.: ORİJİNAL ARAŞTIRMA
The Relationship Between Hounsfield Unit Fuhrman Grades and Subtypes of Renal Cancers: Descriptive Research
Hounsfield Ünitesi Fuhrman Gradeleri ve Renal Kanserlerin Subtipleri Arasındaki İlişki: Tanımlayıcı Araştırma
J Reconstr Urol. 2023;13(3):81-7
doi: 10.5336/urology.2023-97574
Makale Dili: EN
Tam Metin
Ücretsiz Erişim
ABSTRACT
Objective: To determine whether predicting tumor pathology and Fuhrman grade with Hounsfield Unit (HU) increase in computed tomography (CT) is possible. Material and Methods: The study was based on a retrospective evaluation of 71 patients who underwent radical nephrectomy or nephron-sparing surgery due to kidney tumors between May 2013 and May 2016. The patients were divided into 2 groups based on the HU change in the unenhanced and contrastenhanced CT tumor images, namely the ''0-30 HU'' group and the ''>30 HU'' group. Pathological grading was performed in line with the 2010 American Joint Committee on Cancer TNM system, based on the phase of the tumor, size of the tumor, necrosis, and fat invasion. Results: Evaluation of the tumors'' histological type revealed that 31 (43.7%) patients had non-clear cell renal cell carcinoma (RCC), while 40 (56.3%) had clear cell RCC. Twenty-two (61.1%) of the 36 patients with a 0-30 increase in HU had non-clear cell RCC, while 14 (38.9%) had clear cell RCC. Of the 35 patients who had >30 HU increase following the administration of the contrast agent, 9 (25.7%) patients were diagnosed with non-clear cell RCC, versus 26 patients (74.3%) were diagnosed with clear cell RCC (p=0.003). Values above 30 HU, which were considered as the threshold value, pointed out to clear cell RCC with 88.4% sensitivity, 89.3% specificity. Conclusion: The study's results suggested that a HU value greater than 30 indicated Fuhrman Grade 2-4 pathology and a clear-cell RCC pathology in a ratio of approximately 3:4.
Keywords: Computed tomography; renal tumors; pathological conditions; signs and symptoms
Objective: To determine whether predicting tumor pathology and Fuhrman grade with Hounsfield Unit (HU) increase in computed tomography (CT) is possible. Material and Methods: The study was based on a retrospective evaluation of 71 patients who underwent radical nephrectomy or nephron-sparing surgery due to kidney tumors between May 2013 and May 2016. The patients were divided into 2 groups based on the HU change in the unenhanced and contrastenhanced CT tumor images, namely the ''0-30 HU'' group and the ''>30 HU'' group. Pathological grading was performed in line with the 2010 American Joint Committee on Cancer TNM system, based on the phase of the tumor, size of the tumor, necrosis, and fat invasion. Results: Evaluation of the tumors'' histological type revealed that 31 (43.7%) patients had non-clear cell renal cell carcinoma (RCC), while 40 (56.3%) had clear cell RCC. Twenty-two (61.1%) of the 36 patients with a 0-30 increase in HU had non-clear cell RCC, while 14 (38.9%) had clear cell RCC. Of the 35 patients who had >30 HU increase following the administration of the contrast agent, 9 (25.7%) patients were diagnosed with non-clear cell RCC, versus 26 patients (74.3%) were diagnosed with clear cell RCC (p=0.003). Values above 30 HU, which were considered as the threshold value, pointed out to clear cell RCC with 88.4% sensitivity, 89.3% specificity. Conclusion: The study's results suggested that a HU value greater than 30 indicated Fuhrman Grade 2-4 pathology and a clear-cell RCC pathology in a ratio of approximately 3:4.
Keywords: Computed tomography; renal tumors; pathological conditions; signs and symptoms
ÖZET
Amaç: Bu çalışmanın amacı, bilgisayarlı tomografide (BT) Hounsfield Ünitesi (HU) artışı ile tümör patolojisini ve Fuhrman derecesini öngörmenin mümkün olup olmadığını belirlemektir. Gereç ve Yöntemler: Çalışma, Mayıs 2013 ile Mayıs 2016 tarihleri arasında böbrek tümörü nedeniyle radikal nefrektomi veya nefron koruyucu cerrahi uygulanan 71 hastanın retrospektif olarak değerlendirilmesine dayanmaktadır. Hastalar, kontrastsız ve kontrastlı BT tümör görüntülerindeki HU değişimine göre ''0-30 HU'' grubu ve ''>30HU'' grubu olmak üzere 2 gruba ayrılmıştır. Patolojik derecelendirme, 2010 Amerikan Kanser Ortak Komitesi TNM sistemi ile uyumlu olarak, tümörün fazı, tümörün boyutu, nekroz ve yağ invazyonu temelinde yapıldı. Bulgular: Tümörlerin histolojik tipi değerlendirildiğinde, 31 (%43,7) hastada berrak hücreli olmayan renal hücreli karsinom (RHK), 40 (%56,3) hastada ise berrak hücreli RHK olduğu görüldü. HU'da 0-30 artış olan 36 hastanın 22'sinde (%61,1) berrak hücreli olmayan RHK, 14'ünde (%38,9) berrak hücreli RHK vardı. Kontrast madde verilmesini takiben >30HU artışı olan 35 hastadan 9'na (%25,7) berrak hücreli olmayan RHK tanısı konurken, 26 hastaya (%74,3) berrak hücreli RHK tanısı konmuştur (p=0,003). Eşik değer olarak kabul edilen 30 HU üzerindeki değerler %88,4 duyarlılık, %89,3 özgüllük ile berrak hücreli RHK'ye işaret etmiştir. Sonuç: Çalışmanın sonuçları, 30'dan büyük HU değerinin yaklaşık 3:4 oranında Fuhrman Grade 2-4 patolojisine ve berrak hücreli RHK patolojisine işaret ettiğini göstermiştir.
Anahtar Kelimeler: Bilgisayarlı tomografi; böbrek tümörleri; patolojik durumlar; belirti ve semptomlar
Amaç: Bu çalışmanın amacı, bilgisayarlı tomografide (BT) Hounsfield Ünitesi (HU) artışı ile tümör patolojisini ve Fuhrman derecesini öngörmenin mümkün olup olmadığını belirlemektir. Gereç ve Yöntemler: Çalışma, Mayıs 2013 ile Mayıs 2016 tarihleri arasında böbrek tümörü nedeniyle radikal nefrektomi veya nefron koruyucu cerrahi uygulanan 71 hastanın retrospektif olarak değerlendirilmesine dayanmaktadır. Hastalar, kontrastsız ve kontrastlı BT tümör görüntülerindeki HU değişimine göre ''0-30 HU'' grubu ve ''>30HU'' grubu olmak üzere 2 gruba ayrılmıştır. Patolojik derecelendirme, 2010 Amerikan Kanser Ortak Komitesi TNM sistemi ile uyumlu olarak, tümörün fazı, tümörün boyutu, nekroz ve yağ invazyonu temelinde yapıldı. Bulgular: Tümörlerin histolojik tipi değerlendirildiğinde, 31 (%43,7) hastada berrak hücreli olmayan renal hücreli karsinom (RHK), 40 (%56,3) hastada ise berrak hücreli RHK olduğu görüldü. HU'da 0-30 artış olan 36 hastanın 22'sinde (%61,1) berrak hücreli olmayan RHK, 14'ünde (%38,9) berrak hücreli RHK vardı. Kontrast madde verilmesini takiben >30HU artışı olan 35 hastadan 9'na (%25,7) berrak hücreli olmayan RHK tanısı konurken, 26 hastaya (%74,3) berrak hücreli RHK tanısı konmuştur (p=0,003). Eşik değer olarak kabul edilen 30 HU üzerindeki değerler %88,4 duyarlılık, %89,3 özgüllük ile berrak hücreli RHK'ye işaret etmiştir. Sonuç: Çalışmanın sonuçları, 30'dan büyük HU değerinin yaklaşık 3:4 oranında Fuhrman Grade 2-4 patolojisine ve berrak hücreli RHK patolojisine işaret ettiğini göstermiştir.
Anahtar Kelimeler: Bilgisayarlı tomografi; böbrek tümörleri; patolojik durumlar; belirti ve semptomlar
REFERANSLAR:
- American Cancer Society [Internet]. © 2023 American Cancer Society [Cited: April 14, 2023]. Cancer Facts & Figures 2013. Available from: [Link]
- Pahernik S, Ziegler S, Roos F, Melchior SW, Thüroff JW. Small renal tumors: correlation of clinical and pathological features with tumor size. J Urol. 2007;178(2):414-7; discussion 416-7. [Crossref] [PubMed]
- Young JR, Margolis D, Sauk S, Pantuck AJ, Sayre J, Raman SS. Clear cell renal cell carcinoma: discrimination from other renal cell carcinoma subtypes and oncocytoma at multiphasic multidetector CT. Radiology. 2013;267(2):444-53. [Crossref] [PubMed]
- Vargas HA, Chaim J, Lefkowitz RA, Lakhman Y, Zheng J, Moskowitz CS, et al. Renal cortical tumors: use of multiphasic contrast-enhanced MR imaging to differentiate benign and malignant histologic subtypes. Radiology. 2012;264(3):779-88. [Crossref] [PubMed] [PMC]
- Choi SK, Jeon SH, Chang SG. Characterization of small renal masses less than 4 cm with quadriphasic multidetector helical computed tomography: differentiation of benign and malignant lesions. Korean J Urol. 2012;53(3):159-64. [Crossref] [PubMed] [PMC]
- Patel NS, Poder L, Wang ZJ, Yeh BM, Qayyum A, Jin H, et al. The characterization of small hypoattenuating renal masses on contrast-enhanced CT. Clin Imaging. 2009;33(4):295-300. [Crossref] [PubMed] [PMC]
- Kim JK, Kim TK, Ahn HJ, Kim CS, Kim KR, Cho KS. Differentiation of subtypes of renal cell carcinoma on helical CT scans. AJR Am J Roentgenol. 2002;178(6):1499-506. [Crossref] [PubMed]
- Pooler BD, Pickhardt PJ, O'Connor SD, Bruce RJ, Patel SR, Nakada SY. Renal cell carcinoma: attenuation values on unenhanced CT. AJR Am J Roentgenol. 2012;198(5):1115-20. [Crossref] [PubMed]
- Fuhrman SA, Lasky LC, Limas C. Prognostic significance of morphologic parameters in renal cell carcinoma. Am J Surg Pathol. 1982;6(7):655-63. [Crossref] [PubMed]
- Patard JJ, Leray E, Rioux-Leclercq N, Cindolo L, Ficarra V, Zisman A, et al. Prognostic value of histologic subtypes in renal cell carcinoma: a multicenter experience. J Clin Oncol. 2005;23(12):2763-71. [Crossref] [PubMed]
- Herts BR, Coll DM, Novick AC, Obuchowski N, Linnell G, Wirth SL, et al. Enhancement characteristics of papillary renal neoplasms revealed on triphasic helical CT of the kidneys. AJR Am J Roentgenol. 2002;178(2):367-72. [Crossref] [PubMed]
- Sheir KZ, El-Azab M, Mosbah A, El-Baz M, Shaaban AA. Differentiation of renal cell carcinoma subtypes by multislice computerized tomography. J Urol. 2005;174(2):451-5; discussion 455. [Crossref] [PubMed]
- Zhang J, Lefkowitz RA, Ishill NM, Wang L, Moskowitz CS, Russo P, et al. Solid renal cortical tumors: differentiation with CT. Radiology. 2007;244(2):494-504. [Crossref] [PubMed]
- Young KK, Byung HK, Choal HP, Chun IK, Hyuk SC. Effectiveness of computed tomography for predicting the nuclear grade of renal cell carcinoma. Korean J Urol. 2009;50(10):942-6. [Crossref]
- Zokalj I, Marotti M, Kolarić B. Pretreatment differentiation of renal cell carcinoma subtypes by CT: the influence of different tumor enhancement measurement approaches. Int Urol Nephrol. 2014;46(6):1089-100. [Crossref] [PubMed]
- Sheth S, Scatarige JC, Horton KM, Corl FM, Fishman EK. Current concepts in the diagnosis and management of renal cell carcinoma: role of multidetector ct and three-dimensional CT. Radiographics. 2001;21 Spec No:S237-54. [Crossref] [PubMed]
- Coll DM, Smith RC. Update on radiological imaging of renal cell carcinoma. BJU Int. 2007;99(5 Pt B):1217-22. [Crossref] [PubMed]
- Mancini ME, Albergo A, Moschetta M, Angelelli M, Scardapane A, Angelelli G. Diagnostic potential of multidetector computed tomography for characterizing small renal masses. ScientificWorldJournal. 2015;2015:476750. [Crossref] [PubMed] [PMC]
- Choi SY, Sung DJ, Yang KS, Kim KA, Yeom SK, Sim KC, et al. Small (<4 cm) clear cell renal cell carcinoma: correlation between CT findings and histologic grade. Abdom Radiol (NY). 2016;41(6):1160-9. [Crossref] [PubMed]
- Zhu YH, Wang X, Zhang J, Chen YH, Kong W, Huang YR. Low enhancement on multiphase contrast-enhanced CT images: an independent predictor of the presence of high tumor grade of clear cell renal cell carcinoma. AJR Am J Roentgenol. 2014;203(3):W295-300. [Crossref] [PubMed]
.: İşlem Listesi