Ultrasound-based measurements of testicular volume in 6- to 16-year-old boys - intra- and interobserver agreement and comparison with Prader orchidometry

Abstract

Background: Prader orchidometry has been the standard method for evaluating testicular size. As this technique is subjective and tends to overestimate the testicular volume, ultrasound (US) has been proposed as more reliable.

Objective: To evaluate the intra- and interobserver agreement of US measurements of testicular volume and to compare US with the Prader orchidometer.

Materials and methods: Dimensions of the right testicle were measured using US in 57 boys ages 6.5 to 16.4 years (mean: 12.0 years). The measurements were performed twice by one main observer and once by a second observer. A third observer estimated testicular volume using a Prader orchidometer. Agreement was investigated with Bland-Altman plots, summarized as the mean and standard deviation (SD) of differences, 95% limits of agreement and technical error of measurement.

Results: Mean intra-observer difference of testicular volume was 2.2%, SD=9.2% (limits of agreement: -20.3 to 15.9%) and technical error of measurement 6.5%. The mean interobserver difference was 4.8%, SD=20.7% (limits of agreement: -35.7 to 45.3%) and technical error of measurement 14.6%. Comparing US and orchidometer volumes required conversion that was nonlinear and volume dependent, estimated as Vol_OM = 1.96×Vol_US^0.71. The mean difference after transformation was 0.7% with an SD of 18.0% (limits of agreement: -34.5 to 35.9%).

Conclusion: Our results showed a small mean intra- and interobserver difference that indicates the potential of US for measurement of testicular volume at group level. The intra-observer error was limited, which justifies its use in longitudinal follow-up of testicular development in an individual child, but the larger interobserver variability indicates the need for good standardization of methods. Agreement between the two methods requires a power transformation.

Keywords: Children; Interobserver; Observer variability; Orchidometer; Precision; Testicular volume; Ultrasound.