Original Research

Correlation between radiological and histopathological findings in patients undergoing nephrectomy for presumed renal cell carcinoma on computed tomography scan at Grey’s Hospital

Nompumelelo E. Mlambo, Nondumiso N.M. Dlamini, Ronald J. Urry
South African Journal of Radiology | Vol 22, No 1 | a1339 | DOI: https://doi.org/10.4102/sajr.v22i1.1339 | © 2018 Nompumelelo E. Mlambo, Nondumiso N.M. Dlamini, Ronald J. Urry | This work is licensed under CC Attribution 4.0
Submitted: 06 March 2018 | Published: 10 October 2018

About the author(s)

Nompumelelo E. Mlambo, Department of Radiology, College of Health Sciences, University of KwaZulu-Natal, South Africa
Nondumiso N.M. Dlamini, Department of Radiology, College of Health Sciences, University of KwaZulu-Natal, South Africa
Ronald J. Urry, Department of Urology, College of Health Sciences, University of KwaZulu-Natal, South Africa


Share this article

Bookmark and Share

Abstract

Background: The incidence of renal cell carcinoma (RCC) is increasing globally owing to the increased use of cross-sectional imaging. Computed tomography (CT) scan is the modality of choice in the diagnosis and pre-operative assessment of RCC. Nephrectomy is the standard treatment for RCC and pre-surgery biopsy is not routinely practised. The accuracy of CT diagnosis and staging in a South African population has not been established.

Objectives: To determine the accuracy of CT scan in the diagnosis and pre-operative staging of RCC at Grey’s Hospital.

Methods: A retrospective chart review was performed; CT scan reports and histopathological results of adult patients who underwent nephrectomy for presumed RCC on CT scan between January 2010 and December 2016 were compared.

Results: Fifty patients met the inclusion criteria for the study. CT significantly overestimated the size of renal masses by 0.7 cm (p = 0.045) on average. The positive predictive value of CT for RCC was 81%. Cystic tumours and those 4 cm and smaller were more likely to be benign. CT demonstrated good specificity for extra-renal extension, vascular invasion and lymph node involvement, but poor sensitivity.

Conclusion: In our South African study population, CT is accurate at diagnosing RCC, but false-positives do occur. Non-enhancing or poorly enhancing, cystic, fat-containing and small lesions (4 cm or smaller) are more likely to be benign and ultrasound-guided biopsy should be considered to avoid unnecessary surgery. CT assessment of extra-renal extension and vascular invasion is challenging and additional imaging modalities such as magnetic resonance imaging (MRI) venogram, duplex Doppler ultrasound or Positron emission tomography–computed tomography (PET/CT) may be beneficial.


Keywords

renal cell carcinoma; post nephrectomy; CT scan accuracy; histology correlation; CT staging

Metrics

Total abstract views: 152
Total article views: 595


Crossref Citations

No related citations found.