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Ganeshan D, Khatri G, Ali N, Avery R, Caserta MP, Chang SD, De Leon AD, Gupta RT, Lyshchik A, Michalski J, Nicola R, Pierorazio PM, Purysko AS, Smith AD, Taffel MT, Nikolaidis P. ACR Appropriateness Criteria® Staging of Renal Cell Carcinoma: 2022 Update. J Am Coll Radiol 2023; 20:S246-S264. [PMID: 37236747 DOI: 10.1016/j.jacr.2023.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 02/27/2023] [Indexed: 05/28/2023]
Abstract
Renal cell carcinoma is a complex group of highly heterogenous renal tumors demonstrating variable biological behavior. Pretreatment imaging of renal cell carcinoma involves accurate assessment of the primary tumor, presence of nodal, and distant metastases. CT and MRI are the key imaging modalities used in the staging of renal cell carcinoma. Important imaging features that impact treatment include tumor extension into renal sinus and perinephric fat, involvement of pelvicalyceal system, infiltration into adrenal gland, involvement of renal vein and inferior vena cava, as well as the presence of metastatic adenopathy and distant metastases. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision process support the systematic analysis of the medical literature from peer reviewed journals. Established methodology principles such as Grading of Recommendations Assessment, Development, and Evaluation or GRADE are adapted to evaluate the evidence. The RAND/UCLA Appropriateness Method User Manual provides the methodology to determine the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where peer reviewed literature is lacking or equivocal, experts may be the primary evidentiary source available to formulate a recommendation.
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Affiliation(s)
| | - Gaurav Khatri
- Panel Chair, UT Southwestern Medical Center, Dallas, Texas
| | - Norman Ali
- The University of Texas MD Anderson Cancer Center, Houston, Texas, Primary care physician
| | - Ryan Avery
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois; Commission on Nuclear Medicine and Molecular Imaging
| | | | - Silvia D Chang
- University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Rajan T Gupta
- Duke University Medical Center, Durham, North Carolina
| | - Andrej Lyshchik
- Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Jeff Michalski
- Mallinckrodt Institute of Radiology Washington University School of Medicine, Saint Louis, Missouri; Commission on Radiation Oncology
| | - Refky Nicola
- SUNY Upstate Medical University, Syracuse, New York
| | - Phillip M Pierorazio
- Presbyterian Medical Center, University of Pennsylvania, Philadelphia, Pennsylvania; American Urological Association
| | | | - Andrew D Smith
- University of Alabama at Birmingham, Birmingham, Alabama
| | - Myles T Taffel
- New York University Langone Medical Center, New York, New York
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Tsili AC, Moulopoulos LA, Varakarakis IΜ, Argyropoulou MI. Cross-sectional imaging assessment of renal masses with emphasis on MRI. Acta Radiol 2021; 63:1570-1587. [PMID: 34709096 DOI: 10.1177/02841851211052999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Magnetic resonance imaging (MRI) is a useful complementary imaging tool for the diagnosis and characterization of renal masses, as it provides both morphologic and functional information. A core MRI protocol for renal imaging should include a T1-weighted sequence with in- and opposed-phase images (or, alternatively with DIXON technique), T2-weighted and diffusion-weighted images as well as a dynamic contrast-enhanced sequence with subtraction images, followed by a delayed post-contrast T1-weighted sequence. The main advantages of MRI over computed tomography include increased sensitivity for contrast enhancement, less sensitivity for detection of calcifications, absence of pseudoenhancement, and lack of radiation exposure. MRI may be applied for renal cystic lesion characterization, differentiation of renal cell carcinoma (RCC) from benign solid renal tumors, RCC histologic grading, staging, post-treatment follow-up, and active surveillance of patients with treated or untreated RCC.
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Affiliation(s)
- Athina C Tsili
- Department of Clinical Radiology, School of Medicine, University of Ioannina, Ioannina, Greece
| | - Lia-Angela Moulopoulos
- 1st Department of Radiology, School of Medicine, National and Kapodistrian University of Athens, Areteion Hospital, Athens, Greece
| | - Ioannis Μ Varakarakis
- 2nd Department of Urology, National and Kapodistrian University of Athens, Sismanoglio Hospital, Athens, Greece
| | - Maria I Argyropoulou
- Department of Clinical Radiology, School of Medicine, University of Ioannina, Ioannina, Greece
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Lal H, Singh P, Jain M, Singh UP, Sureka SK, Yadav RR, Prasad R, Verma P, Singh A, Yadav P. Role of MRI in staging and surgical planning and its clinicopathological correlation in patients with renal cell carcinoma. Indian J Radiol Imaging 2019; 29:277-283. [PMID: 31741596 PMCID: PMC6857252 DOI: 10.4103/ijri.ijri_177_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2019] [Revised: 10/06/2019] [Accepted: 10/08/2019] [Indexed: 11/05/2022] Open
Abstract
Background and Aims: Radiological evaluation of renal cell carcinoma (RCC) is used for non-invasive staging for better surgical planning. However, the correlation of radiological staging using magnetic resonance imaging (MRI) with histopathological findings has not been done so far. The aim of this study is to assess the role of MRI in pre-operative staging of RCC in patients undergoing radical nephrectomy and nephron sparing surgery (NSS) and correlate it with histopathological findings. Settings and Design: This prospective observational study was conducted from February 2015 to October 2016 at a tertiary care hospital in northern India. Methods: MR imaging was done on 3 Tesla MR scanner (Signa Hdxt General Electrics, Milwaukee, USA). Preoperative staging was based on 2010 TNM staging system. The preoperative parameters in MRI were tumor size, detection/breach of pseudocapsule, tumor extension into perirenal fat and detection of tumor venous thrombus. The staging on MRI was compared with surgical and pathological staging. Statistical Analysis Used: The agreement between these three staging methods was determined using the kappa statistics (0.0-0.2, poor; 0.2-0.4, fair; 0.4-0.6, moderate; 0.6-0.8, good; 0.8-1.0, excellent). Results: 30 patients with suspected RCC underwent NSS (n = 10) and radical nephrectomy (n = 20). Mean tumor size was 9.66 ± 2.99 cm in the radical nephrectomy group and 4.06 ± 1.16 cm in the NSS group. There was perfect agreement between MRI, surgical and pathological staging for breach of pseudocapsule (κ =1.0, Percentage of Agreement = 100%, P < 0.05). In none of the patients, MRI missed extension beyond the Gerota's fascia or presence of venous thrombus. Conclusion: MRI staging of RCC is an accurate predictor of the surgical and pathological stage and has the potential to become a useful tool for preoperative identification of patients with RCC who can undergo NSS.
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Affiliation(s)
- Hira Lal
- Department of Radiology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Raibareli Road, Lucknow, Uttar Pradesh, India
| | - Paritosh Singh
- Department of Radiology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Raibareli Road, Lucknow, Uttar Pradesh, India
| | - Manoj Jain
- Department of Pathology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Raibareli Road, Lucknow, Uttar Pradesh, India
| | - Uday Pratap Singh
- Department of Urology and Renal Transplantation, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Raibareli Road, Lucknow, Uttar Pradesh, India
| | - Sanjoy Kumar Sureka
- Department of Urology and Renal Transplantation, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Raibareli Road, Lucknow, Uttar Pradesh, India
| | - Rajanikant R Yadav
- Department of Radiology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Raibareli Road, Lucknow, Uttar Pradesh, India
| | - Raghunandan Prasad
- Department of Radiology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Raibareli Road, Lucknow, Uttar Pradesh, India
| | - Pragati Verma
- Department of Radiology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Raibareli Road, Lucknow, Uttar Pradesh, India
| | - Anuradha Singh
- Department of Radiology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Raibareli Road, Lucknow, Uttar Pradesh, India
| | - Priyank Yadav
- Department of Urology and Renal Transplantation, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Raibareli Road, Lucknow, Uttar Pradesh, India
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Vikram R, Beland MD, Blaufox MD, Moreno CC, Gore JL, Harvin HJ, Heilbrun ME, Liauw SL, Nguyen PL, Nikolaidis P, Preminger GM, Purysko AS, Raman SS, Taffel MT, Wang ZJ, Weinfeld RM, Remer EM, Lockhart ME. ACR Appropriateness Criteria Renal Cell Carcinoma Staging. J Am Coll Radiol 2016; 13:518-25. [DOI: 10.1016/j.jacr.2016.01.021] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Accepted: 01/28/2016] [Indexed: 12/22/2022]
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Spero M, Brkljacic B, Kolaric B, Marotti M. Preoperative staging of renal cell carcinoma using magnetic resonance imaging: comparison with pathological staging. Clin Imaging 2011; 34:441-7. [PMID: 21092873 DOI: 10.1016/j.clinimag.2009.09.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2009] [Accepted: 09/20/2009] [Indexed: 01/23/2023]
Abstract
We have retrospectively assessed the accuracy of our MRI protocol on 1.0-T MRI system for preoperative staging of renal cell carcinoma using the 2002 TNM staging system and pathological staging as the gold standard. Medical records of 48 patients (mean age, 56.28 years) with 57 renal tumors were reviewed: 52 malignant renal tumors were found; most of the patients were staged T1N0M0. In our study, κ test revealed excellent agreement between all three classes of the TNM staging system.
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Affiliation(s)
- Martina Spero
- Department of Radiology, University Hospital Dubrava, Zagreb, Croatia.
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Sacco E, Pinto F, Totaro A, D'Addessi A, Racioppi M, Gulino G, Volpe A, Marangi F, D'Agostino D, Bassi P. Imaging of renal cell carcinoma: state of the art and recent advances. Urol Int 2010; 86:125-39. [PMID: 21150177 DOI: 10.1159/000322724] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND AND AIM Renal cell carcinoma (RCC) is the 13th most common cancer worldwide and accounts for 4% of all adult malignancies. Herein the state of the art and recent advances in cross-sectional radiological imaging applied to RCC are reviewed, including ultrasonography, computed tomography, magnetic resonance imaging, and positron emission tomography. METHODS Literature search of peer-reviewed papers published by October 2010. RESULTS In front of more conventional and widespread imaging tools, such as ultrasonography and computed tomography, an array of newer and attractive radiological modalities are under investigation and show promise to improve our ability to noninvasively detect renal tumors and its recurrences, accurately assess the extent of the disease, and reliably evaluate treatment response, particularly in the era of antiangiogenetic therapy. CONCLUSIONS Recent major advances in radiological imaging techniques have considerably improved our ability to diagnose, stage and follow-up RCC. Further studies are needed to evaluate the potential of most recent and still investigational imaging tools.
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Affiliation(s)
- Emilio Sacco
- Department of Urology, Agostino Gemelli Hospital, Catholic University Medical School, Rome, Italy. emilio.sacco @ gmail.com
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Imaging of advanced renal cell carcinoma. World J Urol 2010; 28:253-61. [PMID: 20458484 DOI: 10.1007/s00345-010-0557-z] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2010] [Accepted: 04/11/2010] [Indexed: 10/19/2022] Open
Abstract
OBJECTIVES To describe current radiological cross-sectional imaging in the detection and staging of advanced renal cell carcinoma (RCC), defined here as RCC reaching beyond the renal capsule, whether by immediate extension or by metastasis. METHODS Review and summary of current radiological and urological literature, including original articles and reviews, retrieved from the medical data base "PubMed". RESULTS Multi-detector-row computed tomography (MDCT) shows a sensitivity of up to 100% and specificity of about 90% for retroperitoneal disease, venous tumour thrombus, and metastasis, but limited accuracy for lymphadenopathy in RCC. Magnetic resonance imaging (MRI) is applied as a problem-solving modality, with particular strength in imaging metastasis to brain and bone. However, dynamic, contrast-enhanced- (DCE-) and arterial-spin-labelling (ASL-) MRI may help to monitor early response to angiogenesis inhibitor drugs. Ultrasonography (US) shows limited capability of identifying retroperitoneal disease, venous tumour thrombus extension, and metastasis. Positron Emission Tomography with 18-fluoro-desoxy-glucose (FDG-PET) demonstrates modest accuracy for metastasis of RCC, with positive studies being suspicious, while negative studies cannot reliably exclude disease. CONCLUSIONS MDCT represents the diagnostic mainstay for the detection and staging of RCC. In the wake of new systemic therapies for advanced RCC, including angiogenesis inhibitor drugs, monitoring treatment response may become a new task for cross-sectional imaging.
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Surabhi VR, Menias C, Prasad SR, Patel AH, Nagar A, Dalrymple NC. Neoplastic and non-neoplastic proliferative disorders of the perirenal space: cross-sectional imaging findings. Radiographics 2008; 28:1005-17. [PMID: 18635626 DOI: 10.1148/rg.284075157] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
The perirenal space, located between the anterior and the posterior renal fasciae, is shaped like an inverted cone with an apex that extends into the iliac fossa. Perirenal tumors and pseudotumors primarily originate either from the kidney or as part of a systemic disease process and have characteristic histopathologic features and biologic behavior. The lesions may be classified on the basis of their distribution and imaging features as solitary soft-tissue masses (renal cell carcinoma, lymphangioma, hemangioma, and leiomyoma), rindlike soft-tissue lesions (lymphoma, retroperitoneal fibrosis, and Erdheim-Chester disease), masses containing macroscopic fat (angiomyolipoma, liposarcoma, myelolipoma, and extramedullary hematopoiesis), and multifocal soft-tissue masses (metastases, plasma cell tumors). Because of overlap in imaging findings among these diverse perirenal lesions, a definitive diagnosis in most cases can be established only at histopathologic analysis. However, an imaging pattern-based approach may facilitate the diagnosis and optimal management of perirenal tumors and pseudotumors.
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Affiliation(s)
- Venkateswar R Surabhi
- Department of Radiology, University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Dr, San Antonio, TX 78229, USA
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Mueller-Lisse UG, Mueller-Lisse UL, Meindl T, Coppenrath E, Degenhart C, Graser A, Scherr M, Reiser MF. Staging of renal cell carcinoma. Eur Radiol 2007; 17:2268-77. [PMID: 17318606 DOI: 10.1007/s00330-006-0554-1] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2006] [Revised: 09/14/2006] [Accepted: 11/17/2006] [Indexed: 10/23/2022]
Abstract
As in other malignant tumors, prognosis in renal cell carcinoma (RCC) depends on tumor extent and metastasis at the time of primary diagnosis. Staging systems formalize the way in which the extent of RCC is being described and classified. Primary staging of RCC aims at evaluating surgical options. Since surgical excision, which is the mainstay of therapy in non-metastatic RCC, and, recently, minimally invasive ablation methods have evolved significantly over the last decades, staging systems continue to evolve along the way. The 40-year-old Robson classification has been replaced with the TNM classification of RCC, because the latter adapts more easily to changing patterns of diagnosis and therapy. Modern cross-sectional imaging methods, such as multidetector-row computed tomography (MDCT), and magnetic resonance imaging (MRI), perform highly in T-staging of local tumor extent and M-staging of distant metastasis. However, both MDCT and MRI perform poorly in N-staging of lymphadenopathy. At present, 18-F-desoxy-glucose positron emission tomography (FDG-PET) appears to be unreliable in the detection of RCC and its metastasis. This overview of current radiological and surgical literature attempts to describe how modern staging systems for RCC are organized, and which radiological and surgical developments currently influence the way in which primary staging and prognosis of RCC depend on one another.
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Affiliation(s)
- Ullrich G Mueller-Lisse
- Department of Clinical Radiology, Ludwig Maximilian University of Munich, Ziemssenstrasse 1, 80336 München, Germany.
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Abstract
Tumor stage, which describes the anatomic extent of disease, is a powerful determinant of prognosis and survival for patients with renal cell carcinoma (RCC). Stratification of patients based on prognostic outcomes derived from staging systems facilitates therapeutic decision-making, disease surveillance, and clinical research. Staging for RCC has evolved from the Robson classification into the TNM system, developed by the International Union Against Cancer and the American Joint Committee on Cancer. The most recent revisions of the TNM system for RCC introduced in 1997 and 2002 further subdivided organ-confined tumors, reclassified tumors with venous involvement, and clarified the staging of tumors that invade the perisinus fat. Most studies suggest that these revisions have substantially improved prognostication for RCC. Nevertheless, additional modifications have been proposed that would alter the subclassification of organ-confined disease, integrate various levels of venous involvement with other aspects of local tumor aggressiveness, and upgrade the classification of adrenal involvement. The data in support of each of these proposals will be discussed, and the current limitations of clinical and radiographic staging for RCC will be reviewed. Finally, a glimpse into the future of staging of RCC will be offered with a discussion of integrated staging and prognostic systems.
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Affiliation(s)
- Carvell T Nguyen
- Glickman Urological Institute, Cleveland Clinic Foundation, OH 44195, USA
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Abstract
This article discusses the computed tomography (CT) and magnetic resonance (MR) scanning techniques used for the detection and staging of renal cell carcinoma and their pitfalls. Comparison between the Robson and recent modifications to the TNM classifications is also addressed. The accuracy of CT and MR in the staging of renal cell carcinoma and the role of positron emission tomography (PET) scanning is outlined and finally the surveillance of patients who have had curative treatment of renal cell carcinoma is briefly addressed.
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Affiliation(s)
- Isaac R Francis
- Department of Radiology, University of Michigan, Ann Arbor, Michigan 48109-0030, USA.
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