CT Appearance Following Partial Nephrectomy for Renal Cell Carcinoma Using Tissue Adhesive Bioglue

Abstract

<p class="MsoNormal"> <b><span lang="EN-US">Background: </span></b><span lang="EN-US">The use of biological sealants has greatly increased during nephron sparing surgery. In many cases the bulk of the material was erroneously mistaken for tumor recurrence.</span><span lang="EN-US"> </span><b><span lang="EN-US">Objective</span></b><b><span lang="EN-US">:</span></b><span lang="EN-US"> To describe the characteristic appearance of biological adhesive material used for tumor bed closure on computerized tomography (CT) following nephrone sparing surgery (NSS) for renal cell carcinoma, in order to differentiate between typical features of the adhesive material and local tumor recurrence.</span><span lang="EN-US"> </span><b><span lang="EN-US">Design, Setting and Participants:</span></b><span lang="EN-US"> We retrospectively reviewed follow</span><span lang="EN-US">-</span><span lang="EN-US">up CT scans of 120 patients who underwent NSS for T1N<st1:chmetcnv tcsc="0" numbertype="1" negative="False" hasspace="False" sourcevalue="0" unitname="m" w:st="on">0M</st1:chmetcnv>0 RCC. In all cases tumor bed was closed during surgery with biological tissue adhesive (BioGlue). <b>Results and Limitations:</b> During 1994-2009</span><span lang="EN-US">,</span><span lang="EN-US"> 120 patients with a single T1 renal cell carcinoma lesion, underwent NSS with closure of tumor bed with bio adhesive material. There were 66 males and 47 females with mean age of 58.7 years (median: 58 years, range: 28</span><span lang="EN-US"> - </span><span lang="EN-US">85 years). Mean follow</span><span lang="EN-US">-</span><span lang="EN-US">up time was 45</span><span lang="EN-US"> </span><span lang="EN-US">±</span><span lang="EN-US"> </span><span lang="EN-US">34 months (median 42, range 12</span><span lang="EN-US"> </span><span lang="EN-US">-</span><span lang="EN-US"> </span><span lang="EN-US">168). During follow</span><span lang="EN-US">-</span><span lang="EN-US">up, 3 patients had local recurrence at the site of previous enucleated lesion. In the first post-operative CT scan the BG appeared as a heterogeneous mass with sharp edges measuring 20</span><span lang="EN-US"> </span><span lang="EN-US">-</span><span lang="EN-US"> </span><span lang="EN-US">70 HU with no attenuation following the injection of contrast material. In subsequent follow-up scans the BG in most patients remained stable in size; in few patients slight reduction in size was observed probably due to the resolution of post-operative hematoma. Tumor recurrence that was documented in 3 patients was seen as a heterogeneous mass with attenuation of more than 20 HU following the injection of contrast material. In sequential CT</span><span lang="EN-US">’</span><span lang="EN-US">s the mass was increasing in size.</span><span lang="EN-US"> </span><b><span lang="EN-US">Conclusions: </span></b><span lang="EN-US">BG appears as a non-enhancing stable mass in sequential CT</span><span lang="EN-US">’</span><span lang="EN-US">s following NSS, hence could be differentiated from local tumor recurrence. Th...