MP61-01 MULTIPARAMETRIC PROSPECTIVE CONTRAST ENHANCED ULTRASOUND EVALUATION OF KIDNEY LESIONS: COMPARISON WITH HISTOLOGICAL EXAMINATION

Abstract

You have accessJournal of UrologyKidney Cancer: Epidemiology & Evaluation/Staging/Surveillance III (MP61)1 Sep 2021MP61-01 MULTIPARAMETRIC PROSPECTIVE CONTRAST ENHANCED ULTRASOUND EVALUATION OF KIDNEY LESIONS: COMPARISON WITH HISTOLOGICAL EXAMINATION Antonio Tufano, Rocco Simone Flammia, Cesare Gerolimetto, Flavia Proietti, Vittorio Canale, Luca Antonelli, Costantino Leonardo, and Michele Gallucci Antonio TufanoAntonio Tufano More articles by this author , Rocco Simone FlammiaRocco Simone Flammia More articles by this author , Cesare GerolimettoCesare Gerolimetto More articles by this author , Flavia ProiettiFlavia Proietti More articles by this author , Vittorio CanaleVittorio Canale More articles by this author , Luca AntonelliLuca Antonelli More articles by this author , Costantino LeonardoCostantino Leonardo More articles by this author , and Michele GallucciMichele Gallucci More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002101.01AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Outcome of the present prospective single-centre study was to evaluate the diagnostic accuracy of CEUS in the characterization and differentiation between benign and malignant renal masses as confirmed by histological examination. METHODS: Between February 2019 and November 2020, 117 patients with a diagnosis of cT1 renal masses were included. A total of 118 renal masses were previously identified by CT or MRI. A morphological study, including echogenicity, vascularization and tumor margins, was conducted with US B-mode and color-Doppler. All lesions were subjected to ultrasound examination with CEUS after injection of contrast agent before surgery for partial nephrectomy. Qualitative patterns were evaluated: pseudo-capsule (presence/absence), wash-in and wash out (slow/rapid and homogenous/inhomogeneous). Quantitative continuous analysis including time to peak (TPP), peak intensity (PI), mean transit time (MTT) and area under curve (AUC) were obtained from time intensity (TI) curves. Acquired data were statistically analysed to assess the ability of each parameter to differentiate between malignant and benign lesions. Youden test was used to find out the cut-off to maximize diagnostic accuracy. The match between curves has been made using Bonferroni test with a significance level of 0.05. RESULTS: 110 patients (66 male and 44 female), median age was 63.1 (IQ 55-71), median tumor size was 3.45 cm (IQ 2.0-4.8). Out of 118 histological confirmed lesions, 88 (74,5%) were malignant and 30 (25,5%) were benign. From the evaluation of the diagnostic performance of all the parameters analyzed individually, among the morphological patterns, the best predictor of malignancy is echogenicity with a sensitivity of 76.1%, specificity of 75.7%, positive predictive value (PPV) of 88.2% and negative predictive value (NPV) of 57.1%, but without statistically significant differences when compared to the other morphological parameters. Among the qualitative parameters, the most reliable index is the presence of pseudo-capsule (sensitivity of 85.2%, specificity of 86.5%, PPV and NPV of 93.8% and 83,6% respectively), followed by rapid and inhomogeneous wash-in, (sensitivity values of 81.8% and 76.1% and VPP of 86.7% and 89.3% respectively). After comparing diagnostic accuracy of qualitative parameters, the presence of pseudo-capsule significantly outperformed rapid washout (p<0.001). Moreover, among the quantitative parameters, the best and most reliable, were the PI and AUC with excellent sensitivity, specificity, PPV, NPV values of 94.3%, 91.9%, 96.5%, 87.2% and 98.9%, 91.9%, 96.7%, 97.1% respectively. Finally, a combined of the most reliable parameters was carried out to distinguish between benign and malignant lesions. The best combination obtained included PI + AUC (p=0.02), with a diagnostic accuracy of 92%, sensitivity of 100% and specificity of 83.8%. CONCLUSIONS: This study confirms the relevance of CEUS as an essential additional diagnostic tool in the differentiation of renal lesions. Establishing CEUS in clinical routine allows fast, correct, low-risk and cost-effective examinations and thus reducing the number of unnecessary biopsies or operations. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e1083-e1083 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Antonio Tufano More articles by this author Rocco Simone Flammia More articles by this author Cesare Gerolimetto More articles by this author Flavia Proietti More articles by this author Vittorio Canale More articles by this author Luca Antonelli More articles by this author Costantino Leonardo More articles by this author Michele Gallucci More articles by this author Expand All Advertisement Loading ...