Ipsilateral adrenal involvement from renal cell carcinoma: retrospective study of the predictive value of computed tomography

Sawai, Yugo; Kinouchi, Toshiaki; Mano, Masayuki; Meguro, Norio; Maeda, Osamu; Kuroda, Masao; Usami, Michiyuki

doi:10.1016/s0090-4295(01)01480-7

Cited by 29 publications

(16 citation statements)

References 10 publications

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“…This experience stressed the importance of an accurate preoperative diagnosis with imaging techniques. Our results are similar to those from the literature (table 4), with a high (99.4%) negative predictive value and a lower (34.7%) positive predictive value, probably because of an overestimation of abnormal findings in reading CT scans as reported by Sawai et al [28]. In only 1 case was the CT considered normal, but the histological examination revealed an adrenal micrometastasis.…”

Section: Discussionsupporting

confidence: 91%

“…In contrast, the positive predictive value was found to be lower at 92.8%. An even lower positive predictive value (11%) was noted more recently by Sawai et al [28]. The wide range of findings from different series depend above all on how the CT scan was read.…”

Section: Discussionmentioning

confidence: 84%

“…In the description by Robson et al [1] in 1969, this procedure was recommended because of its relative sim- [13] 225 3 (1.9%) Abnormal CT; advanced, large, upper pole tumors Wunderlich et al [17] 639 9 (1.4%) Abnormal CT; macroscopically abnormal adrenals Tsui et al [23] 511 29 (5.7%) Risk factors (high stage, upper pole, multifocality, renal vein thrombus) von Knobloch et al [20] 589 19 (3.2%) All cases Kozak et al [8] 225 8 (3.5%) Abnormal CT; clear parenchymal margin of 1 cm Shalev et al [3] 285 11 (3.8%) Intraoperative suspicion Winter et al [14] 138 8 (5.8%) All cases Gill et al [27] 157 10 (6.4%) Abnormal CT Li et al [19] 129 9 (6.9%) 1 5 cm tumors Sawai et al [28] 73 2 (2.7%) Large tumors Paul et al [18] 866 27 (3.1%) Abnormal CT; 1 6 cm Kuczyk et al [22] 819 27 (3.3%) Abnormal CT; macroscopically abnormal adrenals plicity and adherence to the surgical oncology principle of a wide margin beyond the malignancy. Malignant involvement of the ipsilateral adrenal gland is noted in 1.2-10% of radical nephrectomy specimens at diagnosis [2] and 7-23% of disseminated renal cell carcinoma (RCC) cases at autopsy [3].…”

Section: Introductionmentioning

confidence: 99%

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Adrenalectomy: Defining Its Role in the Surgical Treatment of Renal Cell Carcinoma

Sio

Autorino²,

Lorenzo³

et al. 2003

Urol Int

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Objectives: With the recent widespread use of modern imaging techniques, the frequency of small low-stage renal cell carcinomas (RCC) has grown considerably, giving rise to more conservative surgical approaches. We evaluated the characteristics of adrenal involvement and the accuracy of computerized tomography (CT) in the diagnosis of RCC, defining the real need for adrenalectomy during surgical treatment. Methods: The medical records of 201 patients undergoing radical nephrectomy and ipsilateral adrenalectomy for localized or advanced RCC, from 1996 to 2002, were analyzed, retrospectively. We considered 76 with stage T1–2 disease and 125 with T3–4N0–1M0–1 disease. In all cases a blinded review of the preoperative abdominal CT was performed. Histopathology records of the surgical specimens were examined to determine the accuracy of the CT in identifying adrenal involvement by RCC. Results: The overall incidence of adrenal metastasis was 4.4%. The mean renal tumor size in patients with adrenal involvement was 7.8 cm. The tumor stage correlated with a probability of adrenal spread (p < 0.05), with T1–2 tumors accounting for 1.3% of cases only. The adrenal gland was diagnosed as abnormal on preoperative CT in 21 patients (10.4%). CT scan demonstrated 88.8% sensitivity, 92.1% specificity, 99.4% negative predictive value and 34.7% positive predictive value for adrenal involvement by RCC. Conclusions: Adrenal involvement is not likely in patients with localized early stage RCC and adrenalectomy can be omitted in such cases, particularly when CT is negative. However, in selected patients with large high-risk tumors, radical nephrectomy, including removal of the ipsilateral adrenal gland, should be performed.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 84%

Section: Introductionmentioning

confidence: 99%

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Adrenalectomy: Defining Its Role in the Surgical Treatment of Renal Cell Carcinoma

Sio

Autorino²,

Lorenzo³

et al. 2003

Urol Int

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“…The detection of a normal adrenal gland at MDCT in patients with RCC has been associated with 100% negative predictive value for metastasis [90,91] .…”

Section: Stagingmentioning

confidence: 99%

Imaging of Renal Cell Carcinoma: State of the Art and Recent Advances

Sacco¹,

Pinto²,

Totaro³

et al. 2010

Urol Int

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Background and Aim: Renal cell carcinoma (RCC) is the 13th most common cancer worldwide and accounts for 4% of all adult malignancies. Herein the state of the art and recent advances in cross-sectional radiological imaging applied to RCC are reviewed, including ultrasonography, computed tomography, magnetic resonance imaging, and positron emission tomography. Methods: Literature search of peer-reviewed papers published by October 2010. Results: In front of more conventional and widespread imaging tools, such as ultrasonography and computed tomography, an array of newer and attractive radiological modalities are under investigation and show promise to improve our ability to noninvasively detect renal tumors and its recurrences, accurately assess the extent of the disease, and reliably evaluate treatment response, particularly in the era of antiangiogenetic therapy. Conclusions: Recent major advances in radiological imaging techniques have considerably improved our ability to diagnose, stage and follow-up RCC. Further studies are needed to evaluate the potential of most recent and still investigational imaging tools.

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“…8). Für den Ausschluss eines Befalls der ipsilateralen Nebenniere bietet die CT ebenfalls eine hohe Aussagekraft [5]. Ist eine organerhaltende Operation geplant, muss eine mögliche Infiltration der Strukturen des Sinus renalis ausgeschlossen werden.Dies gelingt weitgehend mit den genannten Methoden der CT, wobei allerdings aufgrund der letztendlich doch begrenzten Ortsauflösung in einigen Fällen eine Infiltration des Nierenbeckenkelchsystems und der intrarenalen Gefäße übersehen werden kann [3].…”

Section: Staging Des Nierenzellkarzinomsunclassified

Moderne Bildgebung bei Nierenerkrankungen: CT und MRT

2003

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Considerable technical advances have been made in computed tomography (CT) and magnetic resonance imaging (MRI) over the last 10 years. Both modalities allow for high-resolution imaging of the entire abdomen before as well as during the arterial and parenchymal perfusion phase after intravenous contrast medium administration. Multiplanar reconstructions of the three-dimensional source data sets yield views in any spatial orientation. Maximum intensity projections enable the generation of CT or MR angiographies as well as CT or MR urographies from delayed images. Thus, both modalities today allow for comprehensive diagnostic evaluation of renal disease by a single examination comprising detailed visualization of the parenchyma as well as of arterial and venous vessels and assessment of excretion. CT and MRI thus enable efficient preoperative diagnostic assessment in particular in patients with renal masses.

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Ipsilateral adrenal involvement from renal cell carcinoma: retrospective study of the predictive value of computed tomography

Cited by 29 publications

References 10 publications

Adrenalectomy: Defining Its Role in the Surgical Treatment of Renal Cell Carcinoma

Adrenalectomy: Defining Its Role in the Surgical Treatment of Renal Cell Carcinoma

Imaging of Renal Cell Carcinoma: State of the Art and Recent Advances

Moderne Bildgebung bei Nierenerkrankungen: CT und MRT

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