Preoperative Staging of Renal Cell Carcinoma With Inferior Vena Cava Thrombus Using Multidetector CT and MRI

Hallscheidt, Peter; Fink, Christian; Haferkamp, Axel; Bock, Michael; Luburic, A.; Zuna, I.; Noeldge, Gerd; Kauffmann, G. W.

doi:10.1097/01.rct.0000146113.56194.6d

Cited by 144 publications

(62 citation statements)

References 18 publications

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“…Several studies published over the past few years compared the accuracy of MDCT and MRI in staging of RCC, also comparing several independent readers, and reported high accuracy of MDCT in delineation of the upper extent of the thrombus with a sensitivity of 93% and a specificity of 80%. MRI has similar sensitivity and specificity as MDCT in staging of the venous expansion of RCC, so these two methods are comparable [41,42]. Recently published study by Lawrentschuk et al also showed the complete accuracy of MDCT in detection of the upper extent of the tumor thrombus compared with surgical report.…”

Section: Discussionmentioning

confidence: 66%

Venous spread of renal cell carcinoma: MDCT

et al. 2006

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Section: Discussionmentioning

confidence: 66%

Venous spread of renal cell carcinoma: MDCT

et al. 2006

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“…Although MRI has been proved superior to other modalities in tumor thrombus detecting and predicting the tumor thrombus level (18,19), it is not easily available and not proper for patients with pacemaker or altered cardio-pulmonary function. In a prospective study, Hallscheidt found no difference in tumor thrombus staging of 23 patients who underwent MRI plus MDCT preoperatively (20). More recently, Guzzo reported that accuracy rate of MDCT in predicting the superior level of tumor thrombus is 96% (21).…”

Section: Discussionmentioning

confidence: 99%

The accuracy of multidetector Computed Tomography for preoperative staging of renal cell carcinoma

et al. 2012

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ARTICLE INFO _________________________________________________________ ___________________Purpose: The purpose of this study was to evaluate the accuracy of multidetector computed tomography (MDCT) in the preoperative staging of renal cell carcinoma (RCC). Materials and Methods:We retrospectively reviewed the clinical and pathological records of 312 patients with RCC who underwent staging MDCT before surgery. Radiographic findings were compared to the findings at surgery and pathological examination. All staging used 2009 updated TNM classification. Results: The difference in tumor size between radiographic and pathological findings was 0.21cm. In T1a group, the difference was 0.33cm. Agreement between MDCT and histopathological findings was moderate for T staging (Kappa = 0.469), fair for N staging (Kappa = 0.322), and excellent for M staging (Kappa = 0.932). The sensitivity and specificity of MDCT in detecting perinephric fat invasion were 32.26% and 85.87%, in detecting tumor thrombosis were 84% and 100%, in detecting adrenal gland invasion were 60% and 95.79%, in detecting lymph node involvement were 50% and 96.36%, in detecting distant metastasis were 100% and 99.67%, respectively. In regard to stage grouping, 237 of 314 patients were correctly staged by MDCT, with an overall accuracy of 75.48%. Conclusions: MDCT with a dynamic contrast protocol is able to delineate RCC with high accuracy. However, a great portion of tumors were overstaged by MDCT because of overestimation of tumor size and poor visualization of infiltration of the perinephric fat. In addition, nodal metastatic lesion evaluation relies on node size only and remains a difficult task.

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“…It was expected that most surgeons would consider perfusion for all the ICTT-IV [11] and some ICTT-III [8], especially where preoperative imaging could not exclude intracardiac thrombus. It is evident that assessment of the cranial extent of the thrombus by preoperative imaging can be inaccurate [40][41][42][43]. It follows that preemptive involvement of the cardiothoracic specialists, including anaesthetists and perfusionists, is prudent, especially where they are not available on site.…”

Section: Choice Of Incision and The Cardiothoracic Surgeonmentioning

confidence: 99%

Tumour Thrombi in the Suprahepatic Inferior Vena Cava: The Cardiothoracic Surgeons’ View

Protopapas

Ashrafian

Athanasiou

2013

ISRN Vascular Medicine

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Background. Retroperitoneal tumours propagate intrathoracic caval tumour thrombi (ICTT) of which we consider two subgroups: ICTT-III (extracardiac) and ICTT-IV (intracardiac). Methods. Case series review. Results. 29 series with 784 patients, 453 with extracardiac and 331 with intracardiac ICTT. Average age was 59 years. 98% of the tumours were RCC, 1% adrenal and Wilms' tumours, and 1% transitional cell carcinomas. The prevalent incision was rooftop with or without sternotomy. Mortality was 10% (5% for ICTT-III, 15% for ICTT-IV). Morbidity was 56% (36% for ICTT-III, 64% for ICTT-IV) and reoperation for bleeding was the commonest complication (14%). Mean Blood loss was 2.6 litres for ICTT-III and 3.7 litres for ICTT-IV. Mean blood product use was 2.4 litres for ICTT-III and 3.5 litres for ICTT-IV. Operative and anaesthetic times exceeded 5 hours. Hospital stay averaged 13 days. Variations in perioperative care included preoperative embolisation, perioperative transoesophageal echo, surgical incisions, and extracorporeal circulation. Brief Summary. Surgery for ICTT has high transfusion, operating/anaesthetic time, and in-hospital stay requirements, and intracardiac ICTT also attract higher risk. Preoperative tumour embolisation is controversial. The cardiothoracic team offers proactive optimisation of blood loss and preemptive management of intracardiac thrombus impaction: we should always be involved in the management the ICTT.

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Preoperative Staging of Renal Cell Carcinoma With Inferior Vena Cava Thrombus Using Multidetector CT and MRI

Abstract: In cases of a suspected tumor thrombus, MRI and multidetector CT imaging showed similar staging results. Consequently, these staging modalities can be used to assess the extension of the tumor thrombus.

Cited by 144 publications

References 18 publications

Venous spread of renal cell carcinoma: MDCT

Venous spread of renal cell carcinoma: MDCT

The accuracy of multidetector Computed Tomography for preoperative staging of renal cell carcinoma

Tumour Thrombi in the Suprahepatic Inferior Vena Cava: The Cardiothoracic Surgeons’ View

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