Department of Clinical Radiology, St. George's Hospital, London, United Kingdom.
AJR Am J Roentgenol. 2012 Apr;198(4):846-53. doi: 10.2214/AJR.11.7376.
The objective of our study was to retrospectively determine the accuracy of CT for differentiating intrarenal transitional cell carcinoma (TCC) from centrally located renal cell carcinoma (RCC) and to define the most discriminating diagnostic CT features.
CT studies of 98 pathologically proven central renal tumors (64 centrally located RCCs and 34 intrarenal TCCs) seen over 5 years at three university hospitals were reviewed by five specialty-trained radiologists who were blinded to the final diagnosis. Multiple CT features and global impression were graded on a 4-point score. The sensitivity and specificity of each feature and of global assessment were calculated and compared using receiver operating characteristic (ROC) analysis. Interobserver agreement (kappa values) was also calculated for each parameter.
All five readers recognized intrarenal TCCs with a high diagnostic accuracy (sensitivity, 90%; specificity, 90%; area under ROC curve [AUC], 0.80-0.95 for global assessment) with moderate-to-excellent interobserver agreement (κ = 0.72-1). Six CT features were most diagnostically specific for identifying intrarenal TCCs: tumor centered within the collecting system; focal filling defect in the pelvicalyceal system; preserved renal shape; absence of cystic or necrotic change; homogeneous tumor enhancement; and tumor extension toward the ureteropelvic junction (sensitivity, 68-82%; specificity, 79-89%; AUC, 0.75-0.84). There was moderate-to-good agreement among the readers over all these features (κ = 0.44-0.69).
Intrarenal TCC can be recognized with a high accuracy on CT; global impression showed the best diagnostic performance. A solid, homogeneously enhancing mass that is centered on the collecting system and extends toward the ureteropelvic junction combined with a focal pelvicalyceal filling defect and preserved renal outline is more likely to be an intrarenal TCC than a centrally located RCC.
本研究旨在回顾性确定 CT 鉴别肾盂内移行细胞癌（TCC）与中央肾细胞癌（RCC）的准确性，并确定最具鉴别力的 CT 诊断特征。
对 3 家大学医院 5 年来经病理证实的 98 例中央肾肿瘤（64 例中央 RCC 和 34 例肾盂内 TCC）的 CT 研究进行了回顾性分析，由 5 名接受过专业培训的放射科医生进行评估，他们对最终诊断结果不知情。对多种 CT 特征和整体印象进行 4 分制评分。使用受试者工作特征（ROC）分析计算并比较每个特征和整体评估的敏感性和特异性。还为每个参数计算了观察者间的一致性（kappa 值）。
所有 5 位观察者均能高度准确地识别肾盂内 TCC（敏感性 90%，特异性 90%，ROC 曲线下面积[AUC]为 0.80-0.95），观察者间一致性为中等至良好（kappa = 0.72-1）。有 6 项 CT 特征对识别肾盂内 TCC 最具诊断特异性：肿瘤位于肾盂系统中央；肾盂系统内局灶性充盈缺损；肾形态保存；无囊性或坏死性改变；肿瘤均匀强化；肿瘤向肾盂输尿管连接部延伸（敏感性 68-82%，特异性 79-89%，AUC 为 0.75-0.84）。读者对所有这些特征的意见一致性均为中等至良好（kappa = 0.44-0.69）。
CT 能高度准确地识别肾盂内 TCC；整体印象显示出最佳的诊断性能。位于肾盂系统中央、向肾盂输尿管连接部延伸、同时伴有局灶性肾盂充盈缺损和肾轮廓保存的实性、均匀强化的肿块更可能是肾盂内 TCC，而不是中央 RCC。
