Detection of a peritumoral pseudocapsule in patients with renal cell carcinoma undergoing robot-assisted partial nephrectomy using enhanced MDCT

Abstract

To investigate the detection of peritumoral pseudocapsule (PC) using multi-detector row computed tomography (MDCT) for tumors resected by robot-assisted laparoscopic partial nephrectomy (RAPN) for T1 renal cell carcinoma (RCC). Study participants included 206 patients with clinical T1 RCC who underwent RAPN between October 2017 and February 2018. Two radiologists who were blinded to the pathological findings evaluated the computed tomography (CT) images. Radiological diagnosis of a PC was defined by a combination of observations, including a low-attenuation rim between the tumor and renal cortex in the cortico-medullary phase and a high-attenuation rim at the edge of the tumor in the nephrogenic or excretory phase. A PC was detected on CT in 156/206 tumors (76%) and identified by pathology in 182/206 (88%) tumors including 153/166 (92%) clear cell RCC, 13/14 (93%) papillary RCC, and 7/16 (44%) chromophobe RCC. In the whole cohort, CT findings showed a sensitivity of 81.3% (148/182), specificity of 66.7% (16/24), and positive predictive value of 94.9% (148/156). When the data were stratified according to pathological subtypes, MDCT was observed to have a sensitivity of 86.9% (133/153) and specificity of 61.5% (8/13) in clear cell RCC, sensitivity of 38.5% (5/13) and specificity of 100% (1/1) in papillary RCC, and sensitivity of 44.4% (4/7) and specificity of 66.7% (6/9) in chromophobe RCC. A low or high-attenuation rim around the tumor in the cortico-medullary or nephrographic-to-excretory phase indicates a PC of RCC, though the accuracy is not satisfactory even with 64- or 320-detector MDCT.

No Detection of Pseudocapsule of Tumor-Parenchyma Interface on Multidetector Computed Tomography (MDCT) Images: Clinical Significance and Histological Reflections in Renal Cell Carcinoma

“…However, pPS thickness and vasculature of TPI were associated with ctPS that ctPS-absent tumors had drastically thinner pPS and enriched vessels (long diameter ≥ 200 um). In a recent study comparing ctPS and pPS, the authors found that the accuracy of ctPS is not satisfactory even with 64- or 320-detector MDCT, 15 which could be explained by our results that whether there is a pPS is not the most important fundamental structure of a ctPS. The finding was interesting.…”

Characteristics of peritumoral pseudocapsule in small renal cell carcinoma and its influencing factors

“…ChRCC is associated with relatively good prognosis, and a high proportion of PC absence 3,9 . In our study, PC was absent in 5 (42%) out of 12 ChRCCs, a proportion that was slightly lower than the previously reported (47%–70%) 5,9,14 . The risk of PC absence was significantly greater when the tumor diameter was less than 34 mm in stage T1 RCC 9 .…”

“…Previous studies reported that CCRCC was associated with tougher and thicker PC composed of higher collagen fiber density compared with PC in non‐CCRCC 6,21 . This may explain why some surgeons hold the view that TE is not suitable for non‐CCRCC patients 9,14,21 . Peritumoral PC is the natural surgical dissection plane for TE.…”

“…The definition of hyperenhancement and hypoenhancement was based on the degree of tumor lesion enhancement compared with the surrounding renal cortex on corticomedullary phase. We defined a clear boundary as the regular and distinct low‐attenuation rim at the tumor‐parenchyma interface on the corticomedullary phase images, based on reports from previous studies 10,14,15 . If the rim was blurred or discontinuous, it was considered an unclear boundary.…”

Sports Medical Image Modeling of Injury Prevention in Dance Learning and Sports Training

“…(1) Insufficient preparation activities 1998 is another epoch-making mark in the development of CT technology [6]. In this year, several major CT equipment manufacturers simultaneously launched four layer acquisition spiral CT (multislice spiral CT), and its principle has been introduced in other literatures [7]. Taking this as a starting point, the 8-layer spiral CT was launched in 2000.…”