2021 CONTRAST-ENHANCED ULTRASOUND OF SOLID RENAL MASSES: NON-INVASIVE DISCRIMINATION BETWEEN RENAL CELL CARCINOMA AND BENIGN RENAL TUMORS

Abstract

You have accessJournal of UrologyImaging/Radiology: Uroradiology (I)1 Apr 20132021 CONTRAST-ENHANCED ULTRASOUND OF SOLID RENAL MASSES: NON-INVASIVE DISCRIMINATION BETWEEN RENAL CELL CARCINOMA AND BENIGN RENAL TUMORS Neal E. Rowe, Jeffrey Bird, Cesare Romagnoli, and Patrick PP Luke Neal E. RoweNeal E. Rowe London, Canada More articles by this author , Jeffrey BirdJeffrey Bird London, Canada More articles by this author , Cesare RomagnoliCesare Romagnoli London, Canada More articles by this author , and Patrick PP LukePatrick PP Luke London, Canada More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2013.02.2440AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Contrast-enhanced ultrasound (CEUS) is an emerging dynamic imaging modality for the diagnostic workup of renal masses. CEUS avoids ionizing radiation for patients and avoids contrast-related toxicity associated with conventional imaging modalities such as computed tomography (CT) or magnetic resonance imaging (MRI). We evaluated the utility of CEUS in predicting the histopathology of solid renal masses. METHODS We assessed the ability of CEUS to predict tumor pathology in 32 solid renal masses in 31 patients (mean age 65 years, 17 males: 14 females) undergoing extirpative therapy at our institution. The presence of four main CEUS characteristic were evaluated in each mass including level of arterial enhancement compared to adjacent renal parenchyma (either hypoenhancment, isoenhancement, or hyperenhancement), enhancement pattern (either homogenous or heterogeneous), washout, and peri-lesional rim enhancement. Two radiologists assessed radiographic findings. The findings for each mass were compared with surgical pathology in order to determine predictive CEUS characteristics. RESULTS Our series consisted of 24 renal carcinomas (19 clear cell, 3 chromophobe, and 2 papillary tumors) and 8 benign tumors (6 oncocytomas, 1 angiomyolipoma and 1 metanephric adenoma). Mean tumor size was 3.1 cm (range 1.2 to 5.7cm). Heterogeneous enhancement alone had a 94% positive predictive value (95% CI 69-99), 44% negative predictive value (95% CI 19-70), 63% sensitivity (95% CI 40-81) and 88% specificity (95% CI 47-99) in predicting malignancy. The combination of isointense or hyperintense enhancement and homogeneous enhancement had a 67% positive predictive value (95% CI 29-92), 91% negative predictive value (95% CI 71-98), 75% sensitivity (95% CI 34-96) and 88% specificity (95% CI 67-97) for a benign tumor. CONCLUSIONS Our early experience with CEUS in the evaluation of solid renal masses demonstrates good accuracy in discrimination between malignant and benign tumors. This non-invasive diagnostic modality appears to be better than CT or MRI and may be comparable to percutaneous biopsy. Our initial results have prompted a larger corroborative prospective trial to evaluate the diagnostic accuracy of CEUS in predicting pathology in renal masses. CEUS may have an important role in the management of small renal masses. © 2013 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 189Issue 4SApril 2013Page: e830 Peer Review Report Advertisement Copyright & Permissions© 2013 by American Urological Association Education and Research, Inc.MetricsAuthor Information Neal E. Rowe London, Canada More articles by this author Jeffrey Bird London, Canada More articles by this author Cesare Romagnoli London, Canada More articles by this author Patrick PP Luke London, Canada More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...