Abstract
Objectives
To assess the accuracy of multi-detector computed tomography (MDCT) in preoperative staging of renal cell carcinoma (RCC) and to detect the possible risk factors for mis-staging. In addition, the impact of radiological mis-staging on surgical decision and operative procedures was evaluated.
Materials and methods
Data files of 693 patients, who underwent either radical or partial nephrectomy after preoperative staging by MDCT between January 2003 and December 2010, were retrospectively reviewed. Radiological data were compared to surgical and histopathological findings. Patients were classified according to 2009 TNM staging classification. Diagnostic accuracy per stage and its impact on surgical intervention were evaluated.
Results
The overall accuracy was 64.5%, and over-stage was detected in 29.5% and under-stage in 6%. Sensitivity and specificity were highest in stage T3b (85 and 99.5%, respectively), while T4 showed the lowest sensitivity and PPV (57 and 45%). Degree of agreement with pathological staging was substantial in T1 (κ = 0.7), fair in T2 (κ = 0. 4), perfect in T3b (κ = 0.81), and slight for the other stages (κ = <0.1). On multivariate analysis, conventional RCC and tumor size > 7 cm represent the significant risk factors (RR: 1.6, 95% CI: 1.1–2.3, P < 0.004 and RR: 2.4, 95% CI: 1.7–3.5, P < 0.001, respectively). Mis-staging was seen to have no negative impact on surgical decision.
Conclusions
MDCT is an accepted tool for renal tumor staging. Tumor mis-staging after MDCT is of little clinical importance. Large tumor size >7 cm and conventional RCC are risk factors for tumor mis-staging.
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References
Garcia JA, Cowey CL, Godley PA (2009) Renal cell carcinoma. Curr Opin Oncol 21:266–271
Kirkali Z, Van Poppel H (2007) A critical analysis of surgery for kidney cancer with vena cava invasion. Eur Urol 52:658–662
Reznek RH (2004) CT/MRI in staging renal cell carcinoma. Cancer Imaging 4:S25–S32
Catalano C, Fraioli F, Laghi A et al (2003) Highresolution multidetector CT in the preoperative evaluation of patients with renal cell carcinoma. AJR Am J Roentgenol 180:1271–1277
Türkvatan A, Akdur PO, Altinel M et al (2009) Preoperative staging of renal cell carcinoma with multidetector CT. Diagn Interv Radiol 15:22–30
Hallscheidt P, Wagener N, Gholipour F et al (2006) Multislice computed tomography in planning nephron-sparing surgery in a prospective study with 76 patients: comparison of radiological and histopathological findings in the infiltration of renal structures. J Comput Assist Tomogr 30:869–874
Mistry R, Manikandan R, Williams P et al (2008) Implications of computer tomography measurement in the management of renal tumours. BMC Urol 8:13–18
Kurta JM, Thompson RH, Kundu S et al (2009) Contemporary imaging of patients with a renal mass: does size on computed tomography equal pathological size? BJU Int 103:24–27
Lee SE, Lee WK, Kim DS et al (2010) Comparison of radiographic and pathologic sizes of renal tumors. World J Urol 28:263–267
Greene FL, Gospodarowicz M, Wittekend C et al (2009) American Joint Committee on Cancer (AJCC) staging manual (7th edn). Springer, Philadelphia
Kovacs G, Akhtar M, Beckwith BJ et al (1997) The Heidelberg classification of renal cell tumours. J Pathol 183:131–133
Fuhrman SA, Lasky LC, Limas C (1982) Prognostic significance of morphologic parameters in renal cell carcinoma. Am J Surg Pathol 6:655–663
Sheth S, Scatarige JC, Horton KM et al (2001) Current concepts in the diagnosis and management of renal cell carcinoma: role of multidetector CT and threedimensional CT. RadioGraphics 1[suppl]:237S–254S
Mueller-Lisse UG, Mueller-Lisse UL, Meindl T et al (2007) Staging of renal cell carcinoma. Eur Radiol 17:2268–2277
Johnson CD, Dunnick NR, Cohan RH et al (1987) Renal adenocarcinoma: CT staging of 100 tumors. AJR Am J Roentgenol 148:59–63
Remzi M, Katzenbeisser D, Waldert M et al (2007) Renal tumour size measuredradiologically before surgery is an unreliable variable for predictinghistopathological features: benign tumours are not necessarily small. BJU Int 99:1002–1006
Schlomer B, Figenshau RS, Yan Y et al (2006) How does the radiographic size of a renal mass compare with the pathologic size? Urology 68:292–295
Pantuck AJ, Zisman A, Dorey F et al (2003) Renal cell carcinoma with retroperitoneal lymph nodes: role of lymph node dissection. J Urol 169:2076–2083
Ergen FB, Hussain HK, Caoili EM et al (2004) MRI for preoperative staging of renal cell carcinoma using the 1997 TNM classification: comparison with surgical and pathologic staging. AJR Am J Roentgenol 182:217–225
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The authors declare that they have no conflict of interest. The study was conducted in UNC institution without any external sponsoring.
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EL-Hefnawy, A.S., Mosbah, A., EL-Diasty, T. et al. Accuracy of multi-detector computed tomography (MDCT) in staging of renal cell carcinoma (RCC): analysis of risk factors for mis-staging and its impact on surgical intervention. World J Urol 31, 887–891 (2013). https://doi.org/10.1007/s00345-011-0816-7
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DOI: https://doi.org/10.1007/s00345-011-0816-7