Çağ ÇAL, Derya KESKİN, Mustafa DELİBAŞ, Refik KİLLİ, Ceyhun ÖZYURT, Oktay NAZLI

Böbrek tümörlerinde bilgisayarlı tomografiyle evrelemenin patolojik evreyle uyumluluğu

En sık görülen erişkin primer böbrek tümörü olan renal adenokarsinomun klinik olarak doğru evrelendirilebilmesi, uygulanacak cerrahi tedavinin şeklinin ve sınırlarının belirlenmesi için önemlidir. Bu çalışmanın amacı, böbrek tümörlerinde bilgisayarlı tomografi (BT) ile yapılan klinik evrelemenin histopatolojik evre ile uyumunu belirlemektir. Renal kitle tanısıyla opere edilen 44 olgu retrospektif olarak değerlendirildi. Klinik ve patolojik evreler karşılaştırıldı. 44 olgudan klinik olarak 34 olguda evre I, 5 olguda evre II ve 5 olguda evre III tümör belirlendi. BT ile evre I hastalık olarak değerlendirilen 4 olgudan, üçünde patolojik olarak evre II ve birinde evre III tümör saptandı. Klinik olarak evre II tümörlü bir olguda ise evre III tümör görüldü. BT ile yapılan klinik evrelemenin evre I, evre II ve evre III tümörlerde histopatolojik evreyle uyumu sırasıyla %88.2, %80 ve %100 olarak belirlendi. Fakat evre II ve evre III tümörlü olgu sayısı bu evrelerdeki oranların güvenilirliği için yeterli değildir. Tüm evrelerde BT evrelemesinin doğruluğu %88.6 olarak bulundu. BT renal hücreli karsinomun evrelemesinde akılcı bir seçenektir ve klinik ve patolojik evreler arasında anlamlı bir farklılık bulunmamaktadır.

Anahtar Kelimeler:

Böbrek neoplazmları, Adenokarsinom, Tomografi, x-ışınlı bilgisayarlı, Geriyedönük çalışma, Neoplazm evrelendirilmesi, Erişkin

The correlation of computerized tomography staging and pathological stage in kidney tumors

Renal adenocarcinoma is the most common primary kidney tumor in adults. Clinically accurate staging of the tumor is important because the type of surgical approach is related with the extension of the tumor. The aim of the study was to determine the accuracy of clinical staging in kidney tumors with computerized tomography (CT). 44 patients operated renal mass in our clinic, were evaluated retrospectively. Clinical and pathological stages were compared. Clinically, 34 of 44 patients were stage I, 5 patients were stage II and 5 patients were stage III. 3 out of 4 patients who were classified as stage I with CT were staged as stage II and the remaining one was stage III pathologically. One of the 5 patients who were clinically stage II was staged as III pathologically. Staging accuracy of CT in stage I, stage II and stage III patients is 88.2%, 80% and 100% respectively. However the number of patients with stage II and stage III is not enough for reliable evaluation. Overall staging accuracy with CT is found to be 88.6%. In conclusion, CT is a reliable method in staging of renal cell carcinoma and the difference between clinical and pathological stages is not significant.

Keywords:

Kidney Neoplasms, Adenocarcinoma, Tomography, X-Ray Computed, Retrospective Studies, Neoplasm Staging, Adult,

PDF

___

1. Woodhouse CRJ, Hedry WF, Bloom HJG. Renal carcinoma. Whitfeld HN, Hendry WF, eds. Textbook of Genitourinary Surgery. 1inci baskı. Philadelphia: Churchill Livingstone, 1985: 945-961.
2. Silverberg E, Boring CC, Squires TS. Cancer statistics. Cancer 1990; 40:9-26.
3. Bosniack MA. The small (_____3cm) renal parenchymal tumor: detection, diagnosis, and controversies. Radiology 1991; 179:307-317.
4. Wills JS. The diagnosis and management of small (_____3cm) renal neoplasms: a commentary. Semin Ultrasound CT MRI 1997; 18:75-81.
5. Zagoria RJ, Wolfman NT, Karstaedt N, et al. CT features of renal celi carcinoma with emphasis on relation to tumor size. Invest Radiol 1990; 25:261-266.
6. Robson CJ, Churchill BM, Anderson W. The results of radical nephrectomy for renal celi carcinoma. Trans Am Assoc Genitourin Surg 1968; 60:122-129.
7. Benson MA, Haaga JR, Resnick MI. Staging renal carcinoma: what is sufficient? Arch Surg 1989; 124:71-73.
8. Kam J, Sandler CM, Benson GS. Angiography in diagnosis of renal tumors. Urology 1981; 18:100-106.
9. Levitt RG, Geisse CG, Sagel SS, et al. Complementary use of ultrasound and computed tomography in studies of pancreas and kidney. Radiology 1978; 126:149-152.
10. Johnson CD, Dunnick NR, Cohan RC, lllescas FF. Renal adenocarcinoma: CT staging of 100 tumors. Am J Roentgenol 1987; 148:59-63.
11. Parks CM, Kellett MJ. Staging renal celi carcinoma. Clin Radiol 1994; 49:223-230.
12. Levine E, Lee KR Weigel J. Preoperative determination of abdominal extent of renal celi carcinoma by computed tomography. Radiology 1979; 132:395-398.
13. Cronan JJ, Zeman RK, Rosenfield AT. Comparison of computerized tomography, uitrasound and angiography in staging renal celi carcinoma. J Urol 1982; 127:712-714.
14. Constantinides C, Recker F, Bruehlmann W, et al. Accuracy of magnetic resonance imaging compared to computerized tomography and renal selective angiography in preoperatively staging renal celi carcinoma. Urol Int 1991; 47:181-185.
15. Studer UE, Scherz S, Scheidegger J, et al. Enlargement of regional lymph nodes in renal celi carcinom is often not due to metastases. J Urol 1990; 144:243-245.
16. Fein AB, Lee JK, Balfe DM, et al. Diagnosis and staging of renal celi carcinoma: a comparison of MR imaging and CT. Am J Roentgenol 1987; 148:749-753.
17. Hatcher PA, Paulson DF, Anderson EE. Accuracy in staging of renal celi carcinoma involving vena cava. Urology 1992; 39:27-30.
18. Tammela TLJ, Leinonen ASS, Konttun MJ. Comparison of excretory urography, angiography, ultrasound and computed tomography for T category staging of renal celi carcinoma. Scand J Urol Nephrol 1991; 25:283-286.
19. Zagoria RJ, Bechtold RE, Dyer RB. Staging of renal adenocarcinoma: role of various imaging procedures. Am J Roentgenol 1995; 164:363-370.
20. Smelka RC, Shoenut JP, Kroeker MA, et al. Renal lesions: controlled comparison betvveen CT and 1.5-T MR imaging with nonenhanced and gadolinium-enhanced fat supressed spin echo and breath-hold FLASH techniques. Radiology 1992; 182:425-430.