Journals / Türk Üroloji Dergisi/Turkish Journal of Urology / 2005 / Cilt: 31 - Sayı: 3
Is computerized tomography reliable for detecting tumor number and adrenal gland involvement in patients with renal cell cancer? A multicenter study
- Pages
- 329–334
- DOI
- —
Abstract
Introduction: Renal cell cancer (RCC) represents the fifth most common cancer in men, with a rising incidence. Computerized tomography (CT) remains the most appropriate imaging modality to diagnose renal malignancies. Preoperative CT imaging provides to differentiate benign from malignant lesions, to assess tumor size, tumor localization, tumor number, to identify lymph node and/or distant metastasis, adrenal gland involvement, and to predict the presence of thrombus of the vena cava. Tumor number and the adrenal gland involvement are the most important factors for surgical planning. In this regard, reliable radiographic guidelines to assess the tumor number and the adrenal gland involvement preoperatively allow the surgeon to select patients for partial nephrectomy or adrenal sparing procedures. In this study we examined preoperative abdominal CT findings for tumor number and adrenal gland involvement. Subsequently these findings were compared to histopathological results to determine the accuracy of CT in the diagnosis of tumor number and adrenal involvement as well as establish parameters to ensure further accurate diagnosis. Materials and Methods: We investigated 198 patients with RCC who were treated with radical nephrectomy and ipsilateral adrenalectomy at five different medical centers from 2000 to 2004 retrospectively. The mean age in the patients was 57.3 (15-86) years. Eighty-two of the patients were female, 116 were male. Mean ages of the male and female patients were 58.1 and 57.7 years, respectively. Renal masses diagnosed with contrast enhanced abdominal CT imaging. Also, tumor localization, tumor number, lymph node and adrenal gland involvement were assessed preoperatively. All the patients underwent radical nephrectomy and ipsilateral adrenalectomy. We assessed the accuracy of preoperative abdominal CT findings for identifying tumor number and adrenal gland involvement compared with postoperative histopathological results. Results: Mean tumor size was 8.0±3.6 (2-23) cm. At the end of the histopathological examination, Stage 1, 2, 3, and 4 tumors were detected in 72 (36.4%), 74 (37.4%), 49 (24.7%) and 3 (1.5%) patients, respectively. Adrenal gland involvement was detected in 13 patients (6.5%) with histopathological examination. While preoperative CT demonstrated adrenal gland involvement in 7 patients, histopathology reports confirmed only in 4 patients. CT demonstrated a sensitivity of 30.8%, specificity of 98.4%, positive predictive value of 57.1%, and negative predictive value of 95.2% for adrenal gland involvement. There was no significant difference between upper pole tumors and other regions tumor with regard to adrenal gland involvement. While CT was demonstrated unifocal tumor in 188 patients, histopathology reports were detected in 180 patients. CT demonstrated a sensitivity of 20%, specificity 95.7%, positive predictive value of 20%, and negative predictive value of 95.7% for detecting tumor multifocality. Conclusion: In the light of our results, preoperative abnormal CT findings are less reliable for detecting tumor multifocality and adrenal gland involvement. According to histopathological examination, preoperative CT findings missed adrenal gland involvement and multifocal tumor in 4.7% and 4.3% of the patients. Although, CT is more reliable diagnostic method for adrenal gland involvement and tumor multifocality, either sophisticated radiological techniques or specific marker should be needed.
Özet
Böbrekte kitle saptanan hastalarda tümörün çok odaklı olup olmadığının bilinmesi parsiyel nefrektomi yapma kararını vermede, sürrenal bez tutulumunun bilinmesi ise radikal nefrektomi ile beraber ipsilateral adrenalektomi kararını vermede önemlidir. Bu çalışmada operasyon öncesinde yapılan bilgisayarlı tomografi (BT) bulgularının tümör sayısı ve adrenal bez tutulumunu göstermedeki güvenilirliği araştırılmıştır. Böbrek kitlesi nedeniyle radikal nefrektomi ve aynı taraf adrenalektomi yapılan, böbrek hücreli kanser tanısı alan 198 hastanın ameliyat öncesindeki BT bulguları, operasyon sonrasındaki histopatolojik inceleme sonuçları ile karşılaştırıldı. Hastaların ortalama yaşı 57.3 (15-86) yıl idi. BT'de 7 hastada adrenal bez tutulumu bulguları mevcut iken, histopatolojik incelemede bu hastaların sadece 4'ünde bu bulgunun varlığı doğrulandı. BT'de 191 hastada adrenal bez normal iken, histopatolojik incelemede bu hastaların 9'unda adrenal bez tutulumu saptandı. BT'de tek odaklı tümör saptanan 188 hastanın 8'inde çok odaklı tümör bulundu. Ameliyat öncesindeki BT'de tek odaklı tümör ve normal adrenal bez saptanması, çok odaklı tümör ve adrenal bez tutulum bulgularına göre daha güvenilir görünmektedir. Operasyon öncesi dönemde yapılan BT, adrenal bez tutulumunu ve çok odaklı tümörü %4.7 ve %4.3 oranında saptayamamıştır. BT'de tek odaklı tümör saptanan veya adrenal bez tutulumu saptanmayan olgulara tedavi planını yaparken bu durum göz önünde bulundurulmalıdır.