Fateh Salah M, Arkawazi Lusan A, Tahir Soran H, Rashid Rezheen J, Rahman Dalshad H, Aghaways Ismaeel, Kakamad Fahmi H, Salih Abdulwahid M, Bapir Rawa, Fakhralddin Saman S, Fattah Fattah H, Abdalla Berun A, Mohammed Shvan H
College of Medicine, University of Sulaimani, Sulaimani, Kurdistan 46000, Republic of Iraq.
Department of Scientific Affairs, Smart Health Tower, Sulaimani, Kurdistan 46000, Republic of Iraq.
Mol Clin Oncol. 2023 Jan 11;18(2):11. doi: 10.3892/mco.2023.2607. eCollection 2023 Feb.
Renal cell carcinoma (RCC) accounts for 1-2% of all malignancies and is the most common renal tumor in adults. Imaging studies are used for diagnosis and staging. Tumor-Node-Metastasis staging strongly affects prognosis and management, while contrast-enhanced computed tomography (CECT) is regarded as a standard imaging technique for local and distant staging. The present study aimed to evaluate the accuracy of CECT for the preoperative staging of RCC by using surgical and pathological staging as the reference methods. This single-center prospective study was conducted between October 2019 and November 2021. The preoperative abdominal CT scans of patients suspected of having RCC were reviewed. Imaging data were collected, including tumor side and size, and perinephric fat invasion. Intraoperative notes were recorded, including the operation type, perinephric fat invasion, renal vein (RV) or inferior vena cava (IVC) tumor extension, and surrounding organ invasion. pathological data were collected on tumor size, RCC type, presence of clear margins, presence of renal capsule or perinephric fat invasion, renal sinus or pelvicalyceal system (PCS) invasion, segmental or main RV extension, and the involvement of Gerota's fascia and nearby organs. Preoperative CECT revealed that 42 out of 59 tumors had a greater maximum diameter than the pathological specimen, with an overall disparity of 0.25 cm. The specificity of CT for the detection of tumor invasion of the perinephric and renal sinus fat and PCS was 95%, and the sensitivity ranged from 80 to 88%. CT had an 83% sensitivity and a 95 specificity in detecting T4 stage cancer, with a 100% specificity for adrenal invasion. The concordance between radiographic and histological results for RV and IVC involvement was high, with specificities of 94 and 98%, and sensitivities of 80 and 100%, respectively. Overall accuracy for correct T staging was 80%. In conclusion, CECT is accurate in the local T staging of RCC, with high sensitivity and specificity for estimating tumor size and detecting extension to nearby structures and venous invasion.
肾细胞癌（RCC）占所有恶性肿瘤的1%-2%，是成人中最常见的肾脏肿瘤。影像学检查用于诊断和分期。肿瘤-淋巴结-转移分期对预后和治疗有很大影响，而对比增强计算机断层扫描（CECT）被视为局部和远处分期的标准影像学技术。本研究旨在以手术和病理分期作为参考方法，评估CECT对RCC术前分期的准确性。这项单中心前瞻性研究于2019年10月至2021年11月进行。对疑似患有RCC患者的术前腹部CT扫描进行了回顾。收集了影像学数据，包括肿瘤侧别和大小以及肾周脂肪浸润情况。记录了术中情况，包括手术类型、肾周脂肪浸润、肾静脉（RV）或下腔静脉（IVC）肿瘤延伸以及周围器官浸润情况。收集了病理数据，包括肿瘤大小、RCC类型、切缘情况、肾包膜或肾周脂肪浸润情况、肾窦或肾盂肾盏系统（PCS）浸润情况、节段性或主RV延伸情况以及肾周筋膜和附近器官的受累情况。术前CECT显示，59个肿瘤中有42个的最大直径大于病理标本，总体差异为0.25厘米。CT检测肾周和肾窦脂肪及PCS肿瘤浸润的特异性为95%，敏感性范围为80%-88%。CT检测T4期癌症的敏感性为83%，特异性为95%，对肾上腺浸润的特异性为100%。对于RV和IVC受累情况，影像学和组织学结果之间的一致性较高，特异性分别为94%和98%，敏感性分别为80%和100%。正确T分期的总体准确率为80%。总之，CECT在RCC的局部T分期中是准确的，在估计肿瘤大小以及检测向附近结构的延伸和静脉侵犯方面具有高敏感性和特异性。
