Shan Kun, Fu A Bu DU Li Ai Ze Zi Ha Li, Liu Ningning, Cai Qiliang, Fu Qingfeng, Liu Leyi, Sun Xiaoyu, Zhang Zhihong
Department of Ultrasonography.
Department of Urology, Tianjin Institute of Urology, The Second Hospital of Tianjin Medical University, Tianjin, China.
Medicine (Baltimore). 2020 Nov 13;99(46):e23110. doi: 10.1097/MD.0000000000023110.
Multilocular cystic renal neoplasm of low malignant potential (MCRNLMP) might be benefited from nephron-sparing surgery. Contrast-enhanced computed tomography is used for the diagnosis of MCRNLMP but contrast-enhanced ultrasound has lack of nephrotoxicity and several advantages over contrast-enhanced computed tomography and contrast-enhanced magnetic resonance. The purpose of the study was to compare diagnostic parameters of preoperative contrast-enhanced ultrasound against contrast-enhanced computed tomography for the detection of MCRNLMP in patients who faced curative surgery for complex cystic renal mass.Data regarding contrast-enhanced ultrasound, contrast-enhanced computed tomography, and clinicopathological results of 219 patients who underwent curative surgery for complex cystic renal mass (Bosniak classification III or IV) were retrospectively collected and analyzed. Bosniak classification for imaging modality and the 2016 WHO criteria for clinic pathology were used for detection of MCRNLMP.Contrast-enhanced ultrasound, contrast-enhanced computed tomography, and clinicopathology were detected 68, 66, and 67 as a MCRNLMP respectively. Contrast-enhanced ultrasound and contrast-enhanced computed tomography had 30.37% and 29.27% sensitivities for the detection of MCRNLMP. While 60% and 50% specificities respectively. Bosniak classification III (P = .045) and lower mean Hounsfield unit (P = .049) were associated with the prevalence of MCRNLMP. Contrast-enhanced computed tomography was detected 6 and 7, while contrast-enhanced ultrasound detected 3 and 2 complex cystic renal mass as false positive and false negative MCRNLMP respectively. A contrast-enhanced ultrasound had 0.011 to 1.0 diagnostic confidence and contrast-enhanced computed tomography had 0.045 to 0.983 diagnostic confidence for decision making of nephron-sparing surgeries.Contrast-enhanced ultrasound may have better visualization of MCRNLMP than contrast-enhanced computed tomography.Level of Evidence: III.
低恶性潜能多房性囊性肾肿瘤(MCRNLMP)可能从保留肾单位手术中获益。对比增强计算机断层扫描用于MCRNLMP的诊断,但对比增强超声没有肾毒性,且与对比增强计算机断层扫描和对比增强磁共振相比有几个优势。本研究的目的是比较术前对比增强超声与对比增强计算机断层扫描在面临复杂囊性肾肿块根治性手术的患者中检测MCRNLMP的诊断参数。回顾性收集并分析了219例接受复杂囊性肾肿块(博斯尼亚克分类III或IV)根治性手术患者的对比增强超声、对比增强计算机断层扫描及临床病理结果。使用成像模态的博斯尼亚克分类和2016年世界卫生组织临床病理标准来检测MCRNLMP。对比增强超声、对比增强计算机断层扫描和临床病理分别检测出68、66和67例为MCRNLMP。对比增强超声和对比增强计算机断层扫描检测MCRNLMP的敏感性分别为30.37%和29.27%。而特异性分别为60%和50%。博斯尼亚克分类III(P = 0.045)和较低的平均亨氏单位(P = 0.049)与MCRNLMP的患病率相关。对比增强计算机断层扫描分别检测出6例和7例复杂囊性肾肿块为假阳性和假阴性MCRNLMP,而对比增强超声分别检测出3例和2例。对比增强超声的诊断置信度为0.011至1.0,对比增强计算机断层扫描的诊断置信度为0.045至0.983,用于保留肾单位手术的决策。对比增强超声对MCRNLMP的可视化可能比对比增强计算机断层扫描更好。证据级别:III。