Burak KÖPRÜ, Turgay EBİLOĞLU, Sinan AKAY, Selçuk SARIKAYA, Murat ZOR, Engin KAYA, Giray ERGİN, İbrahim YAVAN, Mesut GÜRDAL

Preoperatif gelişmiş bilgisayarlı tomografi, renal hücreli karsinomda çevre dokulara invazyonu gösterir mi?

Amaç: Renal hücreli karsinomların cerrahi tedavilerinden önce preoperatif gelişmiş bilgisayarlı tomografinin komşu yapılara invazyonu hakkında yeterli bilgi verip vermediğini belirlemek. Gereç ve Yöntemler: Ocak 2015 ile mart 2018 tarihleri arasında böbrek kitlesi nedeniyle açık radikal veya parsiyel nefrektomi yapılan toplam 50 hasta bu retrospektif çalışmaya dahil edildi. Radyolog tarafından preoperatif gelişmiş bilgisayarlı tomografi ile karaciğer, vena kava, aort, dalak, pankreas, iliopsoas kası, karın arka duvarındaki yağ düzlemleri ve sınırlarının düzenliliğini veya düzensizliğini özenle inceledi. Ürolog tarafından intraoperatif olarak aynı parametreleri kaydedildi ve intraoperatif bulgular kayıt altına alındı. İntraoperatif ortamda invazyon tanısı, söz konusu organın diseksiyonu sırasında elde edilen bulgulara göre değerlendirildi. Bulgular: Çalışmada 16 (% 32) kadın ve 34 (% 68) erkek vardı. Ortalama hasta yaşı 60.14 ± 13.89 (26-88) idi. Etkilenen böbrek ünitesi 22 (% 44) hastada sağ böbrek, 28 (% 56) hastada sol böbrek idi. Preoperatif gelişmiş bilgisayarlı tomografi ile operasyon arası ortalama gecikme süresi 34.48 ± 12.07 (1-60) gün olarak tespit edildi. Sonuç: Karaciğer, dalak, pankreas, iliopsoas kası ve abdominal arka duvar için preoperatif gelişmiş bilgisayarlı tomografinin ameliyatta tespit edilenden daha fazla yanlış pozitif yapışma veya düzensizlik sonuçları vermektedir. Vena kava ve aort için preoperatif gelişmiş bilgisayarlı tomografi cerrahide görülen doku yapışıklıkları veya düzensizliklerini yeterli düzeyde tespit edememiştir.

Anahtar Kelimeler:

Bilgisayarlı tomografi, renal hücreli karsinoma, invazyon

Does preoperative enhanced computed tomography show the invasion to surrounding structures in renal cell carcinoma?

Objective: To determine if preoperative enhanced computed tomography (PECT) yields enough information or not about the invasion to adherent structures before operations for renal cell carcinoma. Material and Methods: A total of 50 patients who had open radical or partial nephrectomy due to renal mass between January 2015 and March 2018 enrolled in this retrospective study. The radiologist elaborately examined the fat planes, and regularity/irregularity of the border at the liver, vena cava, aorta, spleen, pancreas, iliopsoas muscle and abdominal posterior wall. The urologist who took part in the operations noted the same parameters while operations or extracted them from operational notes. The diagnosis of invasion in the intraoperative setting was based on findings while dissection of a mentioned organ.Results: There were 16 (32%) female and 34 (68%) males. The mean patient age was 60.14±13.89 (26-88). The affected renal unit was right kidney in 22 (44%) and left kidney in 28 (56%) patients. The mean time lag from PECT and operations was 34.48±12.07 (1-60) days.Conclusion: For liver, spleen, pancreas, iliopsoas muscle, and abdominal posterior wall, PECT yielded some false-positive results of adherence or irregularity than detected in surgery. For vena cava and aorta, PECT could not detect the adherence or irregularity that was seen in surgery.

Keywords:

Computed tomography, renal cell ca, invasion,

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1. Society, A.C., in Cancer Facts and Figures 2017. 2017: America. p. 4-5.
2. Spero M, Brkljacic B, Kolaric B, Marotti M. Preoperative staging of renal cell carcinoma using magnetic resonance imaging: comparison with pathological staging. Clin Imaging, 2010; 34: 441-447.
3. Mueller-Lisse UG, Mueller-Lisse UL, Meindl T, Coppenrath E, Degenhart C, Graser A, et al., Staging of renal cell carcinoma. Eur Radiol, 200717(9):2268-2277.
4. Kang, S.K. and H. Chandarana, Contemporary imaging of the renal mass. Urol Clin North Am, 2012; 39: 161-170.
5. Catalano C, Fraioli F, Laghi A, Napoli A, Pediconi F, Danti M, et al., High-resolution multidetector CT in the preoperative evaluation of patients with renal cell carcinoma. AJR Am J Roentgenol, 2003; 180: 1271-1277.
6. Yaycioglu O, Rutman MP, Balasubramaniam M, Peters KM, Gonzalez JA. Clinical and pathologic tumor size in renal cell carcinoma; difference, correlation, and analysis of the influencing factors. Urology, 2002;60: 33-38.
7. Kurta JM, Thompson RH, Kundu S, Kaag M, Manion MT, Herr HW, et al., Contemporary imaging of patients with a renal mass: does size on computed tomography equal pathological size? BJU Int, 2009; 103: 24-27.
8. Jorns J, Thiel DD, Arnold ML, Diehl N, Cernigliaro JC, Wu KJ, et al. Correlation of radiographic renal cell carcinoma tumor volume utilizing computed tomography and magnetic resonance imaging compared with pathological tumor volume. Scand J Urol, 2014; 48: 453-459.
9. Hallscheidt PJ, Fink C, Haferkamp A, Bock M, Luburic A, Zuna I, et al., Preoperative staging of renal cell carcinoma with inferior vena cava thrombus using multidetector CT and MRI: prospective study with histopathological correlation. J Comput Assist Tomogr, 2005; 29: 64-68.
10. Lawrentschuk N, Gani J, Riordan R, Esler S, Bolton DM. Multidetector computed tomography vs magnetic resonance imaging for defining the upper limit of tumour thrombus in renal cell carcinoma: a study and review. BJU Int, 2005; 96: 291-295.
11. Tsuburaya A, Noguchi Y, Matsumoto A, Kobayashi S, Masukawa K, Horiguchi K. A preoperative assessment of adjacent organ invasion by stomach carcinoma with high resolution computed tomography. Surg Today, 1994; 24: 299-304.