Herranz Amo F, Hernández Moreno L, Diez Cordero J M, Verdú Tartajo F, Rodríguez Fernández E, Lledó García E, González Chamorro F, Bueno Chomon G
Servicio de Urología, Hospital General Universitario Gregorio Marañón, Universidad Complutense, Madrid, España.
Arch Esp Urol. 1995 Nov;48(9):897-905; discussion 905-6.
We investigated the reliability of local (T) and lymph node (N) category staging of renal adenocarcinoma by CT in patients submitted to radical nephrectomy.
The study comprised 109 patients with renal adenocarcinoma who had undergone radical nephrectomy from 1986-1994. The preoperative staging was done using dynamic CT. Clinical staging was based on the CT data and pathological staging was determined by the pathological findings. All patients had a transperitoneal radical nephrectomy. The sensitivity, specificity, positive (PPV) and negative predictive values (NPV) for tumors localized to the kidney, perirenal fat invasion, central venous and lymphatic invasion were analyzed.
The overall sensitivity rate was 67%; the sensitivity and specificity rates were 77% and the PPV and NPV were 89.5% and 67%, respectively, for tumors localized to the kidney. The sensitivity rate was 66%, specificity was 76% and the PPV and NPV were 48.5% and 87.5%, respectively, for those with perirenal fat invasion. Tumors with venous spread showed a sensitivity of 90%, specificity of 92%, PPV 53% and NPV 99%. Concerning lymph node invasion, the sensitivity was 50%, specificity 96%, PPV 50%, NPV 96%.
CT has a very low sensitivity and specificity in detecting fat invasion, a very high sensitivity and specificity for venous invasion and a low sensitivity, but high specificity in detecting lymphatic spread.
我们研究了接受根治性肾切除术患者中，通过CT对肾腺癌进行局部（T）和淋巴结（N）分期的可靠性。
该研究纳入了1986年至1994年间接受根治性肾切除术的109例肾腺癌患者。术前分期采用动态CT进行。临床分期基于CT数据，病理分期由病理结果确定。所有患者均接受经腹根治性肾切除术。分析了肿瘤局限于肾脏、肾周脂肪浸润、中央静脉和淋巴管浸润的敏感性、特异性、阳性预测值（PPV）和阴性预测值（NPV）。
总体敏感性率为67%；对于局限于肾脏的肿瘤，敏感性和特异性率分别为77%，PPV和NPV分别为89.5%和67%。对于有肾周脂肪浸润的患者，敏感性率为66%，特异性为76%，PPV和NPV分别为48.5%和87.5%。有静脉播散的肿瘤敏感性为90%，特异性为92%，PPV为53%，NPV为99%。关于淋巴结浸润，敏感性为50%，特异性为96%，PPV为50%，NPV为96%。
CT在检测脂肪浸润方面敏感性和特异性非常低，在检测静脉浸润方面敏感性和特异性非常高，在检测淋巴转移方面敏感性低但特异性高。
