肾细胞癌术前CT T分期的准确性：哪些特征可预测晚期？

Accuracy of preoperative CT T staging of renal cell carcinoma: which features predict advanced stage?

作者信息

Bradley A J, MacDonald L, Whiteside S, Johnson R J, Ramani V A C

机构信息

Department of Radiology, University Hospital of South Manchester, Southmoor Road, Wythenshawe, Manchester M23 9LT, UK.

出版信息

Clin Radiol. 2015 Aug;70(8):822-9. doi: 10.1016/j.crad.2015.03.013. Epub 2015 May 5.

DOI:10.1016/j.crad.2015.03.013

PMID:25953656

Abstract

AIMS

To characterise CT findings in renal cell carcinoma (RCC), and establish which features are associated with higher clinical T stage disease, and to evaluate patterns of discrepancy between radiological and pathological staging of RCC.

MATERIALS AND METHODS

Preoperative CT studies of 92 patients with 94 pathologically proven RCCs were retrospectively reviewed. CT stage was compared with pathological stage using the American Joint Committee on Cancer (AJCC), 7(th) edition (2010). The presence or absence of tumour necrosis, perinephric fat standing, thickening of Gerota's fascia, collateral vessels were noted, and correlated with pT stage. The sensitivity, specificity, and positive (PPV) and negative predictive values (NPV) for predicting pT stage ≥pT3a were derived separately for different predictors using cross-tabulations.

RESULTS

Twenty-four lesions were pathological stage T1a, 21 were T1b, seven were T2a, 25 were T3a, 11 were T3b, four were T3c, and two were T4. There were no stage T2b. Sixty-three (67%) patients had necrosis, 27 (29%) thickening of Gerota's fascia (1 T1a), 25 had collateral vessels (0 T1a), 28 (30%) had fat stranding of <2 mm, 20 (21%) of 2-5mm and one (1%) of >5 mm. For pT stage ≥pT3a, the presence of perinephric fat stranding had a sensitivity, specificity, PPV and NPV of 74%, 65%, 63%, and 76%, respectively. Presence of tumour necrosis had a sensitivity, specificity, PPV, and NPV of 81%, 44%, 54%, and 72%, respectively. Thickening of Gerota's fascia had a sensitivity, specificity, PPV, and NPV of 52%, 90%, 81% and 70%, respectively; and enlarged collateral vessels had a sensitivity, specificity, PPV, and NPV value of 52%, 94%, 88%, and 71% respectively.

CONCLUSION

The presence of perinephric stranding and tumour necrosis were not reliable signs for pT stage >T3a. Thickening of Gerota's fascia and the presence of collateral vessels in the peri- or paranephric fat had 90% and 94% specificity, with 82% and 88% PPV, respectively, for the presence of tumour stage for pT stage >T3a. These are considered reliable signs of locally advanced renal cancer.

摘要

目的

描述肾细胞癌（RCC）的CT表现，确定哪些特征与更高临床T分期疾病相关，并评估RCC放射学分期与病理学分期之间的差异模式。

材料与方法

回顾性分析92例经病理证实为RCC的患者的术前CT研究，共94个病灶。根据美国癌症联合委员会（AJCC）第7版（2010年）将CT分期与病理分期进行比较。记录肿瘤坏死、肾周脂肪条索、肾筋膜增厚、侧支血管的有无，并与pT分期相关联。使用交叉表分别得出不同预测指标预测pT分期≥pT3a的敏感性、特异性、阳性预测值（PPV）和阴性预测值（NPV）。

结果

24个病灶病理分期为T1a，21个为T1b，7个为T2a，25个为T3a，11个为T3b，4个为T3c，2个为T4。无T2b期。63例（67%）患者有坏死，27例（29%）肾筋膜增厚（1例T1a），25例有侧支血管（0例T1a），28例（30%）有<2mm的脂肪条索，20例（21%）有2 - 5mm的脂肪条索，1例（1%）有>5mm的脂肪条索。对于pT分期≥pT3a，肾周脂肪条索的存在敏感性为敏74%、特异性为65%、PPV为63%、NPV为76%。肿瘤坏死的存在敏感性为81%、特异性为44%、PPV为54%、NPV为72%。肾筋膜增厚的敏感性为52%、特异性为90%、PPV为81%、NPV为70%；侧支血管增粗的敏感性为52%、特异性为94%、PPV为88%、NPV为71%。