Ritchey M L, Green D M, Breslow N B, Moksness J, Norkool P
Division of Pediatric Surgery, University of Texas, Houston.
Cancer. 1995 Jan 15;75(2):600-4. doi: 10.1002/1097-0142(19950115)75:2<600::aid-cncr2820750225>3.0.co;2-#.
Five percent of patients with Wilms' tumor will present with bilateral disease. Recent reports suggest that preoperative imaging studies can exclude contralateral disease reliably, obviating the need for formal surgical exploration of the contralateral kidney. This study was undertaken to determine the accuracy of preoperative imaging in diagnosing bilateral Wilms' tumor.
The charts of 122 patients with synchronous bilateral Wilms' tumor enrolled in National Wilms Tumor Study-4 were reviewed. With the exception of one child, all had an abdominal computed tomography (CT), ultrasound, or magnetic resonance imaging performed.
There were nine patients (7%) in whom the diagnosis of bilaterality was missed by the preoperative imaging studies. All but one of the missed lesions were small, five less than 1 cm and three 1-3 cm. The accuracy of each imaging modality was correlated with tumor size. Computed tomography was more sensitive in detecting bilaterality than ultrasound. However, there was not a single study that was able to detect more than 50% of lesions less than 1 cm in greatest dimension.
This review indicates that even with current advances in imaging technology, synchronous bilateral Wilms' tumor will go unrecognized in 7% of patients if formal exploration of the contralateral kidney is omitted. Although this represents a small percentage of all patients presenting with Wilms' tumor, preoperative diagnosis of bilaterality is essential if parenchymal-sparing procedures are to be performed. Until a more reliable indicator of bilateral disease is found, exploration of the contralateral kidney continues to be recommended.
5%的肾母细胞瘤患者会出现双侧病变。近期报告表明，术前影像学检查能够可靠地排除对侧病变，从而无需对侧肾脏进行正式的手术探查。本研究旨在确定术前影像学检查诊断双侧肾母细胞瘤的准确性。
回顾了参加国家肾母细胞瘤研究-4的122例同步双侧肾母细胞瘤患者的病历。除1名儿童外，所有患者均进行了腹部计算机断层扫描（CT）、超声或磁共振成像检查。
有9例患者（7%）术前影像学检查漏诊了双侧病变。除1个漏诊病灶外，其余均较小，5个小于1厘米，3个1 - 3厘米。每种影像学检查方法的准确性与肿瘤大小相关。CT在检测双侧病变方面比超声更敏感。然而，没有一项研究能够检测出最大径小于1厘米的病变中的50%以上。
本综述表明，即使有当前影像学技术的进步，如果省略对侧肾脏的正式探查，7%的同步双侧肾母细胞瘤患者仍会漏诊。虽然这在所有肾母细胞瘤患者中占比很小，但如果要进行保留实质的手术，术前诊断双侧病变至关重要。在找到更可靠的双侧病变指标之前，仍建议对侧肾脏进行探查。
