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Shi Y, Ni L, Pei J, Zhan H, Li H, Zhang D, Wang L. Collateral vessels on preoperative enhanced computed tomography for predicting pathological grade of clear cell renal cell carcinoma: A retrospective study. Eur J Radiol 2024; 170:111240. [PMID: 38043383 DOI: 10.1016/j.ejrad.2023.111240] [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: 09/13/2023] [Revised: 11/02/2023] [Accepted: 11/26/2023] [Indexed: 12/05/2023]
Abstract
OBJECTIVES To retrospectively evaluate the association between the presence of collateral vessels and grade of clear cell renal cell carcinoma (ccRCC) and whether the presence of collateral vessels could serve as a predictor to differentiate high- and low-grade ccRCC. MATERIALS AND METHODS From May 2018 to September 2022, a total of 160 ccRCC patients with pathological diagnosis were enrolled in this study. Patients were divided into a high-grade group and a low-grade group according to World Health Organization/International Society of Urological Pathology (WHO/ISUP) grading system. The significant variables were extracted based on the univariate analyses using Student t test, Mann-Whitney U test, Chi-square test or Fisher's exact test. Multivariate logistic regression analyses were performed to determine independent factors among extracted variables. We calculated the sensitivity, specificity and their 95% confidence intervals (CI) of collateral vessels for predicting high WHO/ISUP grade to quantify its predictive performance. Furthermore, to investigate the additional predictive contribution of collateral vessels, a primary model and a control model were constructed to predict WHO/ISUP grade. The primary model included all extracted significant variables and the control model included significant variables except collateral vessels. RESULTS The proportion of ccRCC patients with collateral vessels was significantly larger in high-grade ccRCC than those in low-grade ccRCC (87.5 % vs. 26.8 %, P < 0.001). Multivariate logistic regression analyses showed that the presence of collateral vessels was an independent predictor for high WHO/ISUP grade (P < 0.001). The sensitivity and specificity of the presence of collateral vessels for differentiating high- and low-grade ccRCC were 87.5 % (95 % CI 0.753-0.941) and 73.2 % (95 % CI 0.643-0.806) respectively. Including collateral vessels in predictive model improves predictive performance for WHO/ISUP grade, increasing the area under the curve (AUC) value from 0.889 to 0.914. CONCLUSION The presence of collateral vessels has high sensitivity and specificity for differentiating high- and low-grade ccRCC and can improve the predictive performance for high WHO/ISUP grade.
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Affiliation(s)
- Yuting Shi
- Department of Radiology, The Second Affiliated Hospital of Anhui Medical University, No.678 Furong Road, Hefei, Anhui, China; Medical Imaging Research Center, Anhui Medical University, No.678 Furong Road, Hefei, Anhui, China
| | - Liangping Ni
- Department of Radiology, The Second Affiliated Hospital of Anhui Medical University, No.678 Furong Road, Hefei, Anhui, China; Medical Imaging Research Center, Anhui Medical University, No.678 Furong Road, Hefei, Anhui, China
| | - Jinxia Pei
- Department of Radiology, The Second Affiliated Hospital of Anhui Medical University, No.678 Furong Road, Hefei, Anhui, China; Medical Imaging Research Center, Anhui Medical University, No.678 Furong Road, Hefei, Anhui, China
| | - Hao Zhan
- Department of Radiology, The Second Affiliated Hospital of Anhui Medical University, No.678 Furong Road, Hefei, Anhui, China; Medical Imaging Research Center, Anhui Medical University, No.678 Furong Road, Hefei, Anhui, China
| | - Huan Li
- Department of Radiology, The Second Affiliated Hospital of Anhui Medical University, No.678 Furong Road, Hefei, Anhui, China; Medical Imaging Research Center, Anhui Medical University, No.678 Furong Road, Hefei, Anhui, China
| | - Dai Zhang
- Department of Radiology, The Second Affiliated Hospital of Anhui Medical University, No.678 Furong Road, Hefei, Anhui, China; Medical Imaging Research Center, Anhui Medical University, No.678 Furong Road, Hefei, Anhui, China.
| | - Longsheng Wang
- Department of Radiology, The Second Affiliated Hospital of Anhui Medical University, No.678 Furong Road, Hefei, Anhui, China; Medical Imaging Research Center, Anhui Medical University, No.678 Furong Road, Hefei, Anhui, China.
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Kang C, Shin HJ, Yoon H, Han JW, Lyu CJ, Lee MJ. Differentiation between Clear Cell Sarcoma of the Kidney and Wilms' Tumor with CT. Korean J Radiol 2021; 22:1185-1193. [PMID: 33856131 PMCID: PMC8236369 DOI: 10.3348/kjr.2020.0882] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Revised: 10/09/2020] [Accepted: 10/13/2020] [Indexed: 01/18/2023] Open
Abstract
Objective Clear cell sarcoma of the kidney (CCSK) is the second-most common but extremely rare primary renal malignancy in children after Wilms' tumor. The aims of this study were to evaluate the imaging features that could distinguish between CCSK and Wilms' tumor and to assess the features with diagnostic value for identifying CCSK. Materials and Methods We reviewed the initial contrast-enhanced abdominal-pelvic CT scans of children with CCSK and Wilms' tumor between 2010 to 2019. Fifty-eight children (32 males and 26 females; age, 0.3–10 years), 7 with CCSK, and 51 with Wilms' tumor, were included. The maximum tumor diameter, presence of engorged perinephric vessels, maximum density of the tumor (Tmax) of the enhancing solid portion, paraspinal muscle, contralateral renal vein density, and density ratios (Tmax/muscle and Tmax/vein) were analyzed on the renal parenchymal phase of contrast-enhanced CT. Fisher's exact tests and Mann-Whitney U tests were conducted to analyze the categorical and continuous variables, respectively. Logistic regression and receiver operating characteristic curve analyses were also performed. Results The age, sex, and tumor diameter did not differ between the two groups. Engorged perinephric vessels were more common in patients in the CCSK group (71% [5/7] vs. 16% [8/51], p = 0.005). Tmax (median, 148.0 vs. 111.0 Hounsfield unit, p = 0.004), Tmax/muscle (median, 2.64 vs. 1.67, p = 0.002), and Tmax/vein (median, 0.94 vs. 0.59, p = 0.002) were higher in the CCSK compared to the Wilms' group. Multiple logistic regression revealed that engorged vessels (odds ratio 13.615; 95% confidence interval [CI], 1.770–104.730) and Tmax/muscle (odds ratio 5.881; 95% CI, 1.337–25.871) were significant predictors of CCSK. The cutoff values of Tmax/muscle (86% sensitivity, 77% specificity) and Tmax/vein (71% sensitivity, 86% specificity) for the diagnosis of CCSK were 1.97 and 0.76, respectively. Conclusion Perinephric vessel engorgement and greater tumor enhancement (Tmax/muscle > 1.97 or Tmax/vein > 0.76) are helpful for differentiating between CCSK and Wilms' tumor in children aged below 10 years.
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Affiliation(s)
- Choeum Kang
- Department of Radiology and Research Institute of Radiological Science, Severance Children's Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Hyun Joo Shin
- Department of Radiology and Research Institute of Radiological Science, Severance Children's Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Haesung Yoon
- Department of Radiology and Research Institute of Radiological Science, Severance Children's Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Jung Woo Han
- Division of Pediatric Hematology and Oncology, Department of Pediatrics, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Chuhl Joo Lyu
- Division of Pediatric Hematology and Oncology, Department of Pediatrics, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Mi Jung Lee
- Department of Radiology and Research Institute of Radiological Science, Severance Children's Hospital, Yonsei University College of Medicine, Seoul, Korea.
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Suo X, Chen J, Zhao Y, Tang Q, Yang X, Yuan Y, Nie L, Chen N, Zeng H, Yao J. Clinicopathological and radiological significance of the collateral vessels of renal cell carcinoma on preoperative computed tomography. Sci Rep 2021; 11:5187. [PMID: 33664382 PMCID: PMC7933355 DOI: 10.1038/s41598-021-84631-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Accepted: 02/05/2021] [Indexed: 02/05/2023] Open
Abstract
This study aimed to investigate the clinicopathological and radiological significance of the collateral vessel of renal cell carcinoma (RCC) on preoperative computed tomography (CT). Preoperative contrast-enhanced CT of 236 consecutive patients with pathological documented RCC were retrospectively reviewed during the period of 2014. The associations of the presence of collateral vessels with perioperative clinicopathological and radiological features, as well as long term survival outcomes were analyzed. Totally, collateral vessels were detected by contrast-enhanced CT in 110 of 236 patients. The presence of collateral vessels was significantly associated with higher pathologic T stage, higher Fuhrman grade, higher overall RENAL scores, greater tumor size and enhancement, and more tumor necrosis (all P < 0.05). In patients with clear cell RCC, those harboring collateral vessels had significantly higher SSIGN scores (P < 0.001) and shorter overall survival (P = 0.01) than those without collateral vessel. The incidence of intraoperative blood loss, blood transfusion, radical nephrectomy (RN) and open surgery were also significantly higher in patients with collateral vessels (all P < 0.05). In multivariate analysis, the presence of collateral vessels was significantly associated with RN (P = 0.021) and open surgery (P = 0.012). The presence of collateral vessels was significantly associated with aggressive clinicopathological parameters and worse prognosis. It is worth paying attention to its association with the choice of RN and open surgery in clinical practice.
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Affiliation(s)
- Xueling Suo
- Department of Radiology, West China Hospital of Sichuan University, No. 37 Guo Xue Xiang, Chengdu, 610041, Sichuan, China
| | - Junru Chen
- Department of Urology, Institute of Urology, West China Hospital of Sichuan University, No. 37 Guo Xue Xiang, Chengdu, 610041, Sichuan, China
| | - Yijun Zhao
- Department of Radiology, The Second Xiangya Hospital of Central South University, Changsha, 410011, Hunan, China
| | - Qidun Tang
- Department of Urology, Chengdu Second People's Hospital, Chengdu, 610017, Sichuan, China
| | - Xibiao Yang
- Department of Radiology, West China Hospital of Sichuan University, No. 37 Guo Xue Xiang, Chengdu, 610041, Sichuan, China
| | - Yuan Yuan
- Department of Radiology, West China Hospital of Sichuan University, No. 37 Guo Xue Xiang, Chengdu, 610041, Sichuan, China
| | - Ling Nie
- Department of Pathology, West China Hospital of Sichuan University, Chengdu, 610041, Sichuan, China
| | - Ni Chen
- Department of Pathology, West China Hospital of Sichuan University, Chengdu, 610041, Sichuan, China
| | - Hao Zeng
- Department of Urology, Institute of Urology, West China Hospital of Sichuan University, No. 37 Guo Xue Xiang, Chengdu, 610041, Sichuan, China.
| | - Jin Yao
- Department of Radiology, West China Hospital of Sichuan University, No. 37 Guo Xue Xiang, Chengdu, 610041, Sichuan, China.
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Ficarra V, Caloggero S, Rossanese M, Giannarini G, Crestani A, Ascenti G, Novara G, Porpiglia F. Computed tomography features predicting aggressiveness of malignant parenchymal renal tumors suitable for partial nephrectomy. Minerva Urol Nephrol 2020; 73:17-31. [PMID: 33200903 DOI: 10.23736/s2724-6051.20.04073-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
The aim of this study was to identify and standardize computed tomography (CT) features having a potential role in predicting aggressiveness of malignant parenchymal renal tumors suitable for partial nephrectomy (PN). We performed a non-systematic review of the recent literature to evaluate the potential impact of CT variables proposed by the Society of Abdominal Radiology Disease-Focused Panel on Renal Cell Carcinoma in predicting aggressiveness of newly diagnosed malignant parenchymal renal tumors. The analyzed variables were clinical tumor size, tumor growth rate, enhancement characteristics, amount of cystic component, polar and capsular location, tumor margins and distance between tumor and renal sinus. Unfavorable behavior was defined as: 1) renal cell carcinoma (RCC) with stage ≥pT3; 2) nuclear grade 3 or 4; 3) presence of sarcomatoid de-differentiation; or 4) non-clear cell subtypes with unfavorable prognosis (type 2 papillary RCC, collecting duct or renal medullary carcinoma, unclassified RCC). Beyond clinical tumor size, tumor growth rate, enhancement characteristics, amount of cystic component, tumor margins and distance between tumor and renal sinus are highly relevant features predicting an unfavorable behavior. Moreover, several studies supported the role of necrosis as preoperative predictor of tumor aggressiveness. Peritumoral and intratumoral vasculature as well as capsule status are emerging variables that need to be further evaluated. Tumor size, enhancement characteristics, tumor margins and distance to the renal sinus are highly relevant CT features predicting biological aggressiveness of malignant parenchymal renal tumors. Combination of these parameters might be useful to generate tools to predict the unfavorable behavior of renal tumors suitable for PN.
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Affiliation(s)
- Vincenzo Ficarra
- Unit of Urology, Department of Human and Pediatric Pathology "Gaetano Barresi", G. Martino University Hospital, University of Messina, Messina, Italy -
| | | | - Marta Rossanese
- Unit of Urology, Department of Human and Pediatric Pathology "Gaetano Barresi", G. Martino University Hospital, University of Messina, Messina, Italy
| | - Gianluca Giannarini
- Unit of Urology, Academic Medical Center "Santa Maria della Misericordia", Udine, Italy
| | | | - Giorgio Ascenti
- Department of Radiology, University of Messina, Messina, Italy
| | - Giacomo Novara
- Unit of Urology, Department of Oncological, Surgical and Gastrointestinal Sciences, University of Padua, Padua, Italy
| | - Francesco Porpiglia
- Division of Urology, Department of Oncology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy
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Preoperative Computed Tomography Assessment for Perinephric Fat Invasion. J Comput Assist Tomogr 2017; 41:702-707. [DOI: 10.1097/rct.0000000000000588] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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Tumor diameter accurately predicts perioperative outcomes in T1 renal cancer treated with robot-assisted partial nephrectomy. World J Urol 2016; 34:1643-1650. [DOI: 10.1007/s00345-016-1809-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2016] [Accepted: 03/11/2016] [Indexed: 01/20/2023] Open
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Perirenal fat invasion on renal cell carcinoma: evaluation with multidetector computed tomography-multivariate analysis. J Comput Assist Tomogr 2013; 37:450-7. [PMID: 23674020 DOI: 10.1097/rct.0b013e318283bc8e] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVE The objective of this study was to assess the accuracy of multidetector computed tomography (CT) in diagnosing perinephric (PN) and/or renal sinus (RS) fat invasion in patients with renal cell carcinoma (RCC), with reference to the CT findings predictive for the diagnosis of invasion. METHODS This was a retrospective study of 48 RCCs. Examinations were performed on a 16-row CT scanner, including unenhanced and 3-phase contrast-enhanced CT scanning. Unenhanced transverse images and multiplanar reformations of each contrast-enhanced CT phase were evaluated. The predictive value of CT findings in diagnosing PN and/or RS fat invasion was determined using multivariate logistic regression analysis. RESULTS The CT findings that were most predictive for the diagnosis of PN fat invasion were the presence of contrast-enhancing nodules in the PN fat and tumoral margins. Invasion of the pelvicaliceal system was the most significant predictor in the diagnosis of RS fat invasion. CONCLUSIONS Multidetector CT provides satisfactory results in detecting PN and/or RS fat invasion in RCC.
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Bach AM, Zhang J. Contemporary Radiologic Imaging of Renal Cortical Tumors. Urol Clin North Am 2008; 35:593-604; vi. [DOI: 10.1016/j.ucl.2008.07.012] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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