MRI as a tool to assess surgical margins and pseudocapsule features directly following partial nephrectomy for small renal masses

Abstract

Purpose To evaluate the feasibility of ex vivo 7T MRI to assess surgical margins (SMs) and pseudocapsule (PC) features after partial nephrectomy (PN). Materials and methods In this prospective, IRB-approved study, seven patients undergoing a PN for nine tumours between November 2014 and July 2015 were included for analysis after obtaining informed consent. MRI of the specimen was acquired using a 7T small bore scanner. The imaging protocol consisted of anatomical T1-, T2-and diffusion-weighted imaging. After formalin fixation, specimens were cut for pathology work-up in the same orientation as the MR images were obtained. The entire specimen was processed into H&E slides that were digitally scanned, annotated and correlated with radiological findings for negative SMs, PC presence, PC continuity and extra-PC-extension (EPCE). Sensitivity and specificity of MRI for assessment of these endpoints were calculated. Results The sensitivity and specificity for assessment of the SM were 100% and 75%, respectively. Two falsepositive outcomes were reported, both in case of EPCE and a SM ≤0.5 mm. For the presence of a PC, sensitivity and specificity were 100% and 33%, respectively. Two false-positive scans with anatomical structures mimicking the presence of a PC occurred. If a PC was present, continuity and EPCE were assessed with a sensitivity and specificity of 75% and 100% and 67% and 100%, respectively. Conclusion Ex vivo 7T MRI is a feasible tool for perioperative evaluation of SMs, and if present, PC features after PN. This may facilitate maximal sparing of renal parenchyma without compromising oncological outcomes. Key Points • Ex vivo MRI may contribute to improvement of negative surgical margins during partial nephrectomy.• Due to the assessment of surgical margins within a limited time span from obtaining the partial nephrectomy specimen, surgery for more complex tumours is possible with maximum sparing of healthy renal parenchyma without compromising oncological outcomes.• The intra operative assessment of pseudocapsule continuity along the resection margin enables maximal sparing of healthy renal parenchyma without delayed diagnosis of incomplete resection.

The independent indicators for differentiating renal cell carcinoma from renal angiomyolipoma by contrast-enhanced ultrasound

“…The perilesional rim-like enhancement was observed in 76.7% (115/150) of RCCs, which was similar to the figures reported by Xu et al [11] and Van et al [22]. The presence of perilesional rim-like enhancement was regarded as an important predictor of RCC.…”

The independent indicators for differentiating renal cell carcinoma from renal angiomyolipoma by contrast-enhanced ultrasound

“…And in this study, CEUS showed that more percentage of perilesional rim-like enhancement was observed in RCC than in AML (p = 0.000). The perilesional rim-like enhancement was observed in 76.7% (115/150) of RCCs, which was similar to the figures reported by Xu et al [11] and Van et al [22]. The presence of perilesional rim-like enhancement was regarded as an important predictor of RCC.…”

The independent indicators of contrast-enhanced ultrasound for predicting renal cell carcinoma

“…The perilesional rim-like enhancement was observed in 76.7% (115/150) of RCCs, which was similar to the figures reported by Xu et al [11] and Van et al [22]. The presence of perilesional rim-like enhancement was regard as an important predictor of RCC.…”