Stage T3a renal cell carcinoma: staging accuracy of CT for sinus fat, perinephric fat or renal vein invasion

Sokhi, Heminder; Mok, Wing Yan; Patel, Uday

doi:10.1259/bjr.20140504

Cited by 55 publications

(38 citation statements)

References 29 publications

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“…Clinical staging is typically performed using contrast-enhanced CT, although there is a risk of missing renal sinus fat invasion, perirenal fat invasion, or renal vein thrombosis during CT, which can lead to pT3a upstaging [9, 11, 20]. Sokhi et al reported the sensitivity of CT for sinus fat, perirenal fat and renal vein invasion up to 88, 83, 69% respectively [9]. Previously conducted studies reported T3a upstaging rate of 13.3–30.7% [12–14].…”

Section: Discussionmentioning

confidence: 99%

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Pathological T3a Upstaging of Clinical T1 Renal Cell Carcinoma: Outcomes According to Surgical Technique and Predictors of Upstaging

et al. 2016

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PurposeTo evaluate the prognosis of pT3a upstaging from cT1 renal cell carcinoma, and to compare the outcomes of partial or radical nephrectomy in cases of pT3a upstaging.Materials and MethodsWe reviewed the records of patients who underwent partial or radical nephrectomy for cT1 at our center between January 2001 and October 2013. We compared the 2-year recurrence-free survivals for cases with pT1 or pT3a upstaging, and for partial or radical nephrectomy in cases with pT3a upstaging. Clinicopathological parameters were analyzed in univariate and multivariate analyses to evaluate their associations with upstaging.ResultsAmong the 1,009 eligible patients, 987 patients were included in the analysis. The mean follow-up was 48.5 ± 27.8 months in whole patients. The 2-year recurrence-free survival was worse in the pT3a upstaging group, compared to the pT1 group (87.3% vs. 98.7%; p < 0.001). Partial nephrectomy and radical nephrectomy had no significant difference in 2-year recurrence-free survivals (91.9% vs. 83.7%; p = 0.251). The multivariate analysis revealed that upstaging was associated with old age, cT1b stage, clinical symptoms, and a high Fuhrman grade.ConclusionsPathological T3a upstaging of cT1 renal cell carcinoma was associated with a poorer prognosis, compared to pT1 disease. However, the surgical technique (radical or partial nephrectomy) did not affect the recurrence rate. Therefore, clinicians should select the treatment method based on the clinical stage, and consider the pathological stage during the follow-up.

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Section: Discussionmentioning

confidence: 99%

“…The microscopic perirenal invasion, renal sinus fat infiltration, and renal vein thrombosis can be missed during CT, and pT3a upstaging occasionally occurs in cases of cT1 RCC [9–11]. Furthermore, previous studies have revealed conflicting findings regarding the prognoses and risk factors for T3a upstaging [12–15].…”

Section: Introductionmentioning

confidence: 99%

Pathological T3a Upstaging of Clinical T1 Renal Cell Carcinoma: Outcomes According to Surgical Technique and Predictors of Upstaging

et al. 2016

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“…When the pressure continues to rise, the effusion will enter the renal sinus through the calyx. In plain CT scan, the fat in renal sinus is di cult to be distinguished from renal parenchyma [14], especially during edema, both manifesting as thickening of renal parenchyma. Only when uid accumulated within the renal sinus at the renal hilum can the separation of renal sinus edema and vague fat space be found in CT scan.…”

Section: Discussionmentioning

confidence: 99%

CT Grading in Upper Urinary Tract Calculi with Kidney Infection

Zhang

Lin

Deng

et al. 2020

Preprint

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Background This study is to establish a CT imaging grading system and to explore its value in evaluating upper urinary tract calculi with kidney infection. Methods CT images of 126 patients with kidney infection caused by upper urinary tract calculi were retrospectively analyzed. CT grading system was developed based on CT images. General information, clinical symptoms and examination data of patients in different CT grades were analyzed. With the occurrence of systemic inflammatory response syndrome (SIRS) as the end point, univariate and multivariate analysis was conducted to analyze the risk factors of SIRS. Results CT images were classified into 4 grades. For patients with different CT grades, the factors of fever, diabetes, blood white blood cell counts, urine leucocytes, CT1 (ratios of renal cortex CT values on the affected side and those on the healthy side), CT2 (ratios of renal pelvis CT values on the affected side and those on the healthy side), maximum body temperature, disease time, proportion of blood neutrophils, C-reactive protein, procalcitonin, and the size of stones had statistical significance (P<0.05). Only CT grading was statistically significant by multivariate analysis. The higher the CT grading, the greater the risk of SIRS, with 4.472 times higher of SIRS risk for each increasement of the CT grade. Conclusions CT images may reflect the involvement extent and scope of upper urinary tract calculi with kidney infection. The higher the CT grade is, the more severe the clinical symptoms are and the greater the risk of SIRS is.

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“…The knowledge of the variability of the medial pathways of this plane is essential when evaluating the tumour extension on CT images on the basis of the TNM classification in patients with right renal cell carcinomas. 22,23 The purpose of this study was to retrospectively investigate the medial pathways of the right retromesenteric plane by reviewing multidetector CT (MDCT) images in patients with acute pancreatitis and pyelonephritis.…”

Section: Introductionmentioning

confidence: 99%

“…Tumour invasion to the right mesenteric plane is one of the important criteria in TNM classification in patients with right renal cell carcinoma; the thickening of the right mesenteric plane on CT images is suggestive of tumour invasion and the patient is diagnosed as stage T4. 22,23 Dodds et al 6 considered the right retromesenteric plane to be formed by the fusion of some of the lobes of the mesentery during foetal life, wherein the fusion fascia behind the pancreatic head and descending duodenum is formed by the fusion of the right lobe of the primary mesoduodenum, primary parietal peritoneum and anterior renal fascia (Figure 1), and continues to the central retroperitoneum at 10 weeks embryo. This pathway of the right retromesenteric plane is consistent with Meyers' compartment model.…”

mentioning

confidence: 99%

Medial pathway patterns of the right retromesenteric plane: anatomical investigation using MDCT in patients with acute pancreatitis and pyelonephritis

Takaji

Mori

Yamada

et al. 2016

BJR

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Objective: To investigate the medial pathways of the right retromesenteric plane by reviewing multidetector CT (MDCT) findings in patients with acute pancreatitis and pyelonephritis. Methods: 112 patients with acute pancreatitis and 114 patients with pyelonephritis underwent MDCT scans. 64 of the 112 patients with acute pancreatitis and 34 of the 114 patients with pyelonephritis had right retromesenteric plane thickening because of inflammatory extensions. The medial pathways of the right retromesenteric plane were evaluated by two radiologists in consensus. Results: In 18 (28%) of the 64 patients with acute pancreatitis and 10 (29%) of the 34 patients with pyelonephritis, the right retromesenteric plane continued to the central retroperitoneum behind the descending duodenum and pancreatic head (Type 1 pathway). The right retromesenteric plane extended to the right wall of the descending duodenum (Type 2 pathway) in 46 patients (72%) with acute pancreatitis and 24 patients (71%) with pyelonephritis. There was no significant difference in the pathway patterns of the right retromesenteric plane between the acute pancreatitis group and the pyelonephritis group (Type 1 pathway, p 5 0.89; Type 2 pathway, p 5 0.76). Conclusion: Two patterns were confirmed regarding the medial pathways of the right retromesenteric plane; this anatomical knowledge is important for evaluating the extension of retroperitoneal diseases. Advances in knowledge: Medial aspect of the right retromesenteric plane is thought to have two pathways. The right retromesenteric plane continuing to the right duodenal wall is a common type. Knowledge of these variations is important when evaluating the retroperitoneal diseases.

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Stage T3a renal cell carcinoma: staging accuracy of CT for sinus fat, perinephric fat or renal vein invasion

Cited by 55 publications

References 29 publications

Pathological T3a Upstaging of Clinical T1 Renal Cell Carcinoma: Outcomes According to Surgical Technique and Predictors of Upstaging

Pathological T3a Upstaging of Clinical T1 Renal Cell Carcinoma: Outcomes According to Surgical Technique and Predictors of Upstaging

CT Grading in Upper Urinary Tract Calculi with Kidney Infection

Medial pathway patterns of the right retromesenteric plane: anatomical investigation using MDCT in patients with acute pancreatitis and pyelonephritis

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