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Fateh SM, Arkawazi LA, Tahir SH, Rashid RJ, Rahman DH, Aghaways I, Kakamad FH, Salih AM, Bapir R, Fakhralddin SS, Fattah FH, Abdalla BA, Mohammed SH. Renal cell carcinoma T staging: Diagnostic accuracy of preoperative contrast-enhanced computed tomography. Mol Clin Oncol 2023; 18:11. [PMID: 36761384 PMCID: PMC9892965 DOI: 10.3892/mco.2023.2607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Accepted: 10/19/2022] [Indexed: 01/13/2023] Open
Abstract
Renal cell carcinoma (RCC) accounts for 1-2% of all malignancies and is the most common renal tumor in adults. Imaging studies are used for diagnosis and staging. Tumor-Node-Metastasis staging strongly affects prognosis and management, while contrast-enhanced computed tomography (CECT) is regarded as a standard imaging technique for local and distant staging. The present study aimed to evaluate the accuracy of CECT for the preoperative staging of RCC by using surgical and pathological staging as the reference methods. This single-center prospective study was conducted between October 2019 and November 2021. The preoperative abdominal CT scans of patients suspected of having RCC were reviewed. Imaging data were collected, including tumor side and size, and perinephric fat invasion. Intraoperative notes were recorded, including the operation type, perinephric fat invasion, renal vein (RV) or inferior vena cava (IVC) tumor extension, and surrounding organ invasion. pathological data were collected on tumor size, RCC type, presence of clear margins, presence of renal capsule or perinephric fat invasion, renal sinus or pelvicalyceal system (PCS) invasion, segmental or main RV extension, and the involvement of Gerota's fascia and nearby organs. Preoperative CECT revealed that 42 out of 59 tumors had a greater maximum diameter than the pathological specimen, with an overall disparity of 0.25 cm. The specificity of CT for the detection of tumor invasion of the perinephric and renal sinus fat and PCS was 95%, and the sensitivity ranged from 80 to 88%. CT had an 83% sensitivity and a 95 specificity in detecting T4 stage cancer, with a 100% specificity for adrenal invasion. The concordance between radiographic and histological results for RV and IVC involvement was high, with specificities of 94 and 98%, and sensitivities of 80 and 100%, respectively. Overall accuracy for correct T staging was 80%. In conclusion, CECT is accurate in the local T staging of RCC, with high sensitivity and specificity for estimating tumor size and detecting extension to nearby structures and venous invasion.
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Affiliation(s)
- Salah M. Fateh
- College of Medicine, University of Sulaimani, Sulaimani, Kurdistan 46000, Republic of Iraq
| | - Lusan A. Arkawazi
- College of Medicine, University of Sulaimani, Sulaimani, Kurdistan 46000, Republic of Iraq
| | - Soran H. Tahir
- College of Medicine, University of Sulaimani, Sulaimani, Kurdistan 46000, Republic of Iraq,Department of Scientific Affairs, Smart Health Tower, Sulaimani, Kurdistan 46000, Republic of Iraq,Radiology Center, Sulaimani Teaching Hospital, Sulaimani, Kurdistan 46000, Republic of Iraq
| | - Rezheen J. Rashid
- Department of Scientific Affairs, Smart Health Tower, Sulaimani, Kurdistan 46000, Republic of Iraq,Hiwa Cancer Hospital Centre, Sulaimani Directorate of Health, Sulaimani, Kurdistan 46000, Republic of Iraq,Radiology Center, Sulaimani Teaching Hospital, Sulaimani, Kurdistan 46000, Republic of Iraq
| | - Dalshad H. Rahman
- Department of Surgery, Shar Hospital, Sulaimani, Kurdistan 46000, Republic of Iraq
| | - Ismaeel Aghaways
- College of Medicine, University of Sulaimani, Sulaimani, Kurdistan 46000, Republic of Iraq
| | - Fahmi H. Kakamad
- College of Medicine, University of Sulaimani, Sulaimani, Kurdistan 46000, Republic of Iraq,Department of Scientific Affairs, Smart Health Tower, Sulaimani, Kurdistan 46000, Republic of Iraq,Kscien Organization, Sulaimani, Kurdistan 46000, Republic of Iraq,Correspondence to: Dr Fahmi H. Kakamad, College of Medicine, University of Sulaimani, Doctor City Building 11, Apartment 50, Madam Mitterrand Street, Sulaimani, Kurdistan 46000, Republic of Iraq
| | - Abdulwahid M. Salih
- College of Medicine, University of Sulaimani, Sulaimani, Kurdistan 46000, Republic of Iraq,Department of Scientific Affairs, Smart Health Tower, Sulaimani, Kurdistan 46000, Republic of Iraq
| | - Rawa Bapir
- Department of Scientific Affairs, Smart Health Tower, Sulaimani, Kurdistan 46000, Republic of Iraq,Kscien Organization, Sulaimani, Kurdistan 46000, Republic of Iraq,Department of Urology, Surgical Teaching Hospital, Sulaimani, Kurdistan 46000, Republic of Iraq
| | - Saman S. Fakhralddin
- College of Medicine, University of Sulaimani, Sulaimani, Kurdistan 46000, Republic of Iraq,Department of Scientific Affairs, Smart Health Tower, Sulaimani, Kurdistan 46000, Republic of Iraq
| | - Fattah H. Fattah
- College of Medicine, University of Sulaimani, Sulaimani, Kurdistan 46000, Republic of Iraq,Department of Scientific Affairs, Smart Health Tower, Sulaimani, Kurdistan 46000, Republic of Iraq
| | - Berun A. Abdalla
- Department of Scientific Affairs, Smart Health Tower, Sulaimani, Kurdistan 46000, Republic of Iraq,Kscien Organization, Sulaimani, Kurdistan 46000, Republic of Iraq
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Abou Elkassem AM, Lo SS, Gunn AJ, Shuch BM, Dewitt-Foy ME, Abouassaly R, Vaidya SS, Clark JI, Louie AV, Siva S, Grosu AL, Smith AD. Role of Imaging in Renal Cell Carcinoma: A Multidisciplinary Perspective. Radiographics 2021; 41:1387-1407. [PMID: 34270355 DOI: 10.1148/rg.2021200202] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
With the expansion in cross-sectional imaging over the past few decades, there has been an increase in the number of incidentally detected renal masses and an increase in the incidence of renal cell carcinomas (RCCs). The complete characterization of an indeterminate renal mass on CT or MR images is challenging, and the authors provide a critical review of the best imaging methods and essential, important, and optional reporting elements used to describe the indeterminate renal mass. While surgical staging remains the standard of care for RCC, the role of renal mass CT or MRI in staging RCC is reviewed, specifically with reference to areas that may be overlooked at imaging such as detection of invasion through the renal capsule or perirenal (Gerota) fascia. Treatment options for localized RCC are expanding, and a multidisciplinary group of experts presents an overview of the role of advanced medical imaging in surgery, percutaneous ablation, transarterial embolization, active surveillance, and stereotactic body radiation therapy. Finally, the arsenal of treatments for advanced renal cancer continues to grow to improve response to therapy while limiting treatment side effects. Imaging findings are important in deciding the best treatment options and to monitor response to therapy. However, evaluating response has increased in complexity. The unique imaging findings associated with antiangiogenic targeted therapy and immunotherapy are discussed. An invited commentary by Remer is available online. Online supplemental material is available for this article. ©RSNA, 2021.
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Affiliation(s)
- Asser M Abou Elkassem
- From the Department of Radiology, University of Alabama at Birmingham, 619 19th St S, JTN 452, Birmingham, AL 35249-6830 (A.M.A.E., A.J.G., A.D.S.); Department of Radiation Oncology (S.S.L.) and Department of Radiology (S.S.V.), University of Washington School of Medicine, Seattle, Wash; Department of Urology, UCLA Medical Center, Santa Monica, Calif (B.M.S.); Department of Urology, Cleveland Clinic Foundation, Cleveland, Ohio (M.E.D.F., R.A.); Division of Hematology/Oncology, Department of Internal Medicine, Loyola University Medical Center, Maywood, Ill (J.I.C.); Department of Radiation Oncology, Sunnybrook Health Science Centre, University of Toronto, Toronto, Ontario, Canada (A.V.L.); Division of Radiation Oncology, Peter MacCallum Cancer Centre, University of Melbourne, Parkville, Victoria, Australia (S.S.); and Department of Radiation Oncology, University of Freiburg, Freiburg, Germany (A.L.G.)
| | - Simon S Lo
- From the Department of Radiology, University of Alabama at Birmingham, 619 19th St S, JTN 452, Birmingham, AL 35249-6830 (A.M.A.E., A.J.G., A.D.S.); Department of Radiation Oncology (S.S.L.) and Department of Radiology (S.S.V.), University of Washington School of Medicine, Seattle, Wash; Department of Urology, UCLA Medical Center, Santa Monica, Calif (B.M.S.); Department of Urology, Cleveland Clinic Foundation, Cleveland, Ohio (M.E.D.F., R.A.); Division of Hematology/Oncology, Department of Internal Medicine, Loyola University Medical Center, Maywood, Ill (J.I.C.); Department of Radiation Oncology, Sunnybrook Health Science Centre, University of Toronto, Toronto, Ontario, Canada (A.V.L.); Division of Radiation Oncology, Peter MacCallum Cancer Centre, University of Melbourne, Parkville, Victoria, Australia (S.S.); and Department of Radiation Oncology, University of Freiburg, Freiburg, Germany (A.L.G.)
| | - Andrew J Gunn
- From the Department of Radiology, University of Alabama at Birmingham, 619 19th St S, JTN 452, Birmingham, AL 35249-6830 (A.M.A.E., A.J.G., A.D.S.); Department of Radiation Oncology (S.S.L.) and Department of Radiology (S.S.V.), University of Washington School of Medicine, Seattle, Wash; Department of Urology, UCLA Medical Center, Santa Monica, Calif (B.M.S.); Department of Urology, Cleveland Clinic Foundation, Cleveland, Ohio (M.E.D.F., R.A.); Division of Hematology/Oncology, Department of Internal Medicine, Loyola University Medical Center, Maywood, Ill (J.I.C.); Department of Radiation Oncology, Sunnybrook Health Science Centre, University of Toronto, Toronto, Ontario, Canada (A.V.L.); Division of Radiation Oncology, Peter MacCallum Cancer Centre, University of Melbourne, Parkville, Victoria, Australia (S.S.); and Department of Radiation Oncology, University of Freiburg, Freiburg, Germany (A.L.G.)
| | - Brian M Shuch
- From the Department of Radiology, University of Alabama at Birmingham, 619 19th St S, JTN 452, Birmingham, AL 35249-6830 (A.M.A.E., A.J.G., A.D.S.); Department of Radiation Oncology (S.S.L.) and Department of Radiology (S.S.V.), University of Washington School of Medicine, Seattle, Wash; Department of Urology, UCLA Medical Center, Santa Monica, Calif (B.M.S.); Department of Urology, Cleveland Clinic Foundation, Cleveland, Ohio (M.E.D.F., R.A.); Division of Hematology/Oncology, Department of Internal Medicine, Loyola University Medical Center, Maywood, Ill (J.I.C.); Department of Radiation Oncology, Sunnybrook Health Science Centre, University of Toronto, Toronto, Ontario, Canada (A.V.L.); Division of Radiation Oncology, Peter MacCallum Cancer Centre, University of Melbourne, Parkville, Victoria, Australia (S.S.); and Department of Radiation Oncology, University of Freiburg, Freiburg, Germany (A.L.G.)
| | - Molly E Dewitt-Foy
- From the Department of Radiology, University of Alabama at Birmingham, 619 19th St S, JTN 452, Birmingham, AL 35249-6830 (A.M.A.E., A.J.G., A.D.S.); Department of Radiation Oncology (S.S.L.) and Department of Radiology (S.S.V.), University of Washington School of Medicine, Seattle, Wash; Department of Urology, UCLA Medical Center, Santa Monica, Calif (B.M.S.); Department of Urology, Cleveland Clinic Foundation, Cleveland, Ohio (M.E.D.F., R.A.); Division of Hematology/Oncology, Department of Internal Medicine, Loyola University Medical Center, Maywood, Ill (J.I.C.); Department of Radiation Oncology, Sunnybrook Health Science Centre, University of Toronto, Toronto, Ontario, Canada (A.V.L.); Division of Radiation Oncology, Peter MacCallum Cancer Centre, University of Melbourne, Parkville, Victoria, Australia (S.S.); and Department of Radiation Oncology, University of Freiburg, Freiburg, Germany (A.L.G.)
| | - Robert Abouassaly
- From the Department of Radiology, University of Alabama at Birmingham, 619 19th St S, JTN 452, Birmingham, AL 35249-6830 (A.M.A.E., A.J.G., A.D.S.); Department of Radiation Oncology (S.S.L.) and Department of Radiology (S.S.V.), University of Washington School of Medicine, Seattle, Wash; Department of Urology, UCLA Medical Center, Santa Monica, Calif (B.M.S.); Department of Urology, Cleveland Clinic Foundation, Cleveland, Ohio (M.E.D.F., R.A.); Division of Hematology/Oncology, Department of Internal Medicine, Loyola University Medical Center, Maywood, Ill (J.I.C.); Department of Radiation Oncology, Sunnybrook Health Science Centre, University of Toronto, Toronto, Ontario, Canada (A.V.L.); Division of Radiation Oncology, Peter MacCallum Cancer Centre, University of Melbourne, Parkville, Victoria, Australia (S.S.); and Department of Radiation Oncology, University of Freiburg, Freiburg, Germany (A.L.G.)
| | - Sandeep S Vaidya
- From the Department of Radiology, University of Alabama at Birmingham, 619 19th St S, JTN 452, Birmingham, AL 35249-6830 (A.M.A.E., A.J.G., A.D.S.); Department of Radiation Oncology (S.S.L.) and Department of Radiology (S.S.V.), University of Washington School of Medicine, Seattle, Wash; Department of Urology, UCLA Medical Center, Santa Monica, Calif (B.M.S.); Department of Urology, Cleveland Clinic Foundation, Cleveland, Ohio (M.E.D.F., R.A.); Division of Hematology/Oncology, Department of Internal Medicine, Loyola University Medical Center, Maywood, Ill (J.I.C.); Department of Radiation Oncology, Sunnybrook Health Science Centre, University of Toronto, Toronto, Ontario, Canada (A.V.L.); Division of Radiation Oncology, Peter MacCallum Cancer Centre, University of Melbourne, Parkville, Victoria, Australia (S.S.); and Department of Radiation Oncology, University of Freiburg, Freiburg, Germany (A.L.G.)
| | - Joseph I Clark
- From the Department of Radiology, University of Alabama at Birmingham, 619 19th St S, JTN 452, Birmingham, AL 35249-6830 (A.M.A.E., A.J.G., A.D.S.); Department of Radiation Oncology (S.S.L.) and Department of Radiology (S.S.V.), University of Washington School of Medicine, Seattle, Wash; Department of Urology, UCLA Medical Center, Santa Monica, Calif (B.M.S.); Department of Urology, Cleveland Clinic Foundation, Cleveland, Ohio (M.E.D.F., R.A.); Division of Hematology/Oncology, Department of Internal Medicine, Loyola University Medical Center, Maywood, Ill (J.I.C.); Department of Radiation Oncology, Sunnybrook Health Science Centre, University of Toronto, Toronto, Ontario, Canada (A.V.L.); Division of Radiation Oncology, Peter MacCallum Cancer Centre, University of Melbourne, Parkville, Victoria, Australia (S.S.); and Department of Radiation Oncology, University of Freiburg, Freiburg, Germany (A.L.G.)
| | - Alexander V Louie
- From the Department of Radiology, University of Alabama at Birmingham, 619 19th St S, JTN 452, Birmingham, AL 35249-6830 (A.M.A.E., A.J.G., A.D.S.); Department of Radiation Oncology (S.S.L.) and Department of Radiology (S.S.V.), University of Washington School of Medicine, Seattle, Wash; Department of Urology, UCLA Medical Center, Santa Monica, Calif (B.M.S.); Department of Urology, Cleveland Clinic Foundation, Cleveland, Ohio (M.E.D.F., R.A.); Division of Hematology/Oncology, Department of Internal Medicine, Loyola University Medical Center, Maywood, Ill (J.I.C.); Department of Radiation Oncology, Sunnybrook Health Science Centre, University of Toronto, Toronto, Ontario, Canada (A.V.L.); Division of Radiation Oncology, Peter MacCallum Cancer Centre, University of Melbourne, Parkville, Victoria, Australia (S.S.); and Department of Radiation Oncology, University of Freiburg, Freiburg, Germany (A.L.G.)
| | - Shankar Siva
- From the Department of Radiology, University of Alabama at Birmingham, 619 19th St S, JTN 452, Birmingham, AL 35249-6830 (A.M.A.E., A.J.G., A.D.S.); Department of Radiation Oncology (S.S.L.) and Department of Radiology (S.S.V.), University of Washington School of Medicine, Seattle, Wash; Department of Urology, UCLA Medical Center, Santa Monica, Calif (B.M.S.); Department of Urology, Cleveland Clinic Foundation, Cleveland, Ohio (M.E.D.F., R.A.); Division of Hematology/Oncology, Department of Internal Medicine, Loyola University Medical Center, Maywood, Ill (J.I.C.); Department of Radiation Oncology, Sunnybrook Health Science Centre, University of Toronto, Toronto, Ontario, Canada (A.V.L.); Division of Radiation Oncology, Peter MacCallum Cancer Centre, University of Melbourne, Parkville, Victoria, Australia (S.S.); and Department of Radiation Oncology, University of Freiburg, Freiburg, Germany (A.L.G.)
| | - Anca-Ligia Grosu
- From the Department of Radiology, University of Alabama at Birmingham, 619 19th St S, JTN 452, Birmingham, AL 35249-6830 (A.M.A.E., A.J.G., A.D.S.); Department of Radiation Oncology (S.S.L.) and Department of Radiology (S.S.V.), University of Washington School of Medicine, Seattle, Wash; Department of Urology, UCLA Medical Center, Santa Monica, Calif (B.M.S.); Department of Urology, Cleveland Clinic Foundation, Cleveland, Ohio (M.E.D.F., R.A.); Division of Hematology/Oncology, Department of Internal Medicine, Loyola University Medical Center, Maywood, Ill (J.I.C.); Department of Radiation Oncology, Sunnybrook Health Science Centre, University of Toronto, Toronto, Ontario, Canada (A.V.L.); Division of Radiation Oncology, Peter MacCallum Cancer Centre, University of Melbourne, Parkville, Victoria, Australia (S.S.); and Department of Radiation Oncology, University of Freiburg, Freiburg, Germany (A.L.G.)
| | - Andrew D Smith
- From the Department of Radiology, University of Alabama at Birmingham, 619 19th St S, JTN 452, Birmingham, AL 35249-6830 (A.M.A.E., A.J.G., A.D.S.); Department of Radiation Oncology (S.S.L.) and Department of Radiology (S.S.V.), University of Washington School of Medicine, Seattle, Wash; Department of Urology, UCLA Medical Center, Santa Monica, Calif (B.M.S.); Department of Urology, Cleveland Clinic Foundation, Cleveland, Ohio (M.E.D.F., R.A.); Division of Hematology/Oncology, Department of Internal Medicine, Loyola University Medical Center, Maywood, Ill (J.I.C.); Department of Radiation Oncology, Sunnybrook Health Science Centre, University of Toronto, Toronto, Ontario, Canada (A.V.L.); Division of Radiation Oncology, Peter MacCallum Cancer Centre, University of Melbourne, Parkville, Victoria, Australia (S.S.); and Department of Radiation Oncology, University of Freiburg, Freiburg, Germany (A.L.G.)
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