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Diagnostic test accuracy of ADC values for identification of clear cell renal cell carcinoma: systematic review and meta-analysis

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Abstract

Objectives

To perform a systematic review on apparent diffusion coefficient (ADC) values of renal tumor subtypes and meta-analysis on the diagnostic performance of ADC for differentiation of localized clear cell renal cell carcinoma (ccRCC) from other renal tumor types.

Methods

Medline, Embase, and the Cochrane Library databases were searched for studies published until May 1, 2019, that reported ADC values of renal tumors. Methodological quality was evaluated. For the meta-analysis on diagnostic test accuracy of ADC for differentiation of ccRCC from other renal lesions, we applied a bivariate random-effects model and compared two subgroups of ADC measurement with vs. without cystic and necrotic areas.

Results

We included 48 studies (2588 lesions) in the systematic review and 13 studies (1126 lesions) in the meta-analysis. There was no significant difference in ADC of renal parenchyma using b values of 0–800 vs. 0–1000 (p = 0.08). ADC measured on selected portions (sADC) excluding cystic and necrotic areas differed significantly from whole-lesion ADC (wADC) (p = 0.002). Compared to ccRCC, minimal-fat angiomyolipoma, papillary RCC, and chromophobe RCC showed significantly lower sADC while oncocytoma exhibited higher sADC. Summary estimates of sensitivity and specificity to differentiate ccRCC from other tumors were 80% (95% CI, 0.76–0.88) and 78% (95% CI, 0.64–0.89), respectively, for sADC and 77% (95% CI, 0.59–0.90) and 77% (95% CI, 0.69–0.86) for wADC. sADC offered a higher area under the receiver operating characteristic curve than wADC (0.852 vs. 0.785, p = 0.02).

Conclusions

ADC values of kidney tumors that exclude cystic or necrotic areas more accurately differentiate ccRCC from other renal tumor types than whole-lesion ADC values.

Key Points

• Selective ADC of renal tumors, excluding cystic and necrotic areas, provides better discriminatory ability than whole-lesion ADC to differentiate clear cell RCC from other renal lesions, with area under the receiver operating characteristic curve (AUC) of 0.852 vs. 0.785, respectively (p = 0.02).

• Selective ADC of renal masses provides moderate sensitivity and specificity of 80% and 78%, respectively, for differentiation of clear cell renal cell carcinoma (RCC) from papillary RCC, chromophobe RCC, oncocytoma, and minimal-fat angiomyolipoma.

• Selective ADC excluding cystic and necrotic areas are preferable to whole-lesion ADC as an additional tool to multiphasic MRI to differentiate clear cell RCC from other renal lesions whether the highest b value is 800 or 1000.

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Abbreviations

ADC:

Apparent diffusion coefficient

ANOVA:

Analysis of variance

AUC:

Area under the receiver operating characteristic curve

ccRCC:

Clear cell renal cell carcinoma

chRCC:

Chromophobe renal cell carcinoma

DWI:

Diffusion weighted imaging

MeSH:

Medical subject heading

mfAML:

Minimal-fat angiomyolipoma

pRCC:

Papillary renal cell carcinoma

RCC:

Renal cell carcinoma

ROI:

Regions of interests

sADC:

ADC of selected region of the tumor (excluding cystic, hemorrhagic, and necrotic areas)

wADC:

ADC of the whole lesion

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Acknowledgments

We acknowledge Dr. Mirka, Dr. Mytsyk, and Dr. Cornelis for their help.

Funding

This study has received funding from Agence Regionale de Santé (ARS Ile de France; Mickael Tordjman). Dr. Kang is supported by Award Number K07CA197134 from the National Cancer Institute (P.I. Stella Kang, MD, MSc). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Cancer Institute or the National Institutes of Health.

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Authors and Affiliations

  1. Center for Biomedical Imaging, Department of Radiology, New York University School of Medicine, 660 First Avenue, New York, NY, 10016, USA

    Mickael Tordjman, Rahul Mali, Guillaume Madelin, Vinay Prabhu & Stella K. Kang

  2. Department of Population Health, New York University School of Medicine, New York, NY, 10016, USA

    Stella K. Kang

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  1. Mickael Tordjman
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  2. Rahul Mali
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  3. Guillaume Madelin
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  4. Vinay Prabhu
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  5. Stella K. Kang
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Corresponding author

Correspondence to Mickael Tordjman.

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Guarantor

The scientific guarantor of this publication is Stella Kang.

Conflict of interest

The authors declare that they have no competing interests.

Statistics and biometry

Rahul Mali and Stella Kang kindly provided statistical advice for this manuscript. Two of the authors (R.M. and S.K.) have significant statistical expertise.

Informed consent

Written informed consent was not required for this study because it was a meta-analysis.

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Institutional Review Board approval was not required because it was a systematic review and meta-analysis.

Study subjects or cohorts overlap

This study is a systematic review and meta-analysis.

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• Multicenter study

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Tordjman, M., Mali, R., Madelin, G. et al. Diagnostic test accuracy of ADC values for identification of clear cell renal cell carcinoma: systematic review and meta-analysis. Eur Radiol 30, 4023–4038 (2020). https://doi.org/10.1007/s00330-020-06740-w

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  • DOI: https://doi.org/10.1007/s00330-020-06740-w

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