Adult Sporadic Multifocal Renal Cell Carcinoma: Helical CT and Pathology Correlations in a Recent and Consecutive Set of Patients Assessed According to a Multidisciplinary Approach

Antonio Porcaro; Filippo Migliorini; Stefano Antoniolli; Giulio Cesaro; Elisa Pomaro; Claudio Ghimenton; Carmelo Monaco; Emanuele Rubilotta; Vincenzo Lacola; Mario Romano; Luigi Comunale; Teodoro Sava

Nephro-Urology Monthly

Current Issue All Issues In Press Accepted Manuscripts Search

Journal Information Boards and Committees Indexing and Listing Sources Journal Metrics Open Peer Review (OPR)Publication Ethics and Malpractice Statement Contact Us Support Reviewer and AE Registration Form

APC

Authors Guide Submit Manuscript

Adult Sporadic Multifocal Renal Cell Carcinoma: Helical CT and Pathology Correlations in a Recent and Consecutive Set of Patients Assessed According to a Multidisciplinary Approach

Author(s):

Antonio B Porcaro^1,*,

Filippo Migliorini²,

Stefano Zecchini Antoniolli²,

Giulio Cesaro²,

Elisa Pomaro²,

Claudio Ghimenton²,

Carmelo Monaco²,

Emanuele Rubilotta²,

Vincenzo Lacola²,

Mario Romano²,

Luigi Comunale²,

Teodoro Sava²

1Department of Urology, Ospedale Civile Maggiore, Azienda Ospedaliera, drporcaro@yahoo.com, Italy

2Department of Urology, Ospedale Civile Maggiore, Azienda Ospedaliera, Italy

Nephro-Urology Monthly:Vol. 2, issue 2; 361-367

Article type:Research Article

Received:Jul 11, 2009

Accepted:Aug 06, 2009

How to Cite:Antonio B PorcaroFilippo MiglioriniStefano Zecchini AntoniolliGiulio CesaroElisa PomaroClaudio GhimentonCarmelo MonacoEmanuele RubilottaVincenzo LacolaMario RomanoLuigi ComunaleTeodoro Savaet al.Adult Sporadic Multifocal Renal Cell Carcinoma: Helical CT and Pathology Correlations in a Recent and Consecutive Set of Patients Assessed According to a Multidisciplinary Approach.Nephro-Urol Mon.2(2):361-367.

Abstract

Background and Aims: To assess helical CT sensitivity in detecting preoperatively Multifocal Renal Cell carcinoma (MFRCC) and clinical occult multifocality in a contemporary and consecutive set of patients according to a multidisciplinary approach.

Methods: The renal masses were assessed preoperatively by volumetric multislice helical CT with the objective to detect multifocality. Renal cells carcinoma (RCCs) were classified as unifocal (UF) or multifocal (MF). MFRCCs were selected in 2 groups including CT detected (CT+) and CT undetected (CT-). RCCs were classified in UF and MF. MFRCCs were selected in 2 groups including CT+ and CT-. CT and pathologic findings of MFRCCs were correlated and CT sensitivity was assessed. Statistical methods were performed in order to compare the CT sensitivity with the overall mean sensitivity calculated from the reported literature, to assess statistical inference between UF and MF - RCCs; and to detect statistical significance between CT(+) and CT(-) MFRCCs .

Results: Over a period of 24 months, 116 kidney units (KU) of 111 patients were surgically treated for RCC. Multifocality was assessed in 13/116 KU of 12 patients (10.8%). Helical CT detected preoperative multifocality in 8/111 patients (7.2%) and preoperative occult multifocality was assessed in 4 (3.6%), as well. Helical CT sensitivity difference between our (66.7%) and the reported literature experience (22.9%) was significant (p <0.0001). Significant predictors for multifocality were tumor size (p = 0.007), laterality (p = 0.002), pT (p = 0.008) and surgery (p = 0.0002). Primary tumor size (p = 0.05) and satellite tumor size (p = 0.01) were significantly correlated to CT-undetected (CT-) multifocal tumors.

Conclusions: In our experience, helical CT was effective in improving preoperative detection of sporadic primary MRCC as well as in lowering clinical occult multifocality. Clinical predictors of multifocality including bilaterality and primary tumor size as well as technical and methodological improvements in performing Helical CT will improve its sensibility in detecting renal masses less than 0.5 cm. CT preoperative detection of clinical multifocality may help in planning effective preoperative surgical treatment as well as lowering local recurrence after nephron sparing surgery.

Keywords

Renal Cell Carcinoma

Multifocal Renal Cell Carcinoma

Helical CT

Full Text

Full text is available in PDF

comments