Department of Surgery, Division of Paediatric Surgery, Tygerberg Hospital, Stellenbosch University, Cape Town, South Africa.
Department of Radiology, Tygerberg Hospital, Stellenbosch University, Cape Town, South Africa.
Afr J Paediatr Surg. 2020 Jul-Dec;17(3 & 4):39-44. doi: 10.4103/ajps.AJPS_86_20.
The Sociétè Internationale d'Oncologie Pédiatrique advocates for neoadjuvant chemotherapy in the management of nephroblastoma. Postoperatively, histological findings are used to assign risk classification to resected tumours. The aim of this study is to compare the response demonstrated by pre-operative imaging to the amount of necrosis seen on histology postoperatively.
About 33 patients with nephroblastoma over a 10 year period had adequate imaging and histology records for this study. Three methods were used to assess tumour change following neoadjuvant therapy and were compared with histological records. 1. An estimation of necrosis, 2. Surface areas of apparent necrosis within the tumour measured on static imaging, 3. The change in volume of the mass. Pearson coefficient was calculated to measure the correlation between histologically observed necrosis and radiological changes. Results were considered significant if P< 0.05.
There was no correlation between radiological changes on pre-operative imaging and the percentage of necrosis seen on histology. Change in tumour size on radiological studies showed a moderate correlation to percentage tumour necrosis on histology but was unable to predict tumour risk classification.
In nephroblastoma, there is a moderate correlation between the decrease in size of a mass noted on imaging following chemotherapy and the degree of necrosis found postoperatively on histology. Change in tumour size cannot be used to predict histological risk classification. It is not possible to predict the histological risk classification of a nephroblastoma based on the changes demonstrated on non-contrasted magnetic resonance imaging or computed tomography preoperatively.
国际小儿肿瘤学会提倡在肾母细胞瘤的治疗中使用新辅助化疗。术后，组织学发现用于对切除的肿瘤进行风险分类。本研究的目的是比较术前影像学显示的反应与术后组织学所见的坏死程度。
在过去 10 年中，约有 33 名肾母细胞瘤患者有足够的影像学和组织学记录供本研究使用。使用三种方法评估新辅助治疗后肿瘤的变化，并与组织学记录进行比较。1. 坏死估计值；2. 静态成像中肿瘤内明显坏死的表面积测量值；3. 肿块体积的变化。计算 Pearson 系数以测量组织学观察到的坏死与放射学变化之间的相关性。如果 P<0.05，则认为结果具有统计学意义。
术前影像学上观察到的肿瘤变化与组织学上观察到的坏死百分比之间没有相关性。影像学研究中肿瘤大小的变化与组织学上肿瘤坏死百分比呈中度相关性，但无法预测肿瘤风险分类。
在肾母细胞瘤中，化疗后影像学上肿块大小的减小与术后组织学上发现的坏死程度之间存在中度相关性。肿瘤大小的变化不能用于预测组织学风险分类。不能根据术前非对比磁共振成像或计算机断层扫描显示的变化来预测肾母细胞瘤的组织学风险分类。
