肾肿瘤的临床分期与病理分期：多排CT尿路造影的作用
Clinical versus Pathologic staging of Renal Tumors: Role of Multi-Detector CT Urography.
作者信息
Kamel Ahmed I, Badawy Mohamed H, Elganzoury Hossam, Elkhouly Amr, Elesaily Khalid, Eldahshan S, Ismail Mohamed A A, Elshafie Mostafa F, Abdel Aziz Emam M, El Baz Ahmed G, Roshdy Mamdouh A, El Leithy Tarek R, Ghobashy Samir, Kamal Ahmed M
机构信息
Urology department, Theodor Bilharz Research Institute, Giza, Egypt.
Radiology department, Theodor Bilharz Research Institute, Giza, Egypt.
出版信息
Electron Physician. 2016 Jan 15;8(1):1791-5. doi: 10.19082/1791. eCollection 2016 Jan.
INTRODUCTION
Our ability to diagnose renal cell carcinoma (RCC) has increased in the past 30 years as a result of the extensive application of imaging techniques, such as ultrasonography, computed tomography, and magnetic resonance imaging. Multi-detector computed tomography (MDCT) remains the most appropriate imaging modality for the diagnosis and staging of RCC. The aim of this work was to compare the findings of MDCT with surgical pathology to determine the accuracy of delineating tumor size, localization, organ confinement, lymph node metastases, and the extent of tumor thrombus in the renal vein and inferior vena cava.
METHODS
The clinical, surgical, and anatomo-pathologic records of 99 patients treated by nephrectomy (radical or partial) for solid renal tumors at Theodor Bilharz Research Institute and Nasser Institute from 2005 to 2011 were reviewed retrospectively. All cases were staged pre-operatively with abdominal MDCT (pre- and post-contrast enhancement) in addition to the routine biochemical, hematological, and radiological work-up. The tumors' histologic types were determined according to the WHO classification of renal tumors in adults in 2004, and staging was updated to the TNM 2010 system. Data were analyzed using the t-test.
RESULTS
The mean age was 52 (range 21-73). Seventy-eight patients were males, and 21 patients were females (Male/Female ratio: 3.7:1). There were no significant differences in the mean tumor size between radiographic and pathologic assessments in different tumor stages. The overall incidence of lymph node invasion in surgical specimens was 76%, whereas MDCT showed a positive incidence in 68.4% of cases (false negative result in 7 cases, 7.6%).
CONCLUSION
Our findings indicated that MDCT urography is an accurate method to estimate renal tumor size, lymph node, vascular and visceral metastases preoperatively. Also, preoperative staging of renal tumors with MDCT represents a valuable and accurate tool.
引言
在过去30年里，由于超声、计算机断层扫描（CT）和磁共振成像等成像技术的广泛应用，我们诊断肾细胞癌（RCC）的能力有所提高。多排螺旋CT（MDCT）仍然是RCC诊断和分期最合适的成像方式。这项工作的目的是比较MDCT与手术病理结果，以确定在描绘肿瘤大小、定位、器官局限性、淋巴结转移以及肾静脉和下腔静脉内肿瘤血栓范围方面的准确性。
方法
回顾性分析了2005年至2011年在西奥多·比尔哈兹研究所和纳赛尔研究所接受肾切除术（根治性或部分性）治疗实体肾肿瘤的99例患者的临床、手术和解剖病理记录。除了常规的生化、血液学和放射学检查外，所有病例术前均进行腹部MDCT（增强前后）检查。根据2004年世界卫生组织成人肾肿瘤分类确定肿瘤的组织学类型，并更新为2010年TNM分期系统。数据采用t检验进行分析。
结果
平均年龄为52岁（范围21 - 73岁）。78例为男性，21例为女性（男/女比例：3.7:1）。在不同肿瘤分期中，影像学和病理评估的平均肿瘤大小无显著差异。手术标本中淋巴结侵犯的总发生率为76%，而MDCT显示阳性发生率为68.4%（7例假阴性结果，7.6%）。
结论
我们的研究结果表明，MDCT尿路造影是术前评估肾肿瘤大小、淋巴结、血管和内脏转移的准确方法。此外，MDCT对肾肿瘤进行术前分期是一种有价值且准确的工具。
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