Possibilities of Ultrasound in Diagnosis of Kidney Cancer at the Stage of Surgery

Abstract

Despite the availability of a large number of state programs for the re-equipment of state medical institutions, ultrasonic research, due to the relative simplicity of the organization of the research process and the decisiveness, still remains relevant for the examination of patients and, in particular, kidney cancer. In recent years, a number of new ultrasound techniques have emerged – three-dimensional reconstruction of ultrasound imaging, tissue harmonic technology and echocontrast with intravenous contrast agents. Due to the continuous improvement of the capabilities of ultrasound scanners and ultrasound imaging techniques, a review of the significance of ultrasound in the diagnosis and differential diagnosis of renal cell carcinoma (RCC).The purpose:to evaluate the diagnostic possibilities of ultrasound in patients with kidney tumors at the preoperative stage.Materials and methods.136 patients with kidney tumors aged 21 to 73 years were examined and treated in A.V. Vishnevsky Institute of Surgery in the period from 2012 to 2017. The study slightly dominated by men – 65.4%. All patients underwent a complex clinical and laboratory examination, which included the analysis of complaints, data of anamnesis, clinical examination, laboratory data, as well as a wide range of instrumental studies (ultrasound, MSCT and MRI). Each of the study methods was evaluated according to three criteria (localization, prevalence, presence of vein thrombosis), which are key to assessing the feasibility of surgical intervention and subsequent tactics of surgery. Evaluation of the informative value of each of the radiation methods of the study (ultrasound, MSCT, MRI) was carried out on the basis of the following criteria: sensitivity, specificity and overall accuracy of the method. All patients underwent surgical operations in various volumes, the formations were morphologically verified as RCC. As a “control” for each of the parameters used the protocol of subsequent surgery. The effectiveness of ultrasound is significantly comparable with CT and MRI in assessing such preoperative parameters as tumor localization in the kidney, the prevalence of the pathological process and thrombosis of the inferior vena cava and the main trunk of the renal vein. In the evaluation of thrombosis of segmental renal veins, ultrasound is also comparable to other methods of investigation, but these data can not be considered statistically reliable (due to the small number of observations) and their confirmation requires further study. Conclusion.In the conditions of a specialized surgical hospital focused on the diagnosis and treatment of kidney cancer, ultrasound can be comparable to CT and MRI in its effectiveness, providing the surgeon with pre-operative information sufficient for planning surgical intervention.

Analysis of the Intraoperative Ultrasound Results in the Surgical Treatment of Renal Tumors

“…При невозможности точно оценить границы образования при трансабдоминальном УЗИ, а также при наличии трудностей диагностики метастатического поражения надпочечников, забрюшинных лимфоузлов и контралатеральной почки важную роль играет применение интраоперационного УЗИ (ИОУЗИ) [10,11]. Использование этого метода позволяет получить ответы на вопросы, актуальные при дооперационной диагностике, а ИОУЗИ дает возможность выявлять небольшие, непальпируемые при интраоперационной ревизии опухоли, а также уточнять особенности взаимосвязи новообразования с чашечно-лоханочной системой, капсулой почки, а при больших опухолях -оценивать их распространение на паранефральную клетчатку, окружающие органы и ткани, исследовать забрюшинные лимфатические узлы и печень для выявления отдаленного метастазирования [11,12]. В то же время следует отметить, что сообщения о возможности применения ИОУЗИ у больных при опухолях почки единичны, в доступной литературе практически отсутствуют работы, посвященные изучению диагностической эффективности этого метода, не приводятся данные сравнительного анализа дооперационного и интраоперационного УЗИ.…”