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Objective To investigate the predictive value of CT signs in the pathological Fuhrman grading of clear cell renal carcinoma (ccRCC).Methods The clinicopathological features and CT findings of 72 patients with ccRCC which confirmed by operation and pathology were analyzed retrospectively.According to the WHO Fuhrman grading,all patients were divided into low-grade(Fuhrman gradeⅠorⅡ)or high-grade (Fuhrman gradeⅢorⅣ).ChiG square test and t-test were used to compare the clinical data and CT findings between the two groups,including morphological features (site,whether the renal medulla invasion,morphology,growth pattern,border,pseudo-envelope,lobulation sign,interface,perirenal fascia and the same lateral adrenal invasion,renal sinus and perirenal fat invasion,venous invasion,lymphadenopathy, maximum diameter),density (bleeding,necrosis ratio,calcification,fat)and enhancement characteristics (the degree of enhancement, strengthening method).And the pathological Fuhrman grading was the gold standard.The ROC was used to analyze the diagnostic efficacy of CT signs on Fuhrman grading.The Delong test was used to compare the AUC of different CT signs.Results There were significant differences in tumor maximum diameter,the renal medulla invasion,and lobulation sign between the Fuhrman low-grade and high-grade group(χ2/t＝－4.31 7,9.794,7.325,P＜0.05).There were no differences in gender,age,location sign,morphology,growth pattern, border,pseudo-envelope,interface,perirenal fascia and ipsilateral adrenal invasion,renal sinus and perirenal fat invasion,necrosis ratio,degree of enhancement,strengthening method between two groups (P＞0.05). The largest diameter of the tumor,the renal medulla invasion and the lobulation sign were useful for Fuhrman diagnosis.The AUC was 0.778,0.647 and 0.644,respectively.And there were significant differences between the maximum diameter and the renal medulla invasion or lobulation sign (P＜0.05).Conclusion The maximum diameter,medulla and lobular sign can predict the Fuhrman grading of ccRCC,and the maximum diameter prediction is the most accurate.
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Objective To investigate the application value of CT features of clear cell renal cell carcinoma (CCRCC) whose diameter ≥ 7 cm in predicting its Fuhrman grade.Methods 53 patients with CCRCC confirmed by surgery and pathology were analyzed retrospectively,including 19 patients regarded as a low-grade (Grade Ⅰ and Grade Ⅱ) group,and other 34 ones as a high-grade (Grade Ⅲ and Grade Ⅳ) group.The CT features including necrosis,renal sinus involvement,shape,renal vein invasion,lymphnode metastasis,pseudo-capsule,blood vessels around the tumor and the boundary between the tumor and the perirenal fat were analyzed,and the differences in those CT features between two groups were analyzed with chi-square or Fisher exact test.Results The incidence of fuzzy boundary between the tumor and the perirenal fat in the high-grade group was higher than that in the low-grade group (x2 =6.129,P =0.013),however,the differences of the rest CT features between two groups were not statistically significant (P＞0.05).When the fuzzy boundary was used to predict the high-grade CCRCC,the sensitivity,specificity and accuracy was 61.8 ％,73.7 ％ and 66.0 ％,respectively.Conclusion When the diameter of the tumor ≥7 cm,only the fuzzy boundary between the tumor and the perirenal fat has certain value in predicting high-grade CCRCC.
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Objective To evaluate the correlation of CT enhancement parameters with Fuhrman grade in T1 (≤7 cm) clear cell renal carcinoma(ccRCC).Methods From September 2011 to November 2017,102 post-operation cases in our hospital proven to be T1 ccRCC were retrospectively analyzed.There were 71 males and 31 females,with a mean age of (59.1 ± 12.7)years (26 ～79 years),mean body mass index(BMI) of (24.0 ± 2.8)kg/m2 (14.3 ～ 31.6 kg/m2).Tumors of 55 patients were in left kidneys,47 in right kidneys.Fuhrman grade 1 and 2 were defined as low-grade group,meanwhile high-grade group included grade 3 and 4.There were 46 males and 21 females in low-grade group,with a mean age of (59.0 ± 13.2) years,mean BMI of (24.0 ± 2.9) kg/m2.In high-grade group,there were 25 males and 10 females,with a mean age of (58.8 ± 11.8) years,mean BMI of (24.2 ± 2.7) kg/m2.The maximum diameter and tumor enhancement value (TEVX),relative enhancement value (REVX) were measured and calculated.In arterial phase,X =1;in venous phase X =2.The total consumption amount of iodine was recorded.Comparisons of maximum diameter,TEV1,TEV2,REV1,REV2 and the total consumption of iodine between the two different groups were performed.The ROC curves of TEV1,TEV2,REV1,and REV2 were drawn to predict the grade of tumors..Results The TEV1 [(146.1 ± 29.1) HU vs.(100.2 ± 32.1) HU],TEV2 [(98.2 ± 22.9) HU vs.(75.6 ± 25.7) HU],REV1 (1.12 ± 0.24 vs.0.70 ± 0.16),REV2(0.67 ± 0.17 vs.0.54 ± 0.18) between low-grade group and high-grade group had statistical difference (P ＜ 0.05).There was no significant difference in the maximum diameter[(41.8 ± 15.4)mm vs.(45.3 ± 17.0)mm] and the total consumption of iodine [(33.3 ± 5.0)g vs.(34.2 ± 4.4)g] between the two groups (P ＞ 0.05).The area under ROC curve of TEV1,TEV2,REV1 and REV2 were 0.856,0.755,0.901 and 0.728,respectively.REV1 had the highest distinguish efficiency and the best critical value was 0.93.Conclusions The enhancement parameters of T1 ccRCC could contribute to predicting the Fuhrman grade.When the REV1 ≤0.93,the tumor tended to be high-grade tumor(Fuhrman grade 3-4).
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Objective To investigate the correlation between pathological features of clear cell renal cell carcinoma(ccRCC) and Fuhrman classification with enhanced MDCT image findings.Methods CT findings and clinical data of 108 ccRCC patients confirmed by pathology were collected and the CT values of tumor parenchyma,ipsilateral renal cortex and aorta were measured and absolute and relative CT values of tumor parenchyma were calculated.According to the Fuhrman pathological classification,all cases were divided into low grade (Fuhrman Ⅰ-Ⅱ) and high-grade (Fuhrman Ⅲ-Ⅳ) groups and the CT findings included CT attenuation of four phases and the absolute and relative enhancement values were compared respectively.Results Low-grade tumors differed from high-grade tumors with lower attenuation on unenhanced CT scan,absolute enhancement values in three phases were higher,relative enhancement values were also higher in arterial and venous phases,the difference were statistically significant (P＜0.05).A1 (r =-0.311,P＜0.05) and the absolute enhancement in delay(r =-0.310,P＜0.05) and nephrographic phase(r =-0.304,P＜0.05) were negatively correlated to the Fuhrman grade,A 1 (AUC =0.707),C1 (AUC =0.705) and corticomedullary phase absolute enhancement (AUC =0.675) had the more larger AUCs.Conclusion The MDCT enhancement index of ccRCC is negatively correlated with pathological Fuhrman grading which is helpful to predict the grade of ccRCC before operation and has certain clinical values.
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Objective The aim of this study is to summarize the clinicopathologic characters and factors associated with prognosis of papillary renal cell carcinoma.Methods We treated 72 papillary renal cell carcinoma by surgery from August 2001 to February 2013,which account for 7.2％ of all renal cancer patients (72/1005 cases).There were 60 male and 12 female patients included in this study,with a median age of 50 (ranging from 21-75).The median tumor diameter was 5.8cm (ranging from 4 to 8cm).Fifth-two patients were asymptomatic,14 patients presented with hematuria and 6 presented with backache.In the 72 patients,63 received (87.5％) open surgery and 9 cases (12.5％) underwent laparoscopic surgery.Fortyeight patients (66.7％) were treated with radical nephrectomy and 24 patients (33.3％) were treated with partial nephrectomy.In the current study,we summarized the clinical and pathological records and follow-up data.Cox regression analysis were performed to identify the independent predictors for cancer specific survival.Results Local lymph nodes were involved in 16 cases and distal metastasis was found in 2 cases.There were 11 cases (15.3％) of type Ⅰ papillary renal cell carcinoma and 61 cases (84.7％)of type Ⅱ.All type Ⅰ cases were determined as Fuhrman grade Ⅰ and all type Ⅱ tumor were determined as Fuhrman grade Ⅱ-Ⅳ,including grade Ⅱ in 36 cases,grade Ⅲ in 15 cases and grade Ⅳ in 30 cases.With a median follow-up duration of 35 months (ranging from 7 to 146 months),10 patients died due to renal cancer,1 died due to heart failure and the rest 61 was alive.The cancer specific survival at five years for the whole group was 78.6％ (100.0％ in type Ⅰ and 75.5％ in type Ⅱ).The 5 year cancer specific survival rate for patients with Fuhrman grade Ⅰ-Ⅳ was 100.0％,83.5％,78.8％ and 31.3％,respectively.Cox regression analysis revealed that tumor diameter (hazard ratio 1.141,P =0.019) and Fuhrman grade (hazard ratio 3.034,P =0.004) were independent prognostic factors for cancer specific survival.Conclusions Type Ⅱ papillary renal cell carcinoma has more aggressive characters and poorer prognosis compared with type Ⅰ.Tumor diameter and Fuhrman grade were independent prognostic factors for cancer specific survival.
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Background and purpose:Renal cell carcinoma is the most common type of adult renal cancer, and the Fuhrman grading system is the most widely accepted independent indicator for the prognosis of kidney tumors. This study aimed to explore the correlation between the conventional diffusion weighted imaging (DWI) with various b values and Fuhrman grade of clear cell renal cancer, and assess the diagnostic efifciency of ADC values at different b values in differentiating Fuhrman low- and high-grade tumor. Methods:Thirty-three patients with pathologically proved clear cell renal cell cancer (CCRCC) and qualiifed images were included for the research. The diagnostic efif-ciency of ADC values at different b values for differentiating Fuhrman low-(1 and 2) and high-grade (3 and 4) tumor were also assessed and compared by receiver operator characteristic curve (ROC), and the optimum sensitivity, speciifc-ity and accuracy were selected using Youden index. Results:The 33 patients consist one tumor of Fuhrman grade 1, 14 of grade 2, 16 of grade 3 and 2 of grade 4. A negative correlation was found between the ADC0-800, ADC0-400-800, ADC0-600-1 200, ADC0-400-800-1 200 and ADCtotal with Fuhrman grade (r:-0.553,-0.511,-0.603,-0.645,-0.610, respectively), among these the ADC0-400-800-1200 showed the strongest correlation. The AUCs [area under the (receiver operator characteristic curve) ROC curve] of those parameters for differentiating the low-and high-grade tumor were 0.789, 0.757, 0.813, 0.844 and 0.835, among which the ADC0-400-800-1 200 reveal the best result, but the difference was not statistically signif-icant (P>0.05). The sensitivity of the ADC values were 86.7%, 73.3%, 60.0%, 86.7%and 86.7%;The speciifcity were 66.7%, 77.8, 72.2%, 77.8%and 72.2%. Conclusion:ADC0-800, ADC0-400-800, ADC0-600-1 200, ADC0-400-800-1 200 and ADCtotal re-vealed signiifcant correlation with the Fuhrman grade of clear cell renal cancer, and providing high diagnostic efifciency in differentiating Fuhrman low-and high-grade tumor.