Early detection of renal cell carcinoma by ultrasonographic screening—based on the results of 13 years screening in Japan

Mihara, Shuichi; Kuroda, Keiichiro; Yoshioka, Ritsuko; Koyama, Wasaku

doi:10.1016/s0301-5629(99)00070-8

Cited by 55 publications

(41 citation statements)

References 7 publications

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“…On conventional ultrasonography, RCCs and RAMLs with a maximum diameter of 5 cm were not clearly distinguishable by their echogenicity. There was a high percentage (50%) of hyperechoic tumors in incidentally discovered small RCCs in our study, a proportion similar to that reported by Mihara et al 15 In contrast to previous reports, 16,17 we found that a hypoechoic rim was not a special feature of RCCs with a maximum diameter of 5 cm, nor was the color Doppler vessel pattern of SRPLs with a maximum diameter of 5 cm a valuable criterion, both showing the difficulty in differentially diagnosing small solid RCCs and RAMLs by conventional ultrasonography. However, after UCA injection, we found a significant difference in the enhancement patterns and amounts between RCCs and RAMLs with a maximum diameter of 5 cm.…”

Section: Discussionsupporting

confidence: 91%

Diagnostic Efficacy of Contrast-Enhanced Ultrasonography in Solid Renal Parenchymal Lesions With Maximum Diameters of 5 cm

Fan

Xing

et al. 2008

Journal of Ultrasound in Medicine

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Objective. The purpose of this study was to evaluate the diagnostic efficacy of contrast-enhanced ultrasonography (CEUS) using a sulfur hexafluoride contrast agent and the cadence contrast pulse sequencing mode in differentiating solid renal parenchymal lesions (SRPLs) with a maximum diameter of 5 cm. Methods. Seventy-one patients with 72 SRPLs with a maximum diameter of 5 cm underwent conventional ultrasonographic and CEUS examinations in our department. The final diagnoses were 44 renal cell carcinomas (RCCs; confirmed by pathologic examination), 24 renal angiomyolipomas (4 by pathologic examination and 20 by computed tomography, magnetic resonance imaging, and follow-up studies), 1 oncocytoma (by pathologic examination), 2 hypertrophied columns of Bertin, and 1 renal abscess (both by computed tomography, magnetic resonance imaging, and follow-up studies). Three observers who were blinded to other results and the final diagnoses reviewed the conventional ultrasonographic and CEUS images. Results. Hyperenhancement in the late phase (30-90 seconds after agent injection) was the most important finding for predicting SRPLs with a maximum diameter of 5 cm to be RCCs. With this criterion, the specificity and sensitivity for diagnosing solid RCCs (≤5 cm) were 96.4% and 77.3%, respectively. Heterogeneous enhancement was another valuable finding suggestive of RCCs. Most renal angiomyolipomas were homogeneously enhanced with hypoenhancement in the arterial and late phases. Hypertrophied columns of Bertin could be reliably differentiated on CEUS; however, there was an overlap of CEUS appearances between some benign lesions and hypovascular RCCs. Conclusions. Contrast-enhanced ultrasonography could be an effective and necessary examination for differentially diagnosing SRPLs with a maximum diameter of 5 cm. Key words: clear cell carcinoma; contrast agent; contrast-enhanced ultrasonography; renal cell carcinoma; small lesions. People's Hospital, 85 Wu Jin Rd, 200080 Shanghai, China. E-mail: du_lf@163.com Abbreviations ACQ, autotracking contrast quantification; CECT, contrast-enhanced computed tomography; CPS, contrast pulse sequencing; CT, computed tomography; ΔI 45-55 , change in intensity at 45 to 55 seconds; ΔI TTP , change in intensity at the time to peak; HC, hypertrophied column; HU, Hounsfield unit; MRI, magnetic resonance imaging; RAML, renal angiomyolipoma; RCC, renal cell carcinoma; ROI, region of interest; SE, spin echo; SRPL, solid renal parenchymal lesion; TTP, time to peak; UCA, ultrasonographic contrast agent ith the widespread use of conventional ultrasonography for medical examinations, the incidental detection rate of renal lesions has increased greatly. Most incidentally detected renal lesions are smaller than 5 cm. Conventional ultrasonography has low efficacy for diagnosing small solid renal parenchymal lesions (SRPLs) because of the overlap of gray scale ultrasonographic representations, which are reflections of different portions of intratumoral tissue components.1 Color or power Doppler ultras...

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Section: Discussionsupporting

confidence: 91%

Diagnostic Efficacy of Contrast-Enhanced Ultrasonography in Solid Renal Parenchymal Lesions With Maximum Diameters of 5 cm

Fan

Xing

et al. 2008

Journal of Ultrasound in Medicine

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“…Mihara et al screened 219,640 asymptomatic Japanese individuals selected from the general population (age range 29–70 years) over a 13-year period [60]. RCC was detected in 192 cases: 37.8% of detected tumours were < 25 mm in size and only 19.2% of tumours were > 51 mm.…”

Section: Resultsmentioning

confidence: 99%

Epidemiology and screening for renal cancer

et al. 2018

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PurposeThe widespread use of abdominal imaging has affected the epidemiology of renal cell carcinoma (RCC). Despite this, over 25% of individuals with RCC have evidence of metastases at presentation. Screening for RCC has the potential to downstage the disease.MethodsWe performed a literature review on the epidemiology of RCC and evidence base regarding screening. Furthermore, contemporary RCC epidemiology data was obtained for the United Kingdom and trends in age-standardised rates of incidence and mortality were analysed by annual percentage change statistics and joinpoint regression.ResultsThe incidence of RCC in the UK increased by 3.1% annually from 1993 through 2014. Urinary dipstick is an inadequate screening tool due to low sensitivity and specificity. It is unlikely that CT would be recommended for population screening due to cost, radiation dose and increased potential for other incidental findings. Screening ultrasound has a sensitivity and specificity of 82–83% and 98–99%, respectively; however, accuracy is dependent on tumour size. No clinically validated urinary nor serum biomarkers have been identified. Major barriers to population screening include the relatively low prevalence of the disease, the potential for false positives and over-diagnosis of slow-growing RCCs. Individual patient risk-stratification based on a combination of risk factors may improve screening efficiency and minimise harms by identifying a group at high risk of RCC.ConclusionThe incidence of RCC is increasing. The optimal screening modality and target population remain to be elucidated. An analysis of the benefits and harms of screening for patients and society is warranted.Electronic supplementary materialThe online version of this article (10.1007/s00345-018-2286-7) contains supplementary material, which is available to authorized users.

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“…In this series the prevalence of microhaematuria was significantly lower in patients with tumours found incidentally (39%) than in those presenting with classic symptoms (69%). In large ultrasound screening studies, no abnormalities were found by urine analyses of patients with tumours 18. In summary, only tumours of the bladder present with microhaematuria to an extent that it can be considered to be an early sign of the disease.…”

Section: Diagnostic Value For Diseases Of the Kidney And Lower Urinarmentioning

confidence: 85%

Time to abandon testing for microscopic haematuria in adults?

Malmström

2003

BMJ

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Early detection of renal cell carcinoma by ultrasonographic screening—based on the results of 13 years screening in Japan

Cited by 55 publications

References 7 publications

Diagnostic Efficacy of Contrast-Enhanced Ultrasonography in Solid Renal Parenchymal Lesions With Maximum Diameters of 5 cm

Diagnostic Efficacy of Contrast-Enhanced Ultrasonography in Solid Renal Parenchymal Lesions With Maximum Diameters of 5 cm

Epidemiology and screening for renal cancer

Time to abandon testing for microscopic haematuria in adults?

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