Abstract
PurposeTumorous texture is a marker for tumor tissue inhomogeneity. Based on this assumption, this study aims to evaluate the value of computed tomography texture analysis for imaging-based prediction of perioperative complications during laparoscopic partial tumor nephrectomy.MethodsA total of 106 patients with histologically confirmed renal cell carcinoma and pre-operative CT were included and volumetric texture analysis of the tumors was performed by two readers. Texture analysis parameter ratios and differences were calculated using the kidney parenchyma as reference (“reference-corrected”). Regression analysis was performed, regarding the value of the texture analysis parameters, for assessment of the tumor nuclear grade and the prediction of peri- and postoperative complications and approximated blood loss. Moreover, the inter-rater agreement in terms of the intra-class correlation coefficient (ICC) was calculated.ResultsRegarding the reference-corrected values, the predictive value of texture analysis parameters for severe perioperative complications was highest for the standard deviation of the mean attenuation (Area under curve/AUC, .615; sensitivity, 93.8%, specificity, 30.0%), followed by the uniformity (AUC, .599; sensitivity, 62.5%, specificity, 60.0%), and the uniformity of distribution of positive pixels (AUC, .597; sensitivity, 62.5%; specificity, 61.1%).Regarding the blood loss, the uniformity of positive pixel values (UPP; AUC, 0.638), uniformity (AUC, 0.635), and entropy (AUC, 0.633) yielded the best predictive values, whilst the tumor grade was a weaker predictor (AUC, 0.574).The applied texture analysis parameters did not correlate with the time of surgery or the warm ischemic time. All measured parameters were better predictors for complications than the tumor diameter alone. The inter-rater agreement was almost perfect (ICC, .982).ConclusionCT and CT texture analysis parameters are valuable for prediction of perioperative outcome before laparoscopic partial nephrectomy in patients with renal cell carcinoma.
Highlights
Surgery of renal cell carcinoma (RCC) via laparoscopic partial nephrectomy (LPN) is a common technique, especially for small tumors [1]
Regarding the reference-corrected values, the predictive value of texture analysis parameters for severe perioperative complications was highest for the standard deviation of the mean attenuation (Area under curve/area under curve (AUC), .615; sensitivity, 93.8%, specificity, 30.0%), followed by the uniformity (AUC, .599; sensitivity, 62.5%, specificity, 60.0%), and the uniformity of distribution of positive pixels (AUC, .597; sensitivity, 62.5%; specificity, 61.1%)
We aimed to assess whether computed tomography (CT) texture analysis of the internal structure of renal cell carcinomas is a valuable tool for prediction of perioperative complications during laparoscopic partial nephrectomy
Summary
Surgery of renal cell carcinoma (RCC) via laparoscopic partial nephrectomy (LPN) is a common technique, especially for small tumors [1]. The laparoscopic approach can be accompanied by potentially severe complications, in particular hemorrhage, formation of pseudo aneurysms or urine leakage [2, 3]. Surgical outcome is significantly influenced by the tumor localization and environment, which has led to several predictive imaging-based scoring systems [4]. The R.E.N.A.L. nephrometry scoring system has been identified as a valuable, predictive tool for pretherapeutic assessment of surgical risk [4, 5]. R.E.N.A.L. is mainly based on tumor size and localization, whilst the tumorous internal structure is not taken into consideration. The tumor microstructure, especially tumorous angiogenesis, can be a complicating factor when it comes to intraoperative blood loss [6, 7] and is important
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