Predictive features of pre-operative computed tomography and magnetic resonance imaging for advanced disease in renal cell carcinoma
https://doi.org/10.4081/aiua.2022.1.1
Accepted: January 18, 2022
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Objective: We evaluated predictive features of pre-operative computed tomography and magnetic resonance imaging for advanced disease in renal cell carcinoma.
Materials and methods: 92 patients with pathologically confirmed diagnosis of renal cell carcinoma were included in our study. Patients were divided into two groups according to preoperative imaging as computed tomography (CT) (55 patients) and magnetic resonance imaging (MRI) (37 patients). Within the imaging groups, the patients were divided into two groups according to pathological tumor stage: 1-2 (pT1-2) versus ≥ pT3a. It was evaluated whether there was a difference between the two groups in terms of the presence of pre-operative imaging (CT and MRI) features. Predictive value of these features for ≥ pT3a disease was evaluated both for CT and MRI.
Results: The cut-off value for the Gerota’s fascia thickness in predicting ≥ pT3a disease was calculated as 0.205 cm. Positive predictive value (PPV) for Gerota's fascia thickness was 52.4% (31.0-73.7) and 66.7% (40.0-93.3) for CT and MRI respectively. The PPV value for renal capsule invasion was 75.0% (53.8-96.2) and 90.0% (71.4-108.6) for CT and MRI respectively. PPV of perirenal fat invasion for CT and MRI was 69.2% (44.1-94.3) and 81.8% (59.0-104.6) respectively.
Conclusion: Renal capsular invasion and perirenal fat invasion are reliable signs for locally advanced (≥ pT3a) renal cell carcinoma both in CT and MRI. Gerota’s fascia thickness has relatively low PPV value for prediction of locally advanced disease. Presence of enlarged collateral vessels, tumor necrosis, perinephric stranding are not reliable signs. For all predictors MRI seems more reliable than CT.
Bray F, Ferlay J, Soerjomataram I, et al. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J. Clin 2018; 68:394-424. DOI: https://doi.org/10.3322/caac.21492
Novara G, Ficarra V, Antonelli A, et al. Validation of the 2009 TNM version in a large multi-institutional cohort of patients treated for renal cell carcinoma: are further improvements needed? Eur Urol, 2010; 58:588-95. DOI: https://doi.org/10.1016/j.eururo.2010.07.006
Van Poppel H, Da Pozzo L, Albrecht W, et al. A prospective, randomised EORTC intergroup phase 3 study comparing the oncologic outcome of elective nephron-sparing surgery and radical nephrectomy for low-stage renal cell carcinoma. Eur Urol, 2011; 59:543-52. DOI: https://doi.org/10.1016/j.eururo.2010.12.013
Mir MC, Derweesh I, Porpiglia F, et al. Partial nephrectomy versus radical nephrectomy for clinical T1b and T2 renal tumors: a systematic review and meta-analysis of comparative studies. Eur Urol, 2017; 71:606-617. DOI: https://doi.org/10.1016/j.eururo.2016.08.060
Ljungberg B, Albiges L, Abu-Ghanem Y, et al. European Association of Urology guidelines on renal cell carcinoma: The 2019 update. Eur. Urol.2019; 75:799-810. DOI: https://doi.org/10.1016/j.eururo.2019.02.011
Antonelli A, Furlan M, Tardanico R, et al. Features of ipsilateral renal recurrences after partial nephrectomy: a proposal of a pathogenetic classification. Clin Genitourin Cancer 2017; 15:540-547. DOI: https://doi.org/10.1016/j.clgc.2017.04.028
Hotker AM, Karlo CA, Zheng J, et al. Clear cell renal cell carcinoma: Associations between CT features and patient survival. AJR Am. J. Roentgenol. 2016; 206:1023-1030. DOI: https://doi.org/10.2214/AJR.15.15369
Amin MB, Greene FL, Edge SB, et al. The Eighth Edition AJCC Cancer Staging Manual: Continuing to build a bridge from a population-based to a more “personalized” approach to cancer staging. CA Cancer J Clin. 2017; 67:93-99. DOI: https://doi.org/10.3322/caac.21388
Sokhi HK, Mok WY, Patel U. Stage T3a renal cell carcinoma: staging accuracy of CT for sinus fat, perinephric fat or renal vein invasion. Br J Radiol 2015; 88:20140504 DOI: https://doi.org/10.1259/bjr.20140504
Ha U-S, Lee KW, Jung J-H, et al. Renal capsular invasion is a prognostic biomarker in localized clear cell renal cell carcinoma Sci Rep 2018; 8:202. DOI: https://doi.org/10.1038/s41598-017-18466-9
Zhang Y, Tian H, Zhang S, et al. Multislice spiral computed tomography signs of invasion of the renal capsule by renal cell carcinoma Medicine 2018; 97:e13075. DOI: https://doi.org/10.1097/MD.0000000000013075
Bradley AJ, MacDonald L, Whiteside S, et al. Accuracy of preoperative CT T staging of renal cell carcinoma: which features predict advanced stage? Clin Radiol 2015; 70:822-9. DOI: https://doi.org/10.1016/j.crad.2015.03.013
Shah PH, Lyon TD, Lohse CM, et al. Prognostic evaluation of perinephric fat, renal sinus fat, and renal vein invasion for patients with pathological stage T3a clear-cell renal cell carcinoma BJU Int 2019; 123:270-276. DOI: https://doi.org/10.1111/bju.14523
Brookman-May SD, May M, Wolff I, et al. Evaluation of the prognostic significance of perirenal fat invasion and tumor size in patients with pT1-pT3a localized renal cell carcinoma in a comprehensive multicenter study of the CORONA project. Can we improve prognostic discrimination for patients with stage pT3a tumors? Eur Urol 2015; 67:943-51. DOI: https://doi.org/10.1016/j.eururo.2014.11.055
Renard AS, Nedelcu C, Paisant A, et al. Is multidetector CT-scan able to detect T3a renal tumor before surgery? Scand J Urol 2019;53:350-35. DOI: https://doi.org/10.1080/21681805.2019.1675756
El-Hefnawy AS, Mosbah A, El-Diasty T, et al. Accuracy of multidetector computed tomography (MDCT) in staging of renal cell carcinoma (RCC): analysis of risk factors for mis-staging and its impact on surgical intervention World J Urol 2013; 31:887-91. DOI: https://doi.org/10.1007/s00345-011-0816-7
Nazım SM, Ather MH, Hafeez K, et al. Accuracy of multidetector CT scans in staging of renal carcinoma Int J Surg 2011; 9:86-90. DOI: https://doi.org/10.1016/j.ijsu.2010.07.304
Zhang L, Zha Z, Qu W, et al. Tumor necrosis as a prognostic variable for the clinical outcome in patients with renal cell carcinoma: a systematic review and meta-analysis BMC Cancer 2018; 18:870. DOI: https://doi.org/10.1186/s12885-018-4773-z
Suo X, Chen J, Zhao Y, et al. Clinicopathological and radiological significance of the collateral vessels of renal cell carcinoma on preoperative computed tomography Sci Rep 2021; 11:518. DOI: https://doi.org/10.1038/s41598-021-84631-w
Farrell MR, Papagiannopoulos D, Ebersole J, et al. Perinephric fat stranding is associated with elevated creatinine among patients with acutely obstructing ureterolithiasis. J Endourol 2018; 32:891-89. DOI: https://doi.org/10.1089/end.2018.0252
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