非靶向对比增强超声与对比增强计算机断层扫描：肾脏病变的差异诊断性能（DDP）研究。
Untargeted Contrast-Enhanced Ultrasound Versus Contrast-Enhanced Computed Tomography: A Differential Diagnostic Performance (DDP) Study for Kidney Lesions.
机构信息
Department of Ultrasound, the First People's Hospital of Tian Shui GanSu Province, Tianshui, 741000, China.
Department of Ultrasound, the Second People's Hospital of Lanzhou, Lanzhou, 730000, China.
出版信息
Clinics (Sao Paulo). 2020 Feb 27;75:e1489. doi: 10.6061/clinics/2020/e1489. eCollection 2020.
OBJECTIVES
Histopathology is the 'gold standard' for diagnosing renal cell carcinoma but is limited by sample size. Contrast-enhanced ultrasound can differentiate malignant and benign lesions, but the Chinese guidelines on the management of renal cell carcinoma do not include this method. The purpose of this study was to compare the diagnostic parameters of contrast-enhanced ultrasound against those of contrast-enhanced computed tomography for detecting kidney lesions, with histopathology considered the reference standard.
METHODS
Patients with suspected kidney lesions from prior grayscale ultrasonography and computed tomography were included in the analysis (n=191). The contrast-enhanced ultrasound, contrast-enhanced computed tomography, and histopathology data were collected and analyzed. A solid, enhanced mass was considered a malignant lesion, and an unenhanced mass or cyst was considered a benign lesion. The Bosniak criteria were used to characterize the lesions.
RESULTS
Contrast-enhanced ultrasound and contrast-enhanced computed tomography both detected that 151 patients had malignant tumors and 40 patients had benign tumors. No significant differences in the tumors and their subtypes were reported between contrast-enhanced ultrasound and histopathology (p=0.804). Chromophobe renal cell carcinoma was detected through contrast-enhanced computed tomography (n=1), but no such finding was reported by contrast-enhanced ultrasound. A total of 35 cases of papillary renal cell carcinoma were reported through contrast-enhanced ultrasound while 32 were reported through histopathology.
CONCLUSIONS
Contrast-enhanced ultrasound might be safe and as accurate as histopathology in diagnosing kidney lesions, especially renal cell carcinoma. Additionally, this study provides additional information over histopathology and has an excellent safety profile.
LEVEL OF EVIDENCE
III.
目的
组织病理学是诊断肾细胞癌的“金标准”，但受到样本量的限制。增强超声可以区分良恶性病变，但中国肾细胞癌管理指南不包括这种方法。本研究旨在比较增强超声与增强 CT 在检测肾脏病变方面的诊断参数，以组织病理学为参考标准。
方法
对先前灰阶超声和 CT 检查怀疑有肾脏病变的患者进行分析（n=191）。收集并分析增强超声、增强 CT 和组织病理学数据。实性强化肿块被认为是恶性病变，无强化肿块或囊肿被认为是良性病变。采用 Bosniak 标准对病变进行特征描述。
结果
增强超声和增强 CT 均检测到 151 例患者患有恶性肿瘤，40 例患者患有良性肿瘤。增强超声和组织病理学之间在肿瘤及其亚型方面无显著差异（p=0.804）。嫌色细胞肾细胞癌通过增强 CT 检测到（n=1），但增强超声未发现。增强超声共报告 35 例乳头状肾细胞癌，而组织病理学报告 32 例。
结论
增强超声在诊断肾脏病变，特别是肾细胞癌方面可能安全且与组织病理学一样准确。此外，本研究提供了组织病理学以外的更多信息，且具有出色的安全性。
证据水平
III。
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