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Published on: December 15, 2023
Surgical margin follow-up after nephron-sparing surgery: the possible role of CEUS
Elena Bertelli1,2, Laura Mercatelli3, Elena Savi3
1Department of Radiology, Careggi University Hospital, Florence, Italy. elena.bertelli3@gmail.com.
Purpose:
To evaluate the possible role of CEUS in the management of patients who underwent nephron-sparing surgery (NSS) and presented questionable findings on the surgical margins at the CECT follow-up exam.
Methods:
In our retro-prospective study, we included 952 patients with small renal masses (SRMs) treated with NSS between 2012 and 2015 and followed with CECT for at least 3 years at Careggi University Hospital. Twenty-two of them presented solid masses on the site of surgery with questionable enhancement at CECT and were further studied with CEUS. This examination was followed by a quantitative analysis of the enhancement pattern.
Results:
Out of the 22 masses, 18 were considered possible granulomas, presenting slow wash-in and low enhancement peaks compared to the surrounding parenchyma and persistent delayed wash-out at CEUS. Four lesions presented a suspicious malignant enhancement pattern, with rapid wash-in, high peak and rapid wash-out. In accordance with instructions from the urologist, the first group of 18 patients was strictly monitored, revealing that the mass dimensions and enhancement pattern were stable for at least 3 years of follow-up, while the other 4 patients underwent a second intervention and their masses were confirmed as tumor recurrence at the histopathological evaluation.
Conclusions:
CEUS can play a key role in the surgical margin follow-up after NSS when a suspicious enhancing mass is detected by CECT, giving an accurate depiction of the enhancement pattern and thus helping the clinician in the management of the patient.
Insights
Contrast-enhanced ultrasound (CEUS) helps manage patients after kidney surgery. CEUS accurately differentiates post-nephron-sparing surgery (NSS) masses, guiding treatment decisions for potential tumor recurrence.
Area of Science:
- Nephrology
- Oncology
- Radiology
Background:
- Nephron-sparing surgery (NSS) is standard for small renal masses (SRMs).
- Post-operative surveillance with computed tomography (CT) can yield ambiguous findings regarding surgical margins.
- Differentiating benign changes from tumor recurrence is crucial for patient management.
Purpose of the Study:
- To assess the utility of contrast-enhanced ultrasound (CEUS) in evaluating questionable findings at surgical margins after NSS.
- To determine if CEUS can aid in differentiating benign post-surgical changes from tumor recurrence.
Main Methods:
- Retrospective analysis of 952 patients treated with NSS between 2012-2015.
- Focus on 22 patients with suspicious post-operative masses on contrast-enhanced CT (CECT).
- CEUS with quantitative enhancement pattern analysis was performed on these 22 patients.
Main Results:
- CEUS identified 18 masses as likely granulomas (slow wash-in, low peak, delayed washout).
- Four masses showed a malignant pattern (rapid wash-in, high peak, rapid washout).
- The 18 granuloma patients were monitored; the 4 suspicious cases underwent re-intervention and confirmed recurrence.
Conclusions:
- CEUS is valuable for follow-up after NSS when CECT shows ambiguous masses.
- CEUS accurately characterizes enhancement patterns, aiding clinicians in management decisions.
- This can prevent unnecessary interventions for benign findings and facilitate timely treatment for recurrence.
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