Predicting the Histology of Renal Masses Using Preoperative Doppler Ultrasonography

ArticleinThe Journal of Urology 177(1):53-8 · February 2007with7 Reads
DOI: 10.1016/j.juro.2006.08.067 · Source: PubMed
Traditional imaging techniques cannot differentiate among benign, indolent and malignant renal neoplasms. Since conventional clear cell carcinomas are highly vascular, we used preoperative color and/or power Doppler ultrasonography to evaluate the association between vascular flow in a renal mass and surgical pathology. Nephrectomies performed at our institution between January 2001 and December 2004 were retrospectively evaluated. Any detection of flow in the renal mass on color Doppler ultrasonography was defined as vascular flow. A prospective validation study was then performed from January 2005 to October 2005 and a nomogram was constructed to predict clear cell histology. Of 299 renal lesions in the retrospective cohort 210 (70%) had evidence of vascular flow, including 156 of 169 conventional clear cell carcinomas (92%) (p <0.0001). On logistic regression analysis vascular flow was associated with conventional clear cell histology (OR 16.9, 95% CI 8.7-32.8; p <0.0001). This finding was validated prospectively in 97 patients. Vascular flow was detected in 54 of 65 renal masses (83%) with conventional clear cell histology (p <0.0001), which was associated with an OR of 10.8 (95% CI 4.0-29.0; p <0.0001). A nomogram incorporating vascular flow along with clinical variables (clinical size, patient sex and age) to predict conventional clear cell histology was constructed on the retrospective cohort and validated on the prospective data set (concordance index 0.82 and 0.76, respectively). Vascular flow detected by color Doppler ultrasonography is strongly associated with conventional clear cell histology. A nomogram incorporating vascular flow on color Doppler ultrasonography and clinical parameters may aid in the preoperative characterization of renal lesions.
    • "poor angiomyolipoma [6][7][8][9][10]. If histologic subtype can be predicted preoperatively with an acceptable level of accuracy, it may be possible to manage small suspected benign or indolent malignant renal cortical neoplasms conservatively [11, 12] and reserve surgical intervention for the more aggressive clear cell carcinoma, which has higher risk of metastasis [13][14][15]. "
    [Show abstract] [Hide abstract] ABSTRACT: Nearly 25% of solid renal tumors are indolent cancer or benign and can be managed conservatively in selected patients. This prospective study was performed to determine whether preoperative IV microbubble contrast-enhanced ultrasound can be used to differentiate indolent and benign renal tumors from more aggressive clear cell carcinoma. Thirty-four patients with renal tumors underwent preoperative gray-scale, color, power Doppler, and octafluoropropane microbubble IV contrast-enhanced ultrasound. Three blinded radiologists reading in consensus compared rate of contrast wash-in, grade and pattern of enhancement, and contrast washout compared with adjacent parenchyma. Contrast ultrasound findings were compared with surgical histopathologic findings for all patients. The 34 patients had 23 clear cell carcinomas, three type 1 papillary carcinomas, one chromophobe carcinoma, one clear rare multilocular low-grade malignant tumor, two unclassified lesions, three oncocytomas, and one benign angiomyolipoma. The combination of heterogeneous lesion echotexture and delayed lesion washout had 85% positive predictive value, 43% negative predictive value, 48% sensitivity, and 82% specificity for predicting whether a lesion was conventional clear cell carcinoma or another tumor. Diminished lesion enhancement grade had 75% positive predictive value, 81% negative predictive value, 55% sensitivity, and 91% specificity for non-clear cell histologic features, either benign or low-grade malignant. Combining delayed washout with quantitative lesion peak intensity of at least 20% of kidney peak intensity had 91% positive predictive value, 40% negative predictive value, 63% sensitivity, and 80% specificity in the prediction of clear cell histologic features. Ultrasound features of gray-scale heterogeneity, lesion washout, grade of contrast enhancement, and quantitative measure of peak intensity may be useful for differentiating clear cell carcinoma and non-clear cell renal tumors.
    Full-text · Article · Oct 2011
    • "CEUS is always performed after conventional B-mode US and must, therefore, be regarded as a combination of both methods. As early as 1994 Filippone et al [104] Quaia et al [60] investigated 23 lesions, including 15/23 RCC (65%), 1/23 metanephric adenoma (4%) and 7/23 AML (30%). With SHU 508A, heterogeneous behavior in the arterial phase was typical for RCC. "
    [Show abstract] [Hide abstract] ABSTRACT: Contrast enhanced ultrasound (CEUS) has gained clinical importance over the last years for the characterization of hepatic masses. Its role in extrahepatic indications has been investigated repeatedly but has been less comprehensively studied. Currently more than 50% of renal masses are incidentally diagnosed, mostly by B-mode ultrasound. The method of choice for characterization of renal lesions is contrast enhanced computed tomography (CECT). In the case of cystic lesions CECT refers to the Bosniak classification for cystic lesions to assess the risk of malignant behavior. The majority of masses are renal cell carcinoma, but the exact proportion is controversial. Disadvantages of CECT are a significant risk for patients with impaired renal function, allergic reactions and hyperthyroidism due to iodinated contrast agents. Several studies concerning CEUS for the characterization of both solid and cystic renal lesions have been published, but prospective multicenter studies are missing, the presented data being mainly descriptive. The aim of the this manuscript is to review the current literature for CEUS in renal masses, to summarize the available data and focus on possible concepts for studies in the future.
    Full-text · Article · Jan 2010
    • "CEUS is always performed after conventional B-mode US and must, therefore, be regarded as a combination of both methods. As early as 1994 Filippone et al [104] Quaia et al [60] investigated 23 lesions, including 15/23 RCC (65%), 1/23 metanephric adenoma (4%) and 7/23 AML (30%). With SHU 508A, heterogeneous behavior in the arterial phase was typical for RCC. "
    [Show abstract] [Hide abstract] ABSTRACT: Renal masses are frequently incidentally found on ultrasound. Contrast enhanced computed tomography (CECT) is regarded as the method of choice. Contrast enhanced ultrasound (CEUS) has a high impact for characterisation of hepatic lesions. Its use in renal masses has been less comprehensively studied. Two hundred and one patients referred for surgical treatment of a renal mass, 143 patients fulfilling inclusion criteria (histology and reference method). Baseline ultrasound and CEUS with BR1, histology obtained by surgery (89%) or biopsy (11%). Eighty-eight percent of the patients had renal lesions which were malignant and 12% benign lesions. Eighty percent had renal cell carcinoma (RCC). Seven percent of the lesions were cystic. Two patients were upgraded by CEUS from CECT Bosniak II into CEUS Bosniak III resp. IV. CEUS could predict malignancy with a sensitivity, specificity, positive, negative predictive value and accuracy in 97%, 45%, 91%, 75%, and 90%. The correct staging was diagnosed by CEUS (CECT) in 83% (69%). CEUS was superior to CECT in the staging and characterisation of RCC, also in the subgroup of patients with cystic lesions. CEUS can replace CECT e.g. in patients with allergies or contraindications against CECT. Multicentre studies are necessary to confirm the findings.
    Full-text · Article · Jan 2010
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