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Das CJ, Agarwal K, Sharma S, Seth A. Role of Contrast-Enhanced Ultrasound in Evaluation of Cystic Renal Mass. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2023; 42:2873-2881. [PMID: 37676901 DOI: 10.1002/jum.16328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 08/20/2023] [Accepted: 08/21/2023] [Indexed: 09/09/2023]
Abstract
OBJECTIVES Contrast-enhanced ultrasound (CEUS) allows excellent delineation of perfusion in septa and nodules without exposure to ionizing radiation or nephrotoxic contrast media. The aim of our study was to evaluate the role of CEUS for the assessment of cystic renal masses and compare its diagnostic performance with that of CECT. METHODS Exactly 40 patients diagnosed to have cystic renal masses on CECT scan were prospectively evaluated with CEUS and were assigned a Bosniak class. Based on results of final histopathology and clinical follow-up, internal validity of both CEUS and CECT was evaluated, including agreement between these two modalities. RESULTS Out of the 40 patients (mean size 3.1 ± 2.5 cm), 23 patients had benign lesions and 17 patients had malignant lesions. For CEUS, the sensitivity and negative predictive value was 100%, the specificity and positive predictive value was 73.9%. For CECT, the sensitivity and negative predictive value were 88.2 and 83.3%, respectively, whereas the specificity and positive predictive value was 87 and 90.9%, respectively. Both imaging modalities had similar accuracy with fair to good agreement with the final diagnosis (Κ = 0.71 and 0.75 for CEUS and CECT, respectively). Concordance between CEUS and CECT was seen in 29 patients (72.5%) with fair agreement between the two modalities (K = 0.66). CONCLUSION CEUS has comparable accuracy with CECT and could be used as screening modality to rule out the presence of complex cystic renal masses without exposure of nephrotoxic contrast media and ionizing radiation.
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Affiliation(s)
- Chandan J Das
- Department of Radiodiagnosis and Interventional Radiology, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Keshav Agarwal
- Department of Urology, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Sanjay Sharma
- Department of Radiodiagnosis, RP Centre, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Amlesh Seth
- Department of Radiodiagnosis and Interventional Radiology, All India Institute of Medical Sciences (AIIMS), New Delhi, India
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Audenet F, Sapetti J, Delavaud C, Verkarre V, Correas JM, Mejean A, Timsit MO. Using Contrast-Enhanced Ultrasound in Addition to Cross-Sectional Imaging for Indeterminate Renal Cysts May Lead to Overclassification in Bosniak III Category: A Case-Control Study. Eur Surg Res 2021; 63:19-24. [PMID: 34289472 DOI: 10.1159/000517405] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 05/20/2021] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Indeterminate renal cysts may require several imaging modalities before clinical decision. The aim of this study was to investigate the effect of the imaging modality used to characterize indeterminate renal cysts on the pathological findings after surgical resection. METHODS From our institutional database, we identified all patients surgically treated for Bosniak III renal masses between January 2008 and January 2018. All complex renal cysts were characterized with a combination of computed tomography (CT) and/or magnetic resonance imaging (MRI), and/or contrast-enhanced ultrasound (CEUS) and discussed during a multidisciplinary tumor board. Potential association between clinical/radiological characteristics and the pathological findings were investigated, using univariate and multivariate analyses. RESULTS Of the 52 renal cystic lesions surgically removed, with a preoperative diagnosis of Bosniak III renal cyst, 19 (37%) were malignant and 33 (63%) were benign. The proportion of malignant lesions decreased from 47% when the renal cyst was characterized with cross-sectional imaging (CT and/or MRI) to 17% when the diagnosis required CEUS in addition to cross-sectional imaging. In multivariate analysis, prior history of renal cell carcinoma was associated with a higher risk of malignancy (p = 0.016) and diagnosis made with CEUS was associated with a lower risk of malignancy (p = 0.040). CONCLUSION We found that using CEUS in addition to cross-sectional imaging to characterize indeterminate renal cysts tends to redefine Bosniak III as lesions with a lower risk of malignancy and can lead to overclassification.
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Affiliation(s)
- François Audenet
- Department of Urology, Hôpital Européen Georges Pompidou, AP-HP Centre, Université de Paris, Paris, France
| | - Jordan Sapetti
- Department of Urology, Hôpital Cochin, AP-HP Centre, Université de Paris, Paris, France
| | - Christophe Delavaud
- Department of Adult Radiology, Hôpital Necker, AP-HP Centre, Université de Paris, Paris, France
| | - Virginie Verkarre
- Department of Pathology, Hôpital Européen Georges Pompidou, AP-HP Centre, Université de Paris, Paris, France
| | - Jean-Michel Correas
- Department of Adult Radiology, Hôpital Necker, AP-HP Centre, Université de Paris, Paris, France
| | - Arnaud Mejean
- Department of Urology, Hôpital Européen Georges Pompidou, AP-HP Centre, Université de Paris, Paris, France
| | - Marc-Olivier Timsit
- Department of Urology, Hôpital Européen Georges Pompidou, AP-HP Centre, Université de Paris, Paris, France
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Zhou L, Tang L, Yang T, Chen W. Comparison of contrast-enhanced ultrasound with MRI in the diagnosis of complex cystic renal masses: a meta-analysis. Acta Radiol 2018; 59:1254-1263. [PMID: 29363321 DOI: 10.1177/0284185118755575] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Background The differential diagnosis of cystic renal masses still faces great challenges. There has been no systematically assessment to compare the value of contrast-enhanced ultrasound (CEUS) with magnetic resonance imaging (MRI) in the diagnosis of cystic renal masses. Purpose To perform a meta-analysis to compare the diagnostic efficacy of CEUS with that of MRI for cystic renal masses. Material and Methods A systematic search was performed for literature evaluating the diagnostic performance of CEUS or MRI in cystic renal masses. Quality assessment of diagnostic studies 2 (QUADAS-2) was used to evaluate the quality of each study included. The pooled sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, and the areas under the summary receiver operating characteristic (AUCs-SROC) curve for CEUS and MRI were calculated, respectively. Results Seventeen studies with 1142 lesions were included. The pooled sensitivity, specificity, positive likelihood ratio, and negative likelihood ratio for CEUS /MRI were 0.95/0.92, 0.84/0.91, 5.62/6.74, and 0.09/0.13, respectively. The AUCs-SROC curves for the two methods were 95.66% and 94.65%. The subgroup analysis indicated that the scanning slice thickness may influence the diagnostic efficacy of MRI. Conclusion Both CEUS and MRI have good diagnostic performance for cystic renal masses and can provide the reference for clinicians. CEUS is more sensitive but less specific than MRI.
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Affiliation(s)
- Linli Zhou
- Department of Radiology, School of Medicine, Nantong University, Nantong, Jiangsu, PR China
| | - Lemin Tang
- Department of Radiology, School of Medicine, Nantong University, Nantong, Jiangsu, PR China
| | - Tao Yang
- Department of Radiology, School of Medicine, Nantong University, Nantong, Jiangsu, PR China
| | - Wei Chen
- Department of Radiology, School of Medicine, Nantong University, Nantong, Jiangsu, PR China
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Nouhaud FX, Bernhard JC, Bigot P, Khene ZE, Audenet F, Lang H, Bergerat S, Fraisse G, Grenier N, Cornelis F, Nedelcu C, Béjar S, Fromont-Hankard G, Allory Y, Lindner V, Verkarre V, Daniel L, Yacoub M, Correas JM, Méjean A, Rioux-Leclercq N, Bensalah K. Contemporary assessment of the correlation between Bosniak classification and histological characteristics of surgically removed atypical renal cysts (UroCCR-12 study). World J Urol 2018; 36:1643-1649. [PMID: 29730837 DOI: 10.1007/s00345-018-2307-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Accepted: 04/24/2018] [Indexed: 12/30/2022] Open
Abstract
PURPOSE To evaluate and compare pathological characteristics of renal cysts Bosniak IIF, III and IV in light of recent histological classification. PATIENTS AND METHODS The French research network for kidney cancer UroCCR conducted a multicentre study on patients treated surgically for a renal cyst between 2007 and 2016. Independent radiological and centralized pathological reviews were performed for every patient. Pathological characteristics were compared to the Bosniak classification. RESULTS Of a total 216 patients included, 175 (81.0%) tumours (90.9% of Bosniak IV, 69.8% of Bosniak III) were malignant or had a low malignant potential, with 60% of clear cell renal cell carcinoma (CCRCC), 24% of papillary RCC (PRCC) and 6.9% of multilocular cystic renal tumour of low malignant potential (MCRTLMP). Malignancies were mostly of low pT stage (86.4% of pT1-2), and low ISUP grade (68.0% of 1-2). Bosniak III cysts had a lower rate of CCRCC (46.7 vs. 67.3%), higher rate of PRCC (30 vs. 20.9%) and MCRTLMP (18.3 vs. 0.9%) compared to Bosniak IV (p < 0.001). Low-malignant potential lesions were less likely Bosniak IV and pT3-4 stage was more frequent in Bosniak IV vs. III (15.7 vs. 3.5%; p = 0.04). There were two recurrences (1.1%) and no cancer-related death occurred during follow-up. CONCLUSION These results confirmed that cystic renal malignancies have excellent prognosis. Bosniak III cysts had a low malignant potential, which suggests surveillance could be an option for these lesions.
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Affiliation(s)
| | | | - Pierre Bigot
- Department of Urology, Angers University Hospital, Angers, France
| | | | - François Audenet
- Department of Urology, European Georges Pompidou Hospital, APHP, Paris, France
| | - Herve Lang
- Department of Urology, Strasbourg University Hospital, Strasbourg, France
| | - Sebastien Bergerat
- Department of Urology, Strasbourg University Hospital, Strasbourg, France
| | - Guillaume Fraisse
- Department of Urology, European Georges Pompidou Hospital, APHP, Paris, France
| | - Nicolas Grenier
- Department of Radiology, Bordeaux University Hospital, Bordeaux, France
| | - François Cornelis
- Department of Radiology, Bordeaux University Hospital, Bordeaux, France
| | - Cosmina Nedelcu
- Department of Radiology, Angers Urology Hospital, Angers, France
| | - Sofiane Béjar
- Department of Radiology, Rouen University Hospital, Rouen, France
| | | | - Yves Allory
- Department of Pathology, Henry Mondor University Hospital, APHP, Créteil, France
| | - Véronique Lindner
- Department of Pathology, Strasbourg University Hospital, Strasbourg, France
| | - Virginie Verkarre
- Department of Pathology, European Georges Pompidou Hospital, APHP, Paris, France
| | - Laurent Daniel
- Department of Pathology, Timone University Hospital, APHM, Marseille, France
| | - Mokrane Yacoub
- Department of Pathology, Bordeaux University Hospital, Bordeaux, France
| | - Jean-Michel Correas
- Department of Radiology, European Georges Pompidou Hospital, APHP, Paris, France
| | - Arnaud Méjean
- Department of Urology, European Georges Pompidou Hospital, APHP, Paris, France
| | | | - Karim Bensalah
- Department of Urology, Rennes University Hospital, Rennes, France
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