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Song B, Hwang SI, Lee HJ, Lee H, Oh JJ, Lee S, Hong SK, Byun SS, Kim JK. Computer tomography-based shape of tumor contour and texture of tumor heterogeneity are independent prognostic indicators for clinical T1b-T2 renal cell carcinoma. World J Urol 2023; 41:2723-2734. [PMID: 37530807 DOI: 10.1007/s00345-023-04543-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2022] [Accepted: 07/19/2023] [Indexed: 08/03/2023] Open
Abstract
PURPOSE To evaluate association between computer tomography (CT)-based features of renal cell carcinoma (RCC) and survival outcomes. METHODS Data of 958 patients with clinical T1b-T2 RCC who underwent partial/radical nephrectomy from June 2003 to March 2022 were retrospectively evaluated. CT images of patients were reviewed by two radiologists for texture analysis of tumor heterogeneity and shape analysis of tumor contour. Patients were divided into three groups according to patterns of CT-based features: (1) favorable feature group (n = 117); (2) intermediate feature group (n = 606); and (3) unfavorable feature group (n = 235). Kaplan-Meier survival analysis and multivariate Cox regression analysis were performed to evaluate overall survival (OS), cancer-specific survival (CSS), and recurrence-free survival (RFS). RESULTS RCCs with unfavorable CT-based feature showed larger size on CT, higher nuclear grade, higher rate of histologic necrosis, and higher rate of capsular invasion than those in the other two groups (all p < 0.001). Unfavorable feature was associated with poorer OS (p = 0.001), CSS (p < 0.001), and RFS (p < 0.001) on Kaplan-Meier analysis. In multivariate analysis, intermediate and unfavorable features were independent predictors for recurrence (hazard ratio [HR] 2.51, 95% confidence interval [CI] 1.09-5.79, p = 0.031 and HR 3.71, 95% CI 1.58-8.73, p = 0.003, respectively), but not for overall death or RCC-specific death. CONCLUSIONS A combination of irregular tumor contour feature with heterogeneous tumor texture feature on CT is associated with poor RFS in clinical T1b-T2 RCC preoperatively.
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Affiliation(s)
- Byeongdo Song
- Department of Urology, Seoul National University Bundang Hospital, 166, Gumi-ro, Bundang-gu, Seongnam-si, Gyeonggi-do, 13620, South Korea
| | - Sung Il Hwang
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam-si, South Korea
| | - Hak Jong Lee
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam-si, South Korea
| | - Hakmin Lee
- Department of Urology, Seoul National University Bundang Hospital, 166, Gumi-ro, Bundang-gu, Seongnam-si, Gyeonggi-do, 13620, South Korea
- Department of Urology, Seoul National University College of Medicine, Seoul, South Korea
| | - Jong Jin Oh
- Department of Urology, Seoul National University Bundang Hospital, 166, Gumi-ro, Bundang-gu, Seongnam-si, Gyeonggi-do, 13620, South Korea
- Department of Urology, Seoul National University College of Medicine, Seoul, South Korea
| | - Sangchul Lee
- Department of Urology, Seoul National University Bundang Hospital, 166, Gumi-ro, Bundang-gu, Seongnam-si, Gyeonggi-do, 13620, South Korea
- Department of Urology, Seoul National University College of Medicine, Seoul, South Korea
| | - Sung Kyu Hong
- Department of Urology, Seoul National University Bundang Hospital, 166, Gumi-ro, Bundang-gu, Seongnam-si, Gyeonggi-do, 13620, South Korea
- Department of Urology, Seoul National University College of Medicine, Seoul, South Korea
| | - Seok-Soo Byun
- Department of Urology, Seoul National University Bundang Hospital, 166, Gumi-ro, Bundang-gu, Seongnam-si, Gyeonggi-do, 13620, South Korea
- Department of Urology, Seoul National University College of Medicine, Seoul, South Korea
| | - Jung Kwon Kim
- Department of Urology, Seoul National University Bundang Hospital, 166, Gumi-ro, Bundang-gu, Seongnam-si, Gyeonggi-do, 13620, South Korea.
- Department of Urology, Seoul National University College of Medicine, Seoul, South Korea.
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Halefoglu AM, Ozagari AA. Tumor grade estımatıon of clear cell and papıllary renal cell carcınomas usıng contrast-enhanced MDCT and FSE T2 weıghted MR ımagıng: radıology-pathology correlatıon. LA RADIOLOGIA MEDICA 2021; 126:1139-1148. [PMID: 34100169 DOI: 10.1007/s11547-021-01350-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Accepted: 03/24/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Discrimination of low grade (grade 1-2) renal tumors from high grade (grade 3-4) ones carries crucial importance in terms of the management of these patients and also in the decision-making of appropriate treatment strategies. Our aim was to investigate whether contrast-enhanced multidetector computed tomography (MDCT) and T2 weighted fast spin echo (FSE) magnetic resonance imaging (MRI) could play a specific role in the discrimination of low grade versus high grade tumors in clear cell renal cell carcinoma (ccRCC) and papillary renal cell carcinoma (pRCC) patients. METHODS In this study, we retrospectively evaluated 66 RCC patients based on histopathologic findings who had underwent either partial or total nephrectomies. Our cohort consisted of 52 ccRCC and 14 pRCC patients, of whom 50 were male (%76) and 16 were female (%24). Among the 52 ccRCC patients, 18 had both cortico-medullary phase contrast-enhanced CT and MRI, 15 had only cortico-medullary phase CT and 19 had only MRI examination. In the pRCC group, 8 patients had both cortico-medullary phase contrast-enhanced CT and MRI, 3 had only cortico-medullary phase CT and 3 had only MRI. We both calculated mean tumor attenuation values on cortico-medullary phase MDCT images as HU (hounsfield unit) and also tumor mean signal intensity values on FSE T2 weighted MR images, using both region of interest and whole lesion measurements including normal renal cortex. The obtained values were compared with the grading results of the ccRCC and pRCC tumors according to the WHO/International Society of Urological Pathology grading system. RESULTS A significant positive correlation was found between the mean attenuation values of both tumor subtypes on cortico-medullary phase contrast-enhanced CT and their grades (p < 0.001). High grade tumors exhibited higher mean attenuation values (74.3 ± 22.3 HU) than the low grade tumors (55.2 ± 23.7 HU) in both subtypes. However, a statistically significant correlation was not found between the mean signal intensity values of the two tumor subtypes on FSE T2 weighted MR images and their grades (p > 0.05). Low grade tumors had a mean signal intensity value of 408.9 ± 44.6, while high grade tumors showed a value of 382.1 ± 44.2. The analysis of the ccRCC group patients, yielded a statistically significant correlation between the mean signal intensity values on T2 weighted images and tumor grading (p < 0.001). Low grade (grade 1-2) ccRCC patients exhibited higher mean signal intensity values (475.7 ± 51.3), as compared to those of high grade (grade 3-4) (418.5 ± 45.7) tumors. On the other hand, analysis of the pRCC group patients revealed that there was a significant correlation between the mean attenuation values of tumors on cortico-medullary phase contrast-enhanced CT and their grades (p < 0.001). High grade papillary subtype tumors (54.2 ± 25.2) showed higher mean attenuation values than the low grade (35.5 ± 18.8) ones. CONCLUSIONS Contrast-enhanced MDCT and T2 weighted FSE MRI can play a considerable role in the discrimination of low grade versus high grade tumors of both subtype RCC patients. Thus, these non-invasive evaluation techniques may have positive impact on the determination of the management and treatment strategies of these patients.
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Affiliation(s)
- Ahmet Mesrur Halefoglu
- Sisli Hamidiye Etfal Training and Research Hospital, University of Health Sciences Turkey, Birlik sok. Parksaray ap. No:17/4, Levent, 34340, Istanbul, Turkey.
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Choi SY, Sung DJ, Yang KS, Kim KA, Yeom SK, Sim KC, Han NY, Park BJ, Kim MJ, Cho SB, Lee JH. Small (<4 cm) clear cell renal cell carcinoma: correlation between CT findings and histologic grade. Abdom Radiol (NY) 2016; 41:1160-9. [PMID: 27040407 DOI: 10.1007/s00261-016-0732-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
PURPOSE To evaluate the correlation between CT findings and histologic grade of small clear cell renal cell carcinoma (ccRCC). METHODS CT scans of 101 patients with small ccRCC were reviewed independently by two radiologists for tumor size, shape, margin, encapsulation, enhancement pattern, and visual relative enhancement. Enhancement patterns were defined according to the percentage of uniform enhancement [pattern 1, homogeneous (≥90%); pattern 2, relatively homogeneous (≥75 and <90%); and pattern 3, heterogeneous (<75%)]. Quantitative parameters representing attenuation and degree of enhancement were calculated. Histologic grade was classified as low (Fuhrman grade I or II) and high (Fuhrman grade III or IV). CT imaging variables were analyzed using univariate and multivariate analyses. RESULTS A total of 63 low-grade and 38 high-grade small ccRCCs were assessed. Low-grade tumors differed from high-grade tumors with respect to enhancement pattern 1 or 2 (p < 0.001 and p < 0.001), smaller size (p = 0.002 and p = 0.001), and lower attenuation on unenhanced scan (p < 0.001 and p = 0.008). In multivariate analysis, enhancement pattern 1 or 2 and low attenuation (≤30 HU) were identified as independent predictors of low-grade ccRCC. Accuracy derived from logistic regression analysis was 79.2% for reader 1 and 70.3% for reader 2. CONCLUSIONS CT imaging features including tumor attenuation and enhancement pattern can be useful to predict the biologic behavior of small ccRCC for adequate treatment strategy.
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Villalobos-Gollás M, Aguilar-Davidov B, Culebro-García C, Gómez-Alvarado MO, Rojas-Garcia P, Ibarra-Fombona R, Uribe-Uribe N, Feria-Bernal G, Castillejos-Molina R, Sotomayor M, Gabilondo F, Rodríguez-Covarrubias F. Pathological implications of areas of lower enhancement on contrast-enhanced computed tomography in renal-cell carcinoma: additional information for selecting candidates for surveillance protocols. Int Urol Nephrol 2012; 44:1369-74. [PMID: 22648292 DOI: 10.1007/s11255-012-0199-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2012] [Accepted: 05/09/2012] [Indexed: 01/03/2023]
Abstract
PURPOSE Areas of lower enhancement on computed tomography are frequently seen in renal-cell carcinoma. We investigated whether tumor enhancement on the most prominent hypodense areas correlates with the nuclear grade and other pathologic variables. METHODS From 2004 to 2009, all consecutive patients with a preoperative tomography who underwent radical or partial nephrectomy for renal-cell carcinoma at our tertiary referral center were retrospectively analyzed. Enhancement of the entire tumor on the slice with most prominent areas of lower enhancement was determined. RESULTS Forty-eight patients were included. Clear-cell carcinoma comprised 91.6 %. Mean areas of lower enhancement for nuclear grade tumors 1-4 were 67.4, 38.7, 27.9, and 15.1 HU, respectively. Areas of lower enhancement negatively correlated with size, nuclear grade, T stage, and pathological stage. Tumors with extension beyond Gerota's fascia (10.5 vs. 35.9 HU, p < 0.001) and positive surgical margins (21.2 vs. 34.8 HU, p = 0.04) had more prominent areas of lower enhancement than organ-confined tumors. When comparing nuclear grade 1-3 to nuclear grade 4 tumors, these areas were significantly lower in the later (36.5 vs. 15.1 HU, p < 0.001). Receiver-operating characteristics curves for detecting nuclear grade 4 showed an area under the curve of 0.808 (95 % CI 0.659-0.957). CONCLUSIONS Lower enhancement of the entire tumor at the point where hypodense tumor areas are more predominant on tomography is associated with higher nuclear grade and more advanced stage.
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Affiliation(s)
- Miguel Villalobos-Gollás
- Department of Urology, Hospital Regional de Alta Especialidad de la Peninsula de Yucatan, Merida, Mexico
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