RESUMO
PURPOSE: Areas of lower enhancement on computed tomography are frequently seen in renal-cell carcinoma. We investigated whether tumor enhancement on the most prominent hypodense areas correlates with the nuclear grade and other pathologic variables. METHODS: From 2004 to 2009, all consecutive patients with a preoperative tomography who underwent radical or partial nephrectomy for renal-cell carcinoma at our tertiary referral center were retrospectively analyzed. Enhancement of the entire tumor on the slice with most prominent areas of lower enhancement was determined. RESULTS: Forty-eight patients were included. Clear-cell carcinoma comprised 91.6 %. Mean areas of lower enhancement for nuclear grade tumors 1-4 were 67.4, 38.7, 27.9, and 15.1 HU, respectively. Areas of lower enhancement negatively correlated with size, nuclear grade, T stage, and pathological stage. Tumors with extension beyond Gerota's fascia (10.5 vs. 35.9 HU, p < 0.001) and positive surgical margins (21.2 vs. 34.8 HU, p = 0.04) had more prominent areas of lower enhancement than organ-confined tumors. When comparing nuclear grade 1-3 to nuclear grade 4 tumors, these areas were significantly lower in the later (36.5 vs. 15.1 HU, p < 0.001). Receiver-operating characteristics curves for detecting nuclear grade 4 showed an area under the curve of 0.808 (95 % CI 0.659-0.957). CONCLUSIONS: Lower enhancement of the entire tumor at the point where hypodense tumor areas are more predominant on tomography is associated with higher nuclear grade and more advanced stage.
Assuntos
Carcinoma de Células Renais/diagnóstico por imagem , Carcinoma de Células Renais/patologia , Neoplasias Renais/diagnóstico por imagem , Neoplasias Renais/patologia , Tomografia Computadorizada por Raios X , Área Sob a Curva , Carcinoma de Células Renais/cirurgia , Meios de Contraste , Feminino , Humanos , Neoplasias Renais/cirurgia , Masculino , Gradação de Tumores , Estadiamento de Neoplasias , Nefrectomia , Vigilância da População , Curva ROC , Intensificação de Imagem Radiográfica , Estudos Retrospectivos , Estatísticas não ParamétricasRESUMO
PURPOSE: We determined whether increasing the number of cores at first prostate biopsy would improve the cancer detection rate without increasing the detection of clinically insignificant tumors. MATERIALS AND METHODS: From January 2009 to January 2010 patients scheduled for prostate biopsy were randomized to 12 or 18-core sampling. Study inclusion criteria were 1) age 45 to 75 years, 2) abnormal digital rectal examination and/or prostate specific antigen 4 to 20 ng/ml, and 3) no previous biopsy. The primary end point was the cancer detection rate. Secondary end points were clinically insignificant cancer detection and morbidity. RESULTS: A total of 150 patients were enrolled in the study. Preoperative variables were similar in the 2 groups of 75 patients each. Cancer was detected in 23 patients (30.7%) in group 1 and in 36 (48%) in group 2 (p = 0.02). More cases of insignificant cancer were detected in group 2 (p not significant). In men with prostate volume 65 cc or less the detection rate was 30.9% in group 1 and 52.8% in group 2 (p = 0.02). In men with prostate specific antigen 10 ng/ml or less the detection rate was 19.6% in group 1 and 38.4% in group 2 (p = 0.03). Two group 2 patients (5.5%) were diagnosed based on additional samples but the diagnosis corresponded to insignificant cancer. There was no statistically significant difference in morbidity. CONCLUSIONS: The 18-core protocol improves prostate cancer detection without increasing morbidity. Results suggest that the 12-core biopsy protocol is adequate for prostate cancer detection at first biopsy.