疾病进展患者中出现升高。[34]Sturgeon CM, Duffy MJ, Stenman UH, et al. National Academy of Clinical Biochemistry laboratory medicine practice guidelines for use of tumor markers in testicular, prostate, colorectal, breast, and ovarian cancers. Clin Chem. 2008;54:e11-e79.http://www.clinchem.org/cgi/content/full/54/12/e11http://www.ncbi.nlm.nih.gov/pubmed/19042984?tool=bestpractice.com[35]Stenman UH, Lamerz R, Looijenga LH. Tumor markers in testicular cancers. In: The National Academy of Clinical Biochemistry. Laboratory medicine practice guidelines: use of tumor markers in testicular, prostate, colorectal, breast and ovarian cancers. 2009. http://www.aacc.org/ (last accessed 8 September 2016).https://www.aacc.org/~/media/practice-guidelines/major-tumor-markers/tumormarkersmajor10.pdf?la=en

升高

在1/3的精原细胞瘤患者中升高。[35]Stenman UH, Lamerz R, Looijenga LH. Tumor markers in testicular cancers. In: The National Academy of Clinical Biochemistry. Laboratory medicine practice guidelines: use of tumor markers in testicular, prostate, colorectal, breast and ovarian cancers. 2009. http://www.aacc.org/ (last accessed 8 September 2016).https://www.aacc.org/~/media/practice-guidelines/major-tumor-markers/tumormarkersmajor10.pdf?la=en

＞85 U/L

相对于CT是另一种有效的影像学评估方法。

分级工具

分级工具。当腹部CT阳性或CXR异常时推荐行胸部CT扫描。

可以显示转移病灶

对于睾丸肿物一般不建议行活检评估。 诊断建立在完整睾丸的切除和检测之上。应该尽早施行进行评估。[Figure caption and citation for the preceding image starts]: 精原细胞瘤由 Francisco G. La Rosa 博士收集，经许可后使用 [Citation ends].[Figure caption and citation for the preceding image starts]: 非精原细胞瘤由 Francisco G. La Rosa 博士收集，经许可后使用 [Citation ends].

确定睾丸肿物的组织学类型