IMAGING APPROACH TO STAGING OF RENAL CELL CARCINOMA - 11/09/11
Résumé |
Contemporary imaging techniques have contributed significantly to the detection and staging of renal cell carcinoma. The accuracy of current imaging methods in detecting renal cell carcinoma approaches 100%.59 Almost as many new renal cell carcinomas are being detected incidentally as are being found in patients investigated because of hematuria or flank pain.36 The initial detection of renal masses can be achieved by many imaging methods, including excretory urography,10 ultrasound (US), or CT scan. Once found, however, the main objective is to determine the pathologic nature and stage of a renal mass.10
Survival with renal cell carcinoma depends on the local extent of the primary tumor, presence or absence of distant metastases,41 and tumor histology. The stage at the time of the initiation of treatment correlates directly with prognosis.2 In patients with well-defined tumors with no evidence of capsular, vascular, or lymph node involvement, survival depends on tumor size and grade.4 Evidence shows that CT scan findings can suggest the histologic grade4 in some cases. Radiotherapy and chemotherapy have little effect on renal cell carcinoma,11 making surgery the only effective treatment. Surgical planning largely depends on preoperative imaging delineation of disease extent. Therefore, establishing an accurate stage of the tumor at the earliest possible opportunity is important for properly managing the primary neoplasm and providing accurate prognostic information for the patient. The best overall imaging approach should determine stage and extent of disease accurately, especially identifying distant metastases and adjacent organ invasion, either of which indicates incurable disease.
Many different staging systems have been developed by different authorities. The first staging system for renal cell carcinoma was developed by Flocks and Kadesky in 1958, which subsequently was modified by Robson and associates in 1963,43 and this remains one of the primary staging systems in use today (Table 1). The TNM classification proposed by the American Joint Committee for Cancer Staging and End Results Reporting has not gained wide acceptance, possibly because of the greater number of subgroups involved,41 and the Robson staging system is used in the imaging literature to standardize staging accuracy rates.
Many imaging techniques are available to help stage renal cell carcinoma, including CT scan, MR imaging, US, renal angiography (RA), digital subtraction angiography (DSA), and inferior venacavography (IVCG). The choice of which to use often depends on local physician preferences, patient risk factors, the strengths of each of these imaging methods, and the stage of a tumor in question.
This article describes the features of each of these imaging methods in relation to staging renal cell carcinoma. The discussion centers on advantages, limitations, technical aspects, typical findings, accuracy rates at each stage and overall, and pitfalls associated with each method. The greatest attention is given to CT scan and MR imaging because they are the primary imaging methods with which current staging is accomplished. Finally, the authors conclude with a suggested overall approach to staging renal cell carcinoma, incorporating all methods in a proper order.
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| Address reprint requests to Robert E. Bechtold, MD Department of Radiology Bowman Gray School of Medicine of Wake Forest University Medical Center Boulevard Winston-Salem, NC 27157–1088 |
Vol 24 - N° 3
P. 507-522 - août 1997 Retour au numéro
Article précédent
- RADIOLOGIC EVALUATION OF SMALL AND INDETERMINANT RENAL MASSES
- Nancy S. Curry, Nabil K. Bissada
- CURRENT CONCEPTS AND CONTROVERSIES IN IMAGING OF RENAL CYSTIC DISEASES
- Errol Levine, David S. Hartman, Jon W. Meilstrup, Mark A. Van Slyke, Kenneth A. Edgar, Julie C. Barth
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