Abstract
BackgroundThe incidence of renal cell carcinoma (RCC) is increasing globally owing to the increased use of cross-sectional imaging. Computed tomography (CT) scan is the modality of choice in the diagnosis and pre-operative assessment of RCC. Nephrectomy is the standard treatment for RCC and pre-surgery biopsy is not routinely practised. The accuracy of CT diagnosis and staging in a South African population has not been established.ObjectivesTo determine the accuracy of CT scan in the diagnosis and pre-operative staging of RCC at Grey’s Hospital.MethodsA retrospective chart review was performed; CT scan reports and histopathological results of adult patients who underwent nephrectomy for presumed RCC on CT scan between January 2010 and December 2016 were compared.ResultsFifty patients met the inclusion criteria for the study. CT significantly overestimated the size of renal masses by 0.7 cm (p = 0.045) on average. The positive predictive value of CT for RCC was 81%. Cystic tumours and those 4 cm and smaller were more likely to be benign. CT demonstrated good specificity for extra-renal extension, vascular invasion and lymph node involvement, but poor sensitivity.ConclusionIn our South African study population, CT is accurate at diagnosing RCC, but false-positives do occur. Non-enhancing or poorly enhancing, cystic, fat-containing and small lesions (4 cm or smaller) are more likely to be benign and ultrasound-guided biopsy should be considered to avoid unnecessary surgery. CT assessment of extra-renal extension and vascular invasion is challenging and additional imaging modalities such as magnetic resonance imaging (MRI) venogram, duplex Doppler ultrasound or Positron emission tomography–computed tomography (PET/CT) may be beneficial.
Highlights
The prevalence of renal cell carcinoma (RCC) is increasing globally.[1]
Imaging plays a key role in the diagnosis of RCC and computed tomography (CT) scan is the modality of choice.[3,4]
Thirteen patients (26%) had incidentally discovered renal lesions picked up on other imaging modalities or on CT performed for non-related pathology, 34 patients (68%) were symptomatic with an abdominal mass, flank pain or haematuria and four patients (8%) had imaging to identify a primary lesion after discovery of metastatic disease
Summary
The prevalence of renal cell carcinoma (RCC) is increasing globally.[1] This is partly owing to the increasing use of cross-sectional imaging in the clinical assessment of patients, leading to more tumours being discovered incidentally.[2,3] Imaging plays a key role in the diagnosis of RCC and computed tomography (CT) scan is the modality of choice.[3,4] Surgery is the standard treatment for non-metastatic RCC.[4,5] Currently, in South Africa, pre-surgery biopsy of renal masses in adults is not routinely practised, and nephron sparing surgery is not routinely offered, in the resource-constrained state sector.[5] Accurate imaging is essential, for establishing the likely diagnosis and for staging, surgical planning, determining the extent of nephrectomy to be performed (radical or partial) and choosing the surgical approach.[1,2,3,4]. The accuracy of CT diagnosis and staging in a South African population has not been established
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