PURPOSE:Areas of lower enhancement on computed tomography are frequently seen in renal-cell carcinoma.
We investigated whether tumor enhancement on the most prominent hypodense areas correlates with the nuclear grade and other pathologic variables.
METHODS:From 2004 to 2009, all consecutive patients with a preoperative tomography who underwent radical or partial nephrectomy for renal-cell carcinoma at our tertiary referral center were retrospectively analyzed. Enhancement of the entire tumor on the slice with most prominent areas of lower enhancement was determined.
RESULTS:Forty-eight patients were included. Clear-cell carcinoma comprised 91.6 %. Mean areas of lower enhancement for nuclear grade tumors 1-4 were 67.4, 38.7, 27.9, and 15.1 HU, respectively. Areas of lower enhancement negatively correlated with size, nuclear grade, T stage, and pathological stage. Tumors with extension beyond Gerota's fascia (10.5 vs. 35.9 HU, p < 0.001) and positive surgical margins (21.2 vs. 34.8 HU, p = 0.04) had more prominent areas of lower enhancement than organ-confined tumors. When comparing nuclear grade 1-3 to nuclear grade 4 tumors, these areas were significantly lower in the later (36.5 vs. 15.1 HU, p < 0.001). Receiver-operating characteristics curves for detecting nuclear grade 4 showed an area under the curve of 0.808 (95 % CI 0.659-0.957).
CONCLUSIONS: Lower enhancement of the entire tumor at the point where hypodense tumor areas are more predominant on tomography is associated with higher nuclear grade and more advanced stage.
Written by:
Villalobos-Gollás M, Aguilar-Davidov B, Culebro-García C, Gómez-Alvarado MO, Rojas-Garcia P, Ibarra-Fombona R, Uribe-Uribe N, Feria-Bernal G, Castillejos-Molina R, Sotomayor M, Gabilondo F, Rodríguez-Covarrubias F. Are you the author?
Department of Urology, Hospital Regional de Alta Especialidad de la Peninsula de Yucatan, Merida, Mexico.
Reference: Int Urol Nephrol. 2012 Oct;44(5):1369-74.
doi: 10.1007/s11255-012-0199-8
PubMed Abstract
PMID: 22648292
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