Papillary vs clear cell renal cell carcinoma. Differentiation and grading by iodine concentration using DECT—correlation with microvascular density
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Various imaging methods have been evaluated regarding non-invasive differentiation of renal cell carcinoma (RCC) subtypes. Dual-energy computed tomography (DECT) allows iodine concentration (IC) analysis as a correlate of tissue perfusion. Microvascular density (MVD) in histopathology specimens is evaluated to determine intratumoral vascularization. The objective of this study was to assess the potential of IC and MVD regarding the differentiation between papillary and clear cell RCC and between well- and dedifferentiated tumors. Further, we aimed to investigate a possible correlation between these parameters.
DECT imaging series of 53 patients with clear cell RCC (ccRCC) and 15 with papillary RCC (pRCC) were analyzed regarding IC. Histology samples were stained using CD31/CD34 monoclonal antibodies; MVD was evaluated digitally. Statistical analysis included performance of Mann-Whitney U test, ROC analysis, and Spearman rank correlation.
Analysis of IC demonstrated significant differences between ccRCC and pRCC (p < 0.001). A cutoff value of ≤ 3.1 mg/ml at IC analysis allowed identification of pRCC with an accuracy of 86.8%. Within the ccRCC subgroup, G1/G2 tumors could significantly be differentiated from G3/G4 carcinomas (p = 0.045). A significant positive correlation between IC and MVD could be determined for the entire RCC cohort and the ccRCC subgroup. Limitations include the small percentage of pRCCs.
IC analysis is a useful method to differentiate pRCC from ccRCC. The significant positive correlation between IC and MVD indicates valid representation of tumor perfusion by DECT.
• Analysis of iodine concentration using DECT imaging could reliably distinguish papillary from clear cell subtypes of renal cell cancer (RCC).
• A cutoff value of 3.1 mg/ml allowed a distinction between papillary and clear cell RCCs with an accuracy of 86.8%.
• The positive correlation with microvascular density in tumor specimens indicates correct display of perfusion by iodine concentration analysis.
KeywordsCarcinoma, renal cell Kidney neoplasms Neovascularization, pathologic Cell differentiation Tomography, X-ray computed
Area under the curve
Clear cell renal cell carcinoma
Cluster of differentiation
Chromophobe renal cell carcinoma
Dual-energy computed tomography
Field of view
Hematoxylin and eosin
Magnetic resonance imaging
Mammalian target of rapamycin
Papillary renal cell carcinoma
Renal cell carcinoma
Receiver operating characteristic
Vascular endothelial growth factor
The authors state that this work has not received any funding.
Compliance with ethical standards
The scientific guarantor of this publication is Michael Staehler.
Conflict of interest
The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.
Statistics and biometry
No complex statistical methods were necessary for this paper.
Written informed consent was obtained from all subjects (patients) in this study.
Institutional Review Board approval was obtained.
• Performed at one institution
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