Abstract
Testicular tumors often pose a significant threat to the health of young adult males, and inappropriate radical orchiectomy imposes a heavy physical and psychological burden on many patients.In order to accurately distinguish testicular benign and malignant tumors prior to treatment, we retrospectively enrolled 298 patients with testicular tumors treated at the First Affiliated Hospital of Zhengzhou University between June 2016 and June 2024, all of whom met the inclusion and exclusion criteria. Using a random number method, the patients were divided into a training set (209 cases, 70%) and an internal validation set (89 cases, 30%). Additionally, 55 patients from two different medical centers, treated between January 2019 and January 2024 and meeting the same criter-ia, were included as an external validation set. Tumor size (OR = 2.70, 95% CI: 1.80–4.05, P < 0.001), boundary (OR = 3.99, 95% CI: 1.34–11.86, P = 0.013), AFP (OR = 7.49, 95% CI: 1.92–29.25, P = 0.004), hCG (OR = 5.21, 95% CI: 1.30–20.95, P = 0.020), and CDFI (Grade II: OR = 4.23, 95% CI: 1.35–13.26, P = 0.014; Grade III: OR = 16.26, 95% CI: 3.68–71.83, P < 0.001) were identified as five independent discriminative factors for distinguishing benign from malignant testicular tumors. A nomogram model incorporating these factors was constructed and demonstrated favorable performance. The model was deployed online as a dynamic nomogram (https://nomogram98.shinyapps.io/dynnomapp/).
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The datasets used and/or analysed during the current study available from thecorresponding author on reasonable request.
References
Tateo, V. et al. Epidemiology and risk factors for testicular cancer: a systematic review. European Urology, : S0302-2838(24)02685-X. (2024).
Znaor, A. et al. Testicular cancer incidence predictions in Europe 2010–2035: A rising burden despite population ageing. Int. J. Cancer. 147 (3), 820–828 (2020).
Hu, T. et al. Nomogram to differentiate benign and malignant thyroid nodules in the American College of Radiology Thyroid Imaging Reporting and Data System level 5. Clin. Endocrinol. 98 (2), 249–258 (2023).
Winarno, G. N. A. et al. Nomogram development for predicting ovarian tumor malignancy using inflammatory biomarker and CA-125. Sci. Rep. 14(1), 15790 (2024).
Peduzzi, P. et al. A simulation study of the number of events per variable in logistic regression analysis. J. Clin. Epidemiol. 49 (12), 1373–1379 (1996).
Yuan, X. et al. Development and validation of a model to predict cognitive impairment in traumatic brain injury patients: A prospective observational study. EClin. Med. 80, 103023 (2025).
Moch, H. et al. The 2016 WHO classification of tumours of the urinary system and male genital organs-Part A: Renal, penile, and testicular tumours. Eur. Urol. 70(1), 93–105 (2016).
Moch, H. et al. The 2022 World Health Organization classification of tumours of the urinary system and male genital organs-Part A: Renal, penile, and testicular tumours. Eur. Urol. 82(5), 458–468 (2022).
Adler, D. D. et al. Doppler ultrasound color flow imaging in the study of breast cancer: Preliminary findings. Ultrasound Med. Biol. 16(6), 553–559 (1990).
Van Calster, B. et al. Reporting and interpreting decision curve analysis: A guide for investigators. Eur. Urol. 74(6), 796–804 (2018).
Yu, H. et al. Nomogram for predicting testicular yolk sac tumor in children based on age, alpha-fetoprotein, and ultrasonography. Front. Pediatr. 12, 1407120 (2024).
Zhang, H. et al. A nomogram for predicting survival in patients with primary testicular lymphoma: A population-based study. Urol. Oncol. 43(5), 337.e9-337.e21 (2025).
Zhi, Y. et al. Development and validation of a survival nomogram in patients with primary testicular diffuse large B-cell lymphoma. J. Int. Med. Res. 51(9), 3000605231197052 (2023).
Song, G. et al. The role of tumor size, ultrasonographic findings, and serum tumor markers in predicting the likelihood of malignant testicular histology. Asian J. Androl. 21 (2), 196–200 (2019).
Fang, F. et al. Ultrasound-based deep learning radiomics nomogram for risk stratification of testicular masses: A two-center study. J. Cancer Res. Clin. Oncol. 150(1), 18 (2024).
Hutson, J. M. et al. Cryptorchidism. Semin. Pediatr. Surg. 19(3), 215–224 (2010).
Pettersson, A. et al. Age at surgery for undescended testis and risk of testicular cancer. N. Engl. J. Med. 356(18), 1835–1841 (2007).
Demirci, A. & Başar, H. Can serum tumor marker densities according to tumor volume and testicle size be used to predict progression in patients with testicular cancer? Curr. Urol. 18 (3), 218–224 (2024).
Konstantatou, E. et al. Evaluation of Intratesticular Lesions With Strain Elastography Using Strain Ratio and Color Map Visual Grading: Differentiation of Neoplastic and Nonneoplastic Lesions. J. Ultrasound Medicine: Official J. Am. Inst. Ultrasound Med. 38 (1), 223–232 (2019).
Dell’Atti, L., Fulvi, P. & Benedetto Galosi, A. Are ultrasonographic measurements a reliable parameter to choose non-palpable testicular masses amenable to treatment with sparing surgery?. Journal of B.U.ON.: official journal of the Balkan Union of Oncology 23(2), 439–443 (2018).
Pozza, C. et al. Diagnostic value of qualitative and strain ratio elastography in the differential diagnosis of non-palpable testicular lesions. Andrology 4(6), 1193–1203 (2016).
Huang, D. Y. et al. Multiparametric ultrasound for focal testicular pathology: A ten-year retrospective review. Cancers 16(13), 2309 (2024).
Belfield, J. & Findlay-Line, C. Testicular Germ Cell Tumours-The Role of Conventional Ultrasound. Cancers (Basel). 14 (16), 3882 (2022).
Arellano, C. M. R. et al. Testicular epidermoid cysts in children: Sonographic characteristics with pathological correlation. Pediatr. Radiol. 41(6), 683–689 (2011).
Necas, M., Muthupalaniappaan, M. & Barnard, C. Ultrasound morphological patterns of testicular tumours, correlation with histopathology. J. Med. Radiat. Sci. 68(1), 21–27 (2021).
Damjanov, I. Testicular Germ Cell Tumors: Serological and immunohistochemical diagnosis. Acta Med. Acad. 50(1), 58–70 (2021).
Sykes, J., Kaldany, A. & Jang, T. L. Current and evolving biomarkers in the diagnosis and management of Testicular Germ Cell Tumors. J. Clin. Med. 13(23), 7448 (2024).
Nome, R. V. et al. Lowered reference limits for hCG improve follow-up of patients with hCG-producing tumors. Clin. Biochem. 52, 73–79 (2018).
Trojan, A. et al. False-positive human serum chorionic gonadotropin in a patient with a history of germ cell cancer. Oncology 66(4), 336–338 (2004).
Milose, J. C. et al. Role of biochemical markers in testicular cancer: Diagnosis, staging, and surveillance. Open Access J. Urol. 4, 1–8 (2011).
Schoch, J. et al. Neue Tumormarker bei Hodentumoren – im hier und jetzt und in der Zukunft [New tumor markers for testicular cancer - in the here and now and in the future]. Aktuelle Urol. 55 (6), 520–527 (2024).
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We acknowledge the support from the First Affiliated Hospital of Zhengzhou University and the hard work of all authors.
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Our research received funding from The National Natural Science Foundation of China:82303032.
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CGW and SCL was responsible for conceiving the manuscript and drafting the manuscript. HH and HXJ revised the manuscript. ZKJ provided overall guidance on the manuscript. All authors read and approved the final manuscript.
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Wang, Cg., Li, Sc., He, H. et al. Construction and validation of a nomogram model for the differential diagnosis of primary testicular benign and malignant tumors. Sci Rep (2026). https://doi.org/10.1038/s41598-026-47759-1
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DOI: https://doi.org/10.1038/s41598-026-47759-1


