Preoperative imaging in renal masses: does size on computed tomography correlate with actual tumor size?

Ateş, Ferhat; Akyol, İlker; Sıldıroğlu, Onur; Küçükodacı, Zafer; Soydan, Hasan; Karademir, Kenan; Baykal, Kadir

doi:10.1007/s11255-010-9707-x

Cited by 11 publications

(20 citation statements)

References 25 publications

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“…In several other series, mean radiological tumor size was greater than mean pathological size, but the difference did not reach statistical significance[27,29,30,32,34,36]. Only one study reported an underestimation of pathological tumor size by CT overall, and this achieved statistical significance for T1a tumors only[26]. …”

Section: Discussionmentioning

confidence: 98%

“…The same study found that tumor invasion of perinephric tissues impacted upon the accuracy of CT. For these tumors, CT more frequently underestimated pathological size when compared to tumors confined to the kidney. Ates et al[26] demonstrated less accurate CT measurement of tumor size for locally invasive tumors. It may be more difficult to delineate the radiographic margin of invasive tumors on CT, leading to disagreement between radiological and pathological tumor sizes.…”

Section: Discussionmentioning

confidence: 99%

“…It may be more difficult to delineate the radiographic margin of invasive tumors on CT, leading to disagreement between radiological and pathological tumor sizes. Ates et al[26] also found more accurate measurement of tumors size on CT for exophytic lesions. Herr[35] found that CT more closely approximated pathological tumor size for upper pole tumors, but other studies have failed to confirm this finding[24,32,33].…”

Section: Discussionmentioning

confidence: 99%

“…Authors have disagreed on the clinical significance of these findings. Only two of these studies comprehensively reported instances in which disagreement between CT and pathological size led to discordance between clinical and pathological stage[26,30]. To our knowledge, there has been no such study performed on an Australian population.…”

Section: Introductionmentioning

confidence: 99%

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Discrepancy between radiological and pathological size of renal masses

et al. 2011

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BackgroundTumor size is a critical variable in staging for renal cell carcinoma. Clinicians rely on radiological estimates of pathological tumor size to guide patient counseling regarding prognosis, choice of treatment strategy and entry into clinical trials. If there is a discrepancy between radiological and pathological measurements of renal tumor size, this could have implications for clinical practice. Our study aimed to compare the radiological size of solid renal tumors on computed tomography (CT) to the pathological size in an Australian population.MethodsWe identified 157 patients in the Westmead Renal Tumor Database, for whom data was available for both radiological tumor size on CT and pathological tumor size. The paired Student's t-test was used to compare the mean radiological tumor size and the mean pathological tumor size. Statistical significance was defined as P < 0.05. We also identified all cases in which post-operative down-staging or up-staging occurred due to discrepancy between radiological and pathological tumor sizes. Additionally, we examined the relationship between Fuhrman grade and radiological tumor size and pathological T stage.ResultsOverall, the mean radiological tumor size on CT was 58.3 mm and the mean pathological size was 55.2 mm. On average, CT overestimated pathological size by 3.1 mm (P = 0.012). CT overestimated pathological tumor size in 92 (58.6%) patients, underestimated in 44 (28.0%) patients and equaled pathological size in 21 (31.4%) patients. Among the 122 patients with pT1 or pT2 tumors, there was a discrepancy between clinical and pathological staging in 35 (29%) patients. Of these, 21 (17%) patients were down-staged post-operatively and 14 (11.5%) were up-staged. Fuhrman grade correlated positively with radiological tumor size (P = 0.039) and pathological tumor stage (P = 0.003).ConclusionsThere was a statistically significant but small difference (3.1 mm) between mean radiological and mean pathological tumor size, but this is of uncertain clinical significance. For some patients, the difference leads to a discrepancy between clinical and pathological staging, which may have implications for pre-operative patient counseling regarding prognosis and management.

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Section: Discussionmentioning

confidence: 98%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Discrepancy between radiological and pathological size of renal masses

et al. 2011

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“…The five years survival rate of patients diagnosed with kidney cancer has progressively increased from 51% in the mid-1970s to 69% in the past decade [1]. Reasons for this significant jump include a better understanding of the pathogenesis of renal cell carcinoma (RCC), more innovative medical and surgical options, and increased radiologic detection of smaller renal masses [2] that are more amenable to successful treatment. In patients who have incidental detection of a renal tumor, there is on an average a lower pathologic stage and grade at diagnosis which correlates with a significantly increased 5-year specific survival of 85.3% as opposed to 62.5% in patients with symptomatic renal cell carcinoma [3].…”

Section: Introductionmentioning

confidence: 99%

Robot-assisted partial nephrectomy: current status, techniques, and future directions

Babbar

Hemal

2011

Int Urol Nephrol

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Open partial nephrectomy for the treatment of small renal masses (SRMs) concerning for renal cell carcinoma has been increasingly utilized with the increased incidental detection of SRMs and the growing recognition of the benefits of renal preservation. Laparoscopic partial nephrectomy (LPN) is a minimally invasive technique that achieves comparable oncologic and improved morbidity outcomes when compared to the open procedure. However, LPN is a technically demanding procedure resulting in a long learning curve and a lack of widespread adoption. Robot-assisted partial nephrectomy (RAPN) overcomes many of the technical hurdles of the LPN and is now coming to the forefront for the minimally invasive surgical management of SRMs. To date, the short-term oncologic outcomes of RAPN have been comparable to the open operation while providing the improved morbidity outcomes of LPN. Although encouraging, we await the long-term oncologic results of this new and promising procedure. The current bottleneck is an issue of cost and reliance on a patient-side surgeon. Future developments in instrumentation, newer robots, cost reduction, more streamlined training, increased robotic experience, and adoption by more centers will lead to greater benefit for patients with SRMs requiring nephron-sparing surgery. This review will discuss techniques for RAPN and then delve into the current status of RAPN using parameters such as warm ischemia time, blood loss, hospital stay, oncological outcomes, complications, learning curve, and quality of life. There will be an exploration of potential disadvantages associated with RAPN followed by a look at evolving techniques in regard to this groundbreaking procedure.

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