Association between nuclear grade of renal cell carcinoma and the aorta-lesion-attenuation-difference
| العنوان: | Association between nuclear grade of renal cell carcinoma and the aorta-lesion-attenuation-difference |
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| المؤلفون: | Joseph R. Grajo, Shahab Bozorgmehri, Russell Terry, Li-Ming Su, Paul L. Crispen, Laura L. Magnelli, Padraic O'Malley, Nikhil V. Batra |
| المصدر: | Abdominal Radiology. 46:5629-5638 |
| بيانات النشر: | Springer Science and Business Media LLC, 2021. |
| سنة النشر: | 2021 |
| مصطلحات موضوعية: | medicine.medical_specialty, Radiological and Ultrasound Technology, medicine.diagnostic_test, business.industry, Urology, medicine.medical_treatment, Gastroenterology, Chromophobe cell, Hepatology, medicine.disease, Nephrectomy, Surgical pathology, Renal cell carcinoma, Internal medicine, Hounsfield scale, Biopsy, medicine, Radiology, Nuclear Medicine and imaging, Stage (cooking), Nuclear medicine, business |
| الوصف: | Several features noted on renal mass biopsy (RMB) can influence treatment selection including tumor histology and nuclear grade. However, there is poor concordance between renal cell carcinoma (RCC) nuclear grade on RMB compared to nephrectomy specimens. Here, we evaluate the association of nuclear grade with aorta-lesion-attenuation-difference (ALAD) values determined on preoperative CT scan. A retrospective review of preoperative CT scans and surgical pathology was performed on patients undergoing nephrectomy for solid renal masses. ALAD was calculated by measuring the difference in Hounsfield units (HU) between the aorta and the lesion of interest on the same image slice on preoperative CT scan. The discriminative ability of ALAD to differentiate low-grade (nuclear grade 1 and 2) and high-grade (nuclear grade 3 and 4) tumors was evaluated by sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and area under curve (AUC) using ROC analysis. Sub-group analysis by histologic sub-type was also performed. A total of 368 preoperative CT scans in patients with RCC on nephrectomy specimen were reviewed. Median patient age was 61 years (IQR 52–68). The majority of patients were male, 66% (243/368). Tumor histology was chromophobe RCC in 7.6%, papillary RCC in 15.5%, and clear cell RCC in 76.9%. The majority, 69.3% (253/365) of tumors, were stage T1a. Nuclear grade was grade 1 in 5.46% (19/348), grade 2 in 64.7% (225/348), grade 3 in 26.2% (91/348), and grade 4 in 3.2% (11/348). Nephrographic ALAD values for grade 1, 2, 3, and 4 were 73.7, 46.5, 36.4, and 43.1, respectively (p = 0.0043). Nephrographic ALAD was able to differentiate low-grade from high-grade RCC with a sensitivity of 32%, specificity of 89%, PPV of 86%, and NPV of 36%. ROC analysis demonstrated the predictive utility of nephrographic ALAD to predict high- versus low-grade RCC with an AUC of 0.60 (95% CI 0.51–0.69). ALAD was significantly associated with nuclear grade in our nephrectomy series. Strong specificity and PPV for the nephrographic phrase demonstrate a potential role for ALAD in the pre-operative setting that may augment RMB findings in assessing nuclear grade of RCC. Although this association was statistically significant, the clinical utility is limited at this time given the results of the statistical analysis (relatively poor ROC analysis). Sub-group analysis by histologic subtype yielded very similar diagnostic performance and limitations of ALAD. Further studies are necessary to evaluate this relationship further. |
| تدمد: | 2366-0058 2366-004X |
| الوصول الحر: | https://explore.openaire.eu/search/publication?articleId=doi_________::0296aa5ea9619ebf9a186b2da3a18d89Test https://doi.org/10.1007/s00261-021-03260-zTest |
| حقوق: | CLOSED |
| رقم الانضمام: | edsair.doi...........0296aa5ea9619ebf9a186b2da3a18d89 |
| قاعدة البيانات: | OpenAIRE |
| تدمد: | 23660058 2366004X |
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