Fan Xiaoqing, Fu Fen, Liang Rongxi, Xue Ensheng, Zhang Huiping, Zhu Yifan, Ye Qin
Department of Ultrasound, Fujian Medical University Union Hospital, Fuzhou City, Fujian Province, China.
Int Urol Nephrol. 2024 Mar;56(3):1157-1164. doi: 10.1007/s11255-023-03774-z. Epub 2023 Sep 5.
Clear cell renal cell carcinoma (CCRCC) comprises 70%-80% of RCCs. The World Health Organization/International Society of Urology Pathology (WHO/ISUP) classification is the most important prognostic factor for CCRCC. By evaluating the variations of tumor microvascular density, contrast-enhanced ultrasound (CEUS) can noninvasively predict the WHO/ISUP grade of CCRCC, and provide the appropriate treatment plan before clinical operation.
In this study, we used CEUS features to analyze 116 CCRCC cases and assess the value of correlation between each indicator and CCRCC WHO/ISUP grading.
When compared to high-grade (WHO/ISUP grade III/IV) tumors, low-grade (WHO/ISUP grade I/II) tumors had reduced relative peak intensity (ΔPI) (P = 0.021), relative area under the curve (ΔAUC) (P = 0.019). However, the frequency of incomplete pseudocapsule (P = 0.021) was significantly higher in high-grade tumors. A cut-off value of mean diameter > 5.5 cm, ΔPI > 304 × 10, ΔAUC > 350 × 10 allowed identification of high-grade tumors with an area under the curve (AUC) of 74.6%, 71.7%, 70.7%, respectively (95% confidence interval).
The features of CEUS are effective for differentiating high-grade tumors from low-grade tumors, thus CEUS can be considered an acceptable method for the preoperative assessment of tumor grade.
透明细胞肾细胞癌（CCRCC）占肾细胞癌的70%-80%。世界卫生组织/国际泌尿病理学会（WHO/ISUP）分类是CCRCC最重要的预后因素。通过评估肿瘤微血管密度的变化，超声造影（CEUS）可以无创地预测CCRCC的WHO/ISUP分级，并在临床手术前提供合适的治疗方案。
在本研究中，我们利用CEUS特征分析了116例CCRCC病例，并评估了各指标与CCRCC WHO/ISUP分级之间的相关性价值。
与高级别（WHO/ISUP III/IV级）肿瘤相比，低级别（WHO/ISUP I/II级）肿瘤的相对峰值强度（ΔPI）降低（P = 0.021），曲线下相对面积（ΔAUC）降低（P = 0.019）。然而，高级别肿瘤中不完全假包膜的出现频率（P = 0.021）显著更高。平均直径>5.5 cm、ΔPI>304×10、ΔAUC>350×10的截断值分别以74.6%、71.7%、70.7%的曲线下面积（AUC）（95%置信区间）识别高级别肿瘤。
CEUS特征对区分高级别肿瘤和低级别肿瘤有效，因此CEUS可被认为是术前评估肿瘤分级的可接受方法。
