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Published on: March 30, 2015
Collecting system involvement by renal tumor: are CT measurements reliable enough?
Dmitry Goldin1, Ron Molner, Jacob Shindler
1Department of Urology, Carmel Medical Centre, Rappaport Medical School, Technion, Haifa, Israel.
Objectives:
Smaller kidney lesions which are more often detected recently by accidental imaging are amenable for nephron sparing approach whether at open surgery, laparoscopy or ablative techniques. The pretreatment planning is based on multiplanner CT expected to well define the relationship of the lesion to the major renal blood vessels and collecting system (CS). This study is aimed to compare the pre-surgical CT measurements of the distance from tumor to CS to the actual distances observed on radical nephrectomy specimens.
Patients And Methods:
Contrast CT of 39 patients with renal cell carcinoma (RCC) underwent measurements of the distance between CS and renal tumor. All measurements were confronted with the measurements performed on radical nephrectomy specimens of the same patients.
Results:
Of all 39 patients in 34 (87%) CT showed a contact relation between the tumor and the CS. In fact, the CS involvement has been histologically proven only in three (7.6%) cases. Cutting off the measurements at thresholds of 2 and 5 mm also showed a significant discrepancy between CT and specimen measurements.
Conclusions:
The trend of NSS and ablative techniques stressed out the importance of pretreatment measurements of the distance between the tumor and the CS. This study as performed on radical nephrectomy specimens points out the overestimated proximity of the tumor to the CS. These data if confirmed by other studies, may play a role while planning the management of NS approaches.
Insights
Pre-surgical CT scans may overestimate the proximity of kidney tumors to the collecting system (CS). This finding is crucial for planning nephron-sparing surgery (NSS) and ablative techniques for renal cell carcinoma (RCC).
Area of Science:
- Urology
- Radiology
- Oncology
Background:
- Increasing detection of small renal lesions necessitates precise surgical planning.
- Nephron-sparing surgery (NSS) and ablative techniques are preferred for smaller kidney tumors.
- Multiplanar CT is used for pre-treatment planning to assess tumor proximity to the collecting system (CS).
Purpose of the Study:
- To compare pre-surgical CT measurements of tumor-to-CS distance with actual measurements from radical nephrectomy specimens.
- To evaluate the accuracy of CT in defining the relationship between renal tumors and the collecting system.
Main Methods:
- Contrast-enhanced CT scans were performed on 39 patients with renal cell carcinoma (RCC).
- Measurements of the distance between the CS and the renal tumor were taken from CT scans.
- These measurements were compared with post-operative measurements from radical nephrectomy specimens.
Main Results:
- CT indicated tumor contact with the CS in 87% of cases (34 out of 39 patients).
- Histological confirmation of CS involvement was found in only 7.6% of cases (3 out of 39 patients).
- Significant discrepancies were observed between CT and specimen measurements, particularly at 2 mm and 5 mm thresholds.
Conclusions:
- Pre-surgical CT measurements may overestimate the proximity of renal tumors to the collecting system.
- Accurate assessment of tumor-CS distance is vital for planning NSS and ablative treatments.
- These findings may influence the management strategies for renal tumors undergoing NSS.
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