Tumor grade of clear cell renal cell carcinoma assessed by contrast-enhanced computed tomography.

Kousei Ishigami,Leandro V Leite,David M Kuehn,Marius G Pakalniskis,Danniele G Holanda,Daniel K Lee

doi:10.1186/2193-1801-3-694

Abstract

The purpose of this study was to clarify the association between CT findings and Fuhrman grade of clear cell renal cell carcinoma (ccRCC). The study group consisted of 214 surgically proven ccRCC in 214 patients. Contrast-enhanced CT studies were retrospectively assessed for tumor size, cystic versus solid, calcification, heterogeneity of lesions, percentage of non-enhancing (necrotic) areas, and growth pattern. CT findings and Fuhrman grade were compared. Nineteen of 22 (86.4%) cystic ccRCC were low grade (Fuhrman grades 1-2). There was no significant correlation between tumor size and grade in cystic ccRCC (P = 0.43). In predominantly solid ccRCC, there was significant correlation between tumor size and grade (P < 0.0001). Thirty-eight of 43 (88.4%) infiltrative ccRCC were high grade (Fuhrman grades 3-4). Logistic regression showed tumor size and infiltrative growth were significantly associated with grades 3-4 (P = 0.00083 and P = 0.0059). Cystic ccRCC tends to be low grade. Infiltrative growth and larger tumor size may increase the likelihood of high grade ccRCC.

Highlights

Clear cell renal cell carcinoma is the most common subtype of RCC, accounting for approximately 70 - 80% of RCC (Leibovich et al 2010; Teloken et al 2009; Kim et al 2002)
Because papillary RCC is generally more indolent than Clear cell renal cell carcinoma (ccRCC) (Leibovich et al 2010; Teloken et al 2009), and Fuhrman grade lacks prognostic significance for chromophobe RCC (Cheville et al 2012), papillary and chromophobe RCCs were not considered in this study
We focused solely on the imaging findings of ccRCC and their relationship to Fuhrman grade

Summary

Introduction

Clear cell renal cell carcinoma (ccRCC) is the most common subtype of RCC, accounting for approximately 70 - 80% of RCC (Leibovich et al 2010; Teloken et al 2009; Kim et al 2002). The system most widely employed to classify RCC is the Fuhrman grading system, which uses the characteristics of the nuclei and nucleoli of tumor cells as its basis for grading (Fuhrman et al 1982; Novara et al 2007; Ficarra et al 2005). Grades 1–2 and 3–4 are classified as low and high grades, respectively (Novara et al 2007; Ficarra et al 2005).

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