Role of MRI in staging and surgical planning and its clinicopathological correlation in patients with renal cell carcinoma

Hira Lal; Paritosh Singh; Manoj Jain; Uday Pratap Singh; Sanjoy Kumar Sureka; Rajanikant R Yadav; Raghunandan Prasad; Pragati Verma; Anuradha Singh; Priyank Yadav

doi:10.4103/ijri.IJRI_177_19

Indian Journal of Radiology and Imaging, Table of Contents

CC BY-NC-ND 4.0 · Indian J Radiol Imaging 2019; 29(03): 277-283
DOI: 10.4103/ijri.IJRI_177_19

Genitourinary Imaging

Role of MRI in staging and surgical planning and its clinicopathological correlation in patients with renal cell carcinoma

Authors

Hira Lal

Departments of Radiology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Raibareli Road, Lucknow, Uttar Pradesh, India
Paritosh Singh

Departments of Radiology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Raibareli Road, Lucknow, Uttar Pradesh, India
Manoj Jain

Departments of Pathology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Raibareli Road, Lucknow, Uttar Pradesh, India
Uday Pratap Singh

Departments of Urology and Renal Transplantation, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Raibareli Road, Lucknow, Uttar Pradesh, India
Sanjoy Kumar Sureka

Departments of Urology and Renal Transplantation, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Raibareli Road, Lucknow, Uttar Pradesh, India
Rajanikant R Yadav

Departments of Radiology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Raibareli Road, Lucknow, Uttar Pradesh, India
Raghunandan Prasad

Departments of Radiology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Raibareli Road, Lucknow, Uttar Pradesh, India
Pragati Verma

Departments of Radiology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Raibareli Road, Lucknow, Uttar Pradesh, India
Anuradha Singh

Departments of Radiology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Raibareli Road, Lucknow, Uttar Pradesh, India
Priyank Yadav

Departments of Urology and Renal Transplantation, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Raibareli Road, Lucknow, Uttar Pradesh, India

Abstract

Background and Aims: Radiological evaluation of renal cell carcinoma (RCC) is used for non-invasive staging for better surgical planning. However, the correlation of radiological staging using magnetic resonance imaging (MRI) with histopathological findings has not been done so far. The aim of this study is to assess the role of MRI in pre-operative staging of RCC in patients undergoing radical nephrectomy and nephron sparing surgery (NSS) and correlate it with histopathological findings. Settings and Design: This prospective observational study was conducted from February 2015 to October 2016 at a tertiary care hospital in northern India. Methods: MR imaging was done on 3 Tesla MR scanner (Signa Hdxt General Electrics, Milwaukee, USA). Preoperative staging was based on 2010 TNM staging system. The preoperative parameters in MRI were tumor size, detection/breach of pseudocapsule, tumor extension into perirenal fat and detection of tumor venous thrombus. The staging on MRI was compared with surgical and pathological staging. Statistical Analysis Used: The agreement between these three staging methods was determined using the kappa statistics (0.0-0.2, poor; 0.2-0.4, fair; 0.4-0.6, moderate; 0.6-0.8, good; 0.8-1.0, excellent). Results: 30 patients with suspected RCC underwent NSS (n - 10) and radical nephrectomy (n - 20). Mean tumor size was 9.66 ± 2.99 cm in the radical nephrectomy group and 4.06 ± 1.16 cm in the NSS group. There was perfect agreement between MRI, surgical and pathological staging for breach of pseudocapsule (κ -1.0, Percentage of Agreement - 100%,P < 0.05). In none of the patients, MRI missed extension beyond the Gerota’s fascia or presence of venous thrombus. Conclusion: MRI staging of RCC is an accurate predictor of the surgical and pathological stage and has the potential to become a useful tool for preoperative identification of patients with RCC who can undergo NSS.

Keywords

Magnetic resonance imaging - nephron sparing surgery - radical nephrectomy

Full Text

References

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