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

Abstract

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.

Clinical and radiographic predictors of the need for inferior vena cava resection during nephrectomy for patients with renal cell carcinoma and caval tumour thrombus

“…Additionally, although it is our current institutional preference to use gadolinium‐enhanced MRI within the week before surgery to accurately stage VTT, in the present retrospective series, ~27% of the available imaging studies were obtained by CT. As our institution is a tertiary referral centre, imaging may have been obtained locally or by referring hospital. Although slightly inferior sensitivity and specificity of CT in detecting the superior extension of caval thrombus compared with surgical pathology has been reported , the accuracy of CT and MRI in staging the level of venous tumour thrombus is generally accepted to be similar .…”

Omental Nodular Deposits of Recurrent Chromophobe Renal Cell Carcinoma Seen on FDG-PET/CT

“…According to Liu et al, CT scan tends to overestimate the tumor size. [ 8 ] Furthermore, CT has a low accuracy in detecting perinephric tumor extension because stranding in the perinephric fat is nonspecific and it can be due to edema, vascular engorgement, or previous inflammation. [ 8 ] Both CT and magnetic resonance imaging (MRI) cannot identify metastasis in normal-size lymph nodes.…”

ACR Appropriateness Criteria Renal Cell Carcinoma Staging

“…Both CT and MRI are equally accurate in staging of the primary tumor [33,34]. A change in the pathologic stage of malignant renal neoplasms postoperatively is common, mainly because of disparities in radiographic and pathologic size or the pathologic presence of perinephric or renal sinus fat invasion that is not easily detected on imaging [35][36][37]. RCC can be multifocal.…”