Can multiphase CT scan distinguish between papillary renal cell carcinoma type 1 and type 2?

Autor:	Lejla Aganovic, Ahmet Bindayi, Ahmed Shabaik, Donna E. Hansel, Michelle L. McDonald, Alp Tuna Beksac, Fiona Hughes, Ithaar Derweesh, Gerant Rivera-Sanfeliz
Rok vydání:	2018
Předmět:	Subset Analysis Kidney Disease Percutaneous medicine.diagnostic_test Papillary renal cell carcinomas business.industry medicine.medical_treatment Histology medicine.disease Nephrectomy Rare Diseases Renal cell carcinoma Hounsfield scale Biopsy medicine business Nuclear medicine Urooncology Cancer
Zdroj:	Turkish journal of urology, vol 44, iss 4
ISSN:	2149-3057 2149-3235
DOI:	10.5152/tud.2018.28938
Popis:	Objective To investigate the utility of multiphase computed tomography (CT) and percutaneous renal mass biopsy (PRMB) in differentiating between papillary renal cell carcinoma (pRCC)-Type 1 and -Type 2, as emerging data have suggested differential enhancement patterns in different renal tumor histologies. Material and methods Retrospective analysis of 51 patients (23 pRCC-Type 1/28 pRCC-Type 2) who underwent multiphase CT followed by surgery from July 2011 to April 2016 was performed. Data were analyzed between subgroups based on histology. Multiphase CT was analyzed for tumor size, and attenuation [Hounsfield Units (HU)]. Change in HU (ΔHU) was calculated between noncontrast (NC), corticomedullary (CM), nephrographic (N), and delayed (D) phases. Subset analysis was carried out on patients who underwent PRMB prior to surgery. Results There was no difference in median tumor size (pRCC-Type 1 2.8 vs. pRCC-Type 2 2.6 cm, p=0.832). In addition to tumor size being similar between groups, distribution of tumor stages between groups was also similar (p=0.651). Greater proportion of high-grade tumors (III/IV) was noted in pRCC-Type 2 (42.9% vs. 8.7%) (p=0.011). There was no difference in HU values for NC (p=0.961), CM (p=0.118), N (p=0.277), and D (p=0.256) phases, and in ΔHU between CM-NC (p=0.278), N-NC (p=0.316), and D-NC (p=0.103). Thirteen patients underwent percutaneous biopsy, 11 of whom had diagnostic samples. Examination of 10/11 (90.9%) samples accurately predicted correct histology, and of 6/11 (54.5%) samples correctly identified high-vs. low-grade histology. Conclusion Our findings suggest substantial overlap of CT findings, despite pRCC-Type 2 having greater proportion of high-grade tumors. Utility of CT is limited in the differentiation between pRCC subtypes. Patients with suggested pRCC on CT imaging being considered for a non-extirpative strategy should undergo PRMB for risk stratification.
Databáze:	OpenAIRE
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