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Liang M, Qiu H, Ou B, Wu J, Zhao X, Luo B. Evaluation of contrast-enhanced ultrasound for predicting tumor grade in small (≤4 cm) clear cell renal cell carcinoma: Qualitative and quantitative analysis. Clin Hemorheol Microcirc 2024:CH231990. [PMID: 39031342 DOI: 10.3233/ch-231990] [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: 07/22/2024]
Abstract
OBJECTIVE The study aimed to evaluate the utility of qualitative and quantitative analysis employing contrast-enhanced ultrasound (CEUS) in predicting the WHO/ISUP grade of small (≤4 cm) clear cell renal cell carcinoma (ccRCCs). METHODS Patients with small ccRCCs, confirmed by histological examination, underwent preoperative CEUS and were classified into low- (grade I/II) and high-grade (grade III/IV) groups. Qualitative and quantitative assessments of CEUS were conducted and compared between the two groups. Diagnostic performance was assessed using receiver operating characteristic curves. RESULTS A total of 72 patients were diagnosed with small ccRCCs, comprising 23 individuals in the high-grade group and 49 in the low-grade group. The low-grade group exhibited a significantly greater percentage of hyper-enhancement compared to the high-grade group (79.6% VS 39.1%, P < 0.05). The low-grade group showed significantly higher relative index values for peak enhancement, wash-in area under the curve, wash-in rate, wash-in perfusion index, and wash-out rate compared to the high-grade group (all P < 0.05). The AUC values for qualitative and quantitative parameters in predicting the WHO/ISUP grade of small ccRCCs ranged from 0.676 to 0.756. CONCLUSIONS Both qualitative and quantitative CEUS analysis could help to distinguish the high- from low-grade small ccRCCs.
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Affiliation(s)
- Ming Liang
- Department of Ultrasound, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, Guangdong, China
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Medical Research Center, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Haolin Qiu
- Department of Ultrasound, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, Guangdong, China
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Medical Research Center, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Bing Ou
- Department of Ultrasound, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, Guangdong, China
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Medical Research Center, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Jiayi Wu
- Department of Ultrasound, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, Guangdong, China
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Medical Research Center, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Xinbao Zhao
- Department of Ultrasound, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, Guangdong, China
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Medical Research Center, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Baoming Luo
- Department of Ultrasound, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, Guangdong, China
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Medical Research Center, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
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Barkovich KJ, Gibson AC, Brahmbhatt S, Tadisetty S, Wilds EC, Nelson LW, Gupta M, Gedaly R, Khurana A. Contrast-enhanced ultrasound of renal masses in the pre-transplant setting: literature review with case highlights. Abdom Radiol (NY) 2024:10.1007/s00261-024-04366-w. [PMID: 38900316 DOI: 10.1007/s00261-024-04366-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2024] [Revised: 04/29/2024] [Accepted: 04/29/2024] [Indexed: 06/21/2024]
Abstract
With the rising incidence of chronic kidney disease worldwide, an increasing number of patients are expected to require renal transplantation, which remains the definitive treatment of end stage renal disease. Medical imaging, primarily ultrasonography and contrast-enhanced CT and/or MRI, plays a large role in pre-transplantation assessment, especially in the characterization of lesions within the native kidneys. However, patients with CKD/ESRD often have relative contraindications to CT- and MR-contrast agents, limiting their utilization within this patient population. Contrast-enhanced ultrasound (CEUS), which combines the high temporal and spatial resolution of ultrasonography with intravascular microbubble contrast agents, provides a promising alternative. This review aims to familiarize the reader with the literature regarding the use of CEUS in the evaluation of cystic and solid renal lesions and provide case examples of its use at our institution in the pre-transplant setting.
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Affiliation(s)
- Krister J Barkovich
- Department of Radiology, University of California, San Diego, La Jolla, CA, 92093, USA
| | - Amanda C Gibson
- Department of Radiology, University of Kentucky, Lexington, KY, 40508, USA
| | - Sneh Brahmbhatt
- Department of Radiology, Mayo Clinic Florida, Jacksonville, FL, 32224, USA
| | - Sindhura Tadisetty
- Department of Radiology, University of Kentucky, Lexington, KY, 40508, USA
| | - Emory C Wilds
- College of Medicine, University of Kentucky, Lexington, KY, 40506, USA
| | - Leslie W Nelson
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, WI, 53792, USA
| | - Meera Gupta
- Department of Surgery, University of Kentucky, Lexington, KY, 40508, USA
| | - Roberto Gedaly
- Department of Surgery, University of Kentucky, Lexington, KY, 40508, USA
| | - Aman Khurana
- Department of Radiology, University of California, San Diego, La Jolla, CA, 92093, USA.
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Zhang W, Wang J, Chen L, Shi J. Qualitative and quantitative assessment of non-clear cell renal cell carcinoma using contrast-enhanced ultrasound. BMC Urol 2024; 24:129. [PMID: 38886684 PMCID: PMC11181612 DOI: 10.1186/s12894-024-01514-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2024] [Accepted: 06/10/2024] [Indexed: 06/20/2024] Open
Abstract
BACKGROUND Non-clear cell renal cell carcinoma (nccRCC) represents a rare form of renal cell carcinoma (RCC) in the clinic. It is now understood that contrast-enhanced ultrasound (CEUS) exhibits diverse manifestations and can be prone to misdiagnosis. Therefore, summarizing the distinctive features of contrast-enhanced ultrasonography is essential for differentiation from ccRCC. OBJECTIVE This study aims to evaluate the diagnostic efficacy of qualitative and quantitative CEUS in diagnosing nccRCC to enhance our understanding of this condition. METHODS We conducted a retrospective analysis of 21 patients with confirmed nccRCC following surgery and assessed the characteristic conventional ultrasound and CEUS imaging features. The paired Wilcoxon signed-rank sum test was employed to compare differences in CEUS time-intensity curve (TIC) parameters between the lesions and the normal renal cortex. RESULTS Routine ultrasound revealed the following primary characteristics in the 21 nccRCC cases: hypoechoic appearance (10/21, 47.6%), absence of liquefaction (18/21, 66.7%), regular shape (19/21, 90.5%), clear boundaries (21/21, 100%), and absence of calcification (17/21, 81%). Color Doppler flow imaging (CDFI) indicated a low blood flow signal (only 1 case of grade III). Qualitative CEUS analysis demonstrated that nccRCC predominantly exhibited slow progression (76.1%), fast washout (57%), uniformity (61.9%), low enhancement (71.5%), and ring enhancement (61.9%). Quantitative CEUS analysis revealed that parameters such as PE, WiAUC, mTTI, WiR, WiPI, WoAUC, WiWoAUC, and WOR in the lesions were significantly lower than those in the normal renal cortex (Z=-3.980, -3.563, -2.427, -3.389, -3.980, -3.493, -3.528, -2.763, P < 0.001, < 0.001, = 0.015, = 0.001, < 0.001, < 0.001, < 0.001, = 0.006). However, there were no significant differences in RT, TTP, FT, or QOF (all P > 0.05). CONCLUSION nccRCC exhibits distinctive CEUS characteristics, including slow progression, fast washout, low homogeneity enhancement, and ring enhancement, which can aid in distinguishing nccRCC from ccRCC.
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Affiliation(s)
- WeiPing Zhang
- Department of Ultrasound, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, China.
| | - JingLing Wang
- Department of Ultrasound, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, China
| | - Li Chen
- Department of Ultrasound, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, China
| | - Jiayu Shi
- Department of Ultrasound, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, China
- The First Clinical Medical College, Jiangxi Medical College, Nanchang University, Nanchang, China
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Tufano A, Rosati D, Moriconi M, Santarelli V, Canale V, Salciccia S, Sciarra A, Franco G, Cantisani V, Di Pierro GB. Diagnostic Accuracy of Contrast-Enhanced Ultrasound (CEUS) in the Detection of Muscle-Invasive Bladder Cancer: A Systematic Review and Diagnostic Meta-Analysis. Curr Oncol 2024; 31:818-827. [PMID: 38392054 PMCID: PMC10888477 DOI: 10.3390/curroncol31020060] [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: 01/02/2024] [Revised: 01/17/2024] [Accepted: 01/30/2024] [Indexed: 02/24/2024] Open
Abstract
BACKGROUND Contrast-enhanced ultrasound (CEUS) is a diagnostic tool that is gaining popularity for its ability to improve overall diagnostic accuracy in bladder cancer (BC) staging. Our aim is to determine the cumulative diagnostic performance of CEUS in predicting preoperative muscle invasiveness using a comprehensive systematic review and pooled meta-analysis. METHODS A systematic review until October 2023 was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Patients with BC suspicion were offered CEUS before the transurethral resection of the bladder tumor (TURBT). The diagnostic performance of CEUS was evaluated based on non-muscle-invasive bladder cancer (NMIBC) vs. muscle-invasive bladder cancer (MIBC) confirmed at the final histopathological examination after TURBT. The outcomes were determined through pooled sensitivity, specificity, pooled positive likelihood ratio (PLR+), negative likelihood ratio (PLR-), and area under the summary receiver operating characteristic (SROC) along with their respective 95% confidence intervals (CI). RESULTS Overall, five studies were included. In these studies, a total of 362 patients underwent CEUS prior to TURBT. The pooled sensitivity and specificity were 0.88 (95% CI: 0.81-0.93) and 0.88 (95% CI: 0.82-0.92), respectively. SROC curve depicted a diagnostic accuracy of 0.94 (95% CI: 0.81-0.98). The pooled PLR+ and PLR- were 7.3 (95% CI: 4.8-11.2) and 0.14 (95% CI: 0.08-0.23), respectively. CONCLUSIONS Our meta-analysis indicates that CEUS is highly accurate in the diagnosis and staging for BC. Beyond its accuracy, CEUS offers the advantage of being a cost-effective, safe, and versatile imaging tool.
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Affiliation(s)
- Antonio Tufano
- Department of Maternal-Infant and Urological Sciences, “Sapienza” Rome University, Policlinico Umberto I Hospital, 00185 Rome, Italy
| | - Davide Rosati
- Department of Maternal-Infant and Urological Sciences, “Sapienza” Rome University, Policlinico Umberto I Hospital, 00185 Rome, Italy
| | - Martina Moriconi
- Department of Maternal-Infant and Urological Sciences, “Sapienza” Rome University, Policlinico Umberto I Hospital, 00185 Rome, Italy
| | - Valerio Santarelli
- Department of Maternal-Infant and Urological Sciences, “Sapienza” Rome University, Policlinico Umberto I Hospital, 00185 Rome, Italy
| | - Vittorio Canale
- Department of Maternal-Infant and Urological Sciences, “Sapienza” Rome University, Policlinico Umberto I Hospital, 00185 Rome, Italy
| | - Stefano Salciccia
- Department of Maternal-Infant and Urological Sciences, “Sapienza” Rome University, Policlinico Umberto I Hospital, 00185 Rome, Italy
| | - Alessandro Sciarra
- Department of Maternal-Infant and Urological Sciences, “Sapienza” Rome University, Policlinico Umberto I Hospital, 00185 Rome, Italy
| | - Giorgio Franco
- Department of Maternal-Infant and Urological Sciences, “Sapienza” Rome University, Policlinico Umberto I Hospital, 00185 Rome, Italy
| | - Vito Cantisani
- Department of Radiology, Oncology and Pathology, University La Sapienza of Rome, 00185 Rome, Italy
| | - Giovanni Battista Di Pierro
- Department of Maternal-Infant and Urological Sciences, “Sapienza” Rome University, Policlinico Umberto I Hospital, 00185 Rome, Italy
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Isgrò G, Rogers A, Veeratterapillay R, Rix D, Page T, Maestroni U, Bertolotti L, Pagnini F, Martini C, De Filippo M, Ziglioli F. Role of Renal Biopsy in the Management of Renal Cancer: Concordance between Ultrasound/CT-Guided Biopsy Results and Definitive Pathology, Adverse Events, and Complication Rate. J Clin Med 2023; 13:31. [PMID: 38202038 PMCID: PMC10779766 DOI: 10.3390/jcm13010031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Revised: 10/24/2023] [Accepted: 10/26/2023] [Indexed: 01/12/2024] Open
Abstract
(1) Background: In the last decade, the number of detected renal cancer cases has increased, with the highest incidence in Western countries. Although renal biopsy is reported as a safe procedure, it is not adopted in all centres. As it is not possible to accurately distinguish benign tumours using imaging, this may lead to overtreatment. Most of the cancer detected on imaging is treated by surgery, radiofrequency ablation (RFA), or cryotherapy. (2) Methods: This was a single-centre retrospective study of 225 patients studied preoperatively with ultrasound (US)/CT-guided renal biopsy, with the aim of supporting clinical management. Decisions regarding the biopsy were based on either MDT indication or physician preference. US-guided renal biopsy was the first option for all patients; CT-guided biopsy was used when US-guided biopsy was not feasible. The efficacy of renal biopsy in terms of diagnostic performance and the concordance between biopsy results and definitive pathology were investigated. Additionally, adverse events related to the biopsy were recorded and analysed. Data collected throughout the study were analysed using binary logistic regression, Fisher's exact test, and Pearson's chi-square test to investigate possible correlations between post-procedural complications and the size of the lesion. (3) Results: Renal biopsy was not diagnostic in 23/225 (10.2%) patients. A CT-guided approach was necessary in 20/225 patients after failure of US-guided biopsy. The complication rate of renal biopsy was 4.8% overall-all Clavien grade I and without any serious sequelae. Interestingly, complications occurred in patients with very different sizes of renal cell carcinoma. No correlation between complications and anticoagulant/antiplatelet drugs was found. No seeding was reported among the patients who underwent partial/radical nephrectomy. (4) Conclusions: Renal biopsy was shown to be safe and effective, with a high concordance between biopsy results and definitive pathology and a low rate of complications. The use of a CT-guided approach whenever the US-guided approach failed improved the diagnostic performance of renal biopsy.
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Affiliation(s)
- Gianmarco Isgrò
- Department of Urology, James Cook University Hospital, Middlesbrough TS4 3BW, UK
| | - Alistair Rogers
- Department of Urology, The Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne NE7 7DN, UK (R.V.)
| | - Rajan Veeratterapillay
- Department of Urology, The Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne NE7 7DN, UK (R.V.)
| | - David Rix
- Department of Urology, The Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne NE7 7DN, UK (R.V.)
| | - Toby Page
- Department of Urology, James Cook University Hospital, Middlesbrough TS4 3BW, UK
| | - Umberto Maestroni
- Department of Urology, University Hospital of Parma, 43100 Parma, Italy (F.Z.)
| | - Lorenzo Bertolotti
- Department of Medicine and Surgery, Section of Radiology, University-Hospital of Parma, 43100 Parma, Italy (M.D.F.)
| | - Francesco Pagnini
- Department of Medicine and Surgery, Section of Radiology, University-Hospital of Parma, 43100 Parma, Italy (M.D.F.)
| | - Chiara Martini
- Department of Medicine and Surgery, University-Hospital of Parma, 43100 Parma, Italy
| | - Massimo De Filippo
- Department of Medicine and Surgery, Section of Radiology, University-Hospital of Parma, 43100 Parma, Italy (M.D.F.)
| | - Francesco Ziglioli
- Department of Urology, University Hospital of Parma, 43100 Parma, Italy (F.Z.)
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Toffoli T, Saut O, Etchegaray C, Jambon E, Le Bras Y, Grenier N, Marcelin C. Differentiation of Small Clear Renal Cell Carcinoma and Oncocytoma through Magnetic Resonance Imaging-Based Radiomics Analysis: Toward the End of Percutaneous Biopsy. J Pers Med 2023; 13:1444. [PMID: 37888055 PMCID: PMC10608459 DOI: 10.3390/jpm13101444] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 09/13/2023] [Accepted: 09/21/2023] [Indexed: 10/28/2023] Open
Abstract
PURPOSE The aim of this study was to ascertain whether radiomics data can assist in differentiating small (<4 cm) clear cell renal cell carcinomas (ccRCCs) from small oncocytomas using T2-weighted magnetic resonance imaging (MRI). MATERIAL AND METHODS This retrospective study incorporated 48 tumors, 28 of which were ccRCCs and 20 were oncocytomas. All tumors were less than 4 cm in size and had undergone pre-biopsy or pre-surgery MRI. Following image pre-processing, 102 radiomics features were evaluated. A univariate analysis was performed using the Wilcoxon rank-sum test with Bonferroni correction. We compared multiple radiomics pipelines of normalization, feature selection, and machine learning (ML) algorithms, including random forest (RF), logistic regression (LR), AdaBoost, K-nearest neighbor, and support vector machine, using a supervised ML approach. RESULTS No statistically significant features were identified via the univariate analysis with Bonferroni correction. The most effective algorithm was identified using a pipeline incorporating standard normalization, RF-based feature selection, and LR, which achieved an area under the curve (AUC) of 83%, accuracy of 73%, sensitivity of 79%, and specificity of 65%. Subsequently, the most significant features were identified from this algorithm, and two groups of uncorrelated features were established based on Pearson correlation scores. Using these features, an algorithm was established after a pipeline of standard normalization and LR, achieving an AUC of 90%, an accuracy of 77%, sensitivity of 83%, and specificity of 69% for distinguishing ccRCCs from oncocytomas. CONCLUSIONS Radiomics analysis based on T2-weighted MRI can aid in distinguishing small ccRCCs from small oncocytomas. However, it is not superior to standard multiparameter renal MRI and does not yet allow us to dispense with percutaneous biopsy.
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Affiliation(s)
- Thibault Toffoli
- Centre Hospitalier Universitaire (CHU) de Bordeaux, Imaging and Interventional Radiology, Hôpital Pellegrin, 33000 Bordeaux, France; (T.T.); (E.J.); (Y.L.B.)
| | - Olivier Saut
- University of Bordeaux, IMB, UMR CNRS 5251, INRIA Project Team Monc, F-33400 Talence, France; (O.S.); (C.E.); (N.G.)
| | - Christele Etchegaray
- University of Bordeaux, IMB, UMR CNRS 5251, INRIA Project Team Monc, F-33400 Talence, France; (O.S.); (C.E.); (N.G.)
| | - Eva Jambon
- Centre Hospitalier Universitaire (CHU) de Bordeaux, Imaging and Interventional Radiology, Hôpital Pellegrin, 33000 Bordeaux, France; (T.T.); (E.J.); (Y.L.B.)
| | - Yann Le Bras
- Centre Hospitalier Universitaire (CHU) de Bordeaux, Imaging and Interventional Radiology, Hôpital Pellegrin, 33000 Bordeaux, France; (T.T.); (E.J.); (Y.L.B.)
| | - Nicolas Grenier
- University of Bordeaux, IMB, UMR CNRS 5251, INRIA Project Team Monc, F-33400 Talence, France; (O.S.); (C.E.); (N.G.)
| | - Clément Marcelin
- Centre Hospitalier Universitaire (CHU) de Bordeaux, Imaging and Interventional Radiology, Hôpital Pellegrin, 33000 Bordeaux, France; (T.T.); (E.J.); (Y.L.B.)
- Bordeaux Institute of Oncology, BRIC U1312, INSERM, Bordeaux University, 33000 Bordeaux, France
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