Irani J, Humbert M, Lecocq B, Pires C, Lefèbvre O, Doré B
Department of Urology, Centre Hospitalier Universitaire La Milétrie, F-86000 Poitiers, France.
Eur Urol. 2001 Mar;39(3):300-3. doi: 10.1159/000052457.
We studied the agreement between renal tumor size as assessed on computed tomography (CT) before surgery and that measured during histopathological examination on the radical nephrectomy specimen.
We retrospectively analyzed the records of 100 consecutive patients treated with radical nephrectomy for a renal tumor. The tumor size was determined in all patients by the largest diameter shown within the month before surgery on contrast-enhanced CT and as measured postoperatively by the pathologist. A possible influence of the clinical and pathological parameters was assessed in a multivariate analysis.
CT estimate and surgical measurement of tumor size were highly correlated (r = 0.9; p<0.001). Median (range) tumor size was 70.0 mm (13-180) and 60.0 mm (10-180) as measured, respectively, on CT and in the specimen, with a significant difference (p = 0.005). Multiple regression did not reveal any significant influence of tumor side, location, type, nuclear grade as well as patient gender, body mass index and radiological center (p>0.3 in all cases). The extent of difference between CT and surgical measurements was significantly influenced by the surgical size of the tumor (p = 0.03): the smaller the tumor, the more the CT overestimated the tumor size. If nephron-sparing surgery had been planned for tumors equal to or less than 40 mm, 24 patients would have been selected following the CT estimate, while 27 patients would have met this criterion on the surgical measurement.
Renal tumors were statistically smaller than the estimate from CT, although this was not systematically the case. This should be kept in mind when issuing recommendations on the optimal cutoff size value under which nephron-sparing surgery is considered equivalent to radical nephrectomy.
我们研究了术前计算机断层扫描（CT）评估的肾肿瘤大小与根治性肾切除标本组织病理学检查时测量的大小之间的一致性。
我们回顾性分析了100例连续接受根治性肾切除术治疗肾肿瘤患者的记录。所有患者的肿瘤大小通过术前1个月内增强CT显示的最大直径确定，并由病理学家术后测量。在多变量分析中评估临床和病理参数的可能影响。
CT估计的肿瘤大小与手术测量值高度相关（r = 0.9；p<0.001）。CT测量的肿瘤大小中位数（范围）为70.0 mm（13 - 180），标本中测量的为60.0 mm（10 - 180），差异有统计学意义（p = 0.005）。多元回归未显示肿瘤侧别、位置、类型、核分级以及患者性别、体重指数和放射中心有任何显著影响（所有情况下p>0.3）。CT与手术测量值之间的差异程度受肿瘤手术大小的显著影响（p = 0.03）：肿瘤越小，CT对肿瘤大小的高估越明显。如果计划对直径小于或等于40 mm的肿瘤进行保留肾单位手术，按照CT估计会选择24例患者，而根据手术测量则有27例患者符合该标准。
肾肿瘤在统计学上比CT估计值小，尽管并非总是如此。在发布关于保留肾单位手术被认为等同于根治性肾切除术的最佳临界大小值的建议时应牢记这一点。
