Journal of Reconstructive Urology

.: ORIGINAL RESEARCH
Comparison of Three-dimensional Calculated Tumor Size, Radiologic Tumor Size, and Pathologic Tumor Size in Renal Cell Carcinoma
Renal Hücre Karsinomunda 3-D Yöntemle Hesaplanmış Tümör Boyutu, Radyolojik Tümör Boyutu ve Patolojik Tümör Boyutunun Karşılaştırılması
Sait ÖZBİRa, Hasan Anıl ATALAYa
aClinic of Urology, Okmeydanı Training and Research Hospital, İstanbul, TURKEY
J Reconstr Urol. 2019;9(2):39-44
doi: 10.5336/urology.2019-71141
Article Language: EN
Full Text
ABSTRACT
 Objective: The aim of the study was to investigate the correlation between tumor sizes of surgical specimens and tumor sizes obtained preoperatively by radiology and three-dimensional (3D) segmentation in our series. Material and Methods: All patients underwent an intravenous contrast-enhanced abdominal computed tomography (CT) within 4 weeks before surgery. The size of the tumor on CT was measured in coronal, sagittal and transverse axes. The radiologic tumor size (RTS) was defined as the largest of these three measurements. Tomography data were uploaded to 3D segmentation software (Dornheim Segmenter'). The largest diameter of the tumor was measured and defined as 3D-calculated tumor size (3DTS).The largest diameter of the tumor in the pathologic specimen was defined as the pathologic tumor size (PTS). Afterward, the mean measurements of RTS, PTS, and 3DTS were calculated and compared. Results: A total of 113 patients were included in the study. Mean age was 64.2±13.1 years. There were 61 (54%) men and 52 (46%) women. While 65 (57.5%) patients underwent radical nephrectomy (RN), 48 (42.5%) underwent partial nephrectomy (PN). The most common histology was clear cell 93 (82.3%) while the most common pathologic stage was T2a 40 (35.4%). The mean 3DTS was 7.5±3.2, the mean RTS was 7.1±3.1 cm and the mean PTS was 6.8±2.8 (p <0.001). Comparison of 3 DTS, PTS, and PTS according to the grade revealed that high-grade tumors seem to be larger than low-grade tumors with all of 3 measurement methods. Conclusion: Our study found that RTS was overestimated compared to PTS. Similarly, 3DTS of a tumor was overestimated compared to PTS. Additionally, we found that high-grade tumors were larger than low-grade tumors. Three-dimensional measurement of tumor size could be utilized preoperatively for assessment of tumor. However, it should be kept in mind that three-dimensional imaging modalities could overestimate the tumor size compared to pathologic specimens.

Keywords: Kidney; carcinoma, renal cell; imaging, three-dimensional; neoplasm staging
ÖZET
 Amaç: Çalışmamızın amacı, serimizdeki operasyon öncesi radyoloji ve 3 boyutlu (3D) segmentasyon analizi ile elde edilen tümör boyutlarını cerrahi örneklerden elde ile tümör boyutları ile karşılaştırmak idi. Gereç ve Yöntemler: Tüm hastalara ameliyattan önceki 4 hafta içinde intravenöz kontrastlı abdominal bilgisayarlı tomografi (BT) çekildi. Tomografide tümör boyutu koronal, sagital ve enine eksenlerde ölçüldü. Radyolojik tümör boyutu (RTS) bu üç ölçümün en büyüğü olarak tanımlandı. Tomografi verileri 3D segmentasyon yazılımına (Dornheim Segmenter') yüklendi. Tümörün en büyük çapı ölçüldü ve 3D- hesaplanmış tümör büyüklüğü (3DTS) olarak tanımlandı. Patolojik örnekteki tümörün en büyük çapı patolojik tümör büyüklüğü (PTS) olarak tanımlandı. Daha sonra, ortalama RTS, PTS ve 3DTS ölçümleri hesaplandı ve karşılaştırıldı. Bulgular: Toplamda 113 hasta bu çalışmaya dahil edildi. Yaş ortalaması 64.2±13.1 idi. Altmış bir (%54) erkek ve 52 (%46) kadın vardı. Bu hastalardan 65'ine (%57,5) radikal nefrektomi (RN), 48'ine (%42,5) parsiyel nefrektomi (PN) uygulandı. En sık görülen histoloji, berrak hücreli 93 (%82,3) iken, en yaygın patolojik evre T2a 40 (%35,4) idi. Ortalama 3DTS 7,5 ±3,2, ortalama RTS 7,1±3,1 cm ve ortalama PTS 6,8±2,8 idi (p <0,001). 3 DTS, PTS ve PTS' nin tümör derecesine göre karşılaştırıldığında, yüksek dereceli tümörlerin, üç ölçüm yönteminin hepsinde düşük dereceli tümörlerden daha büyük ölçülmesiyle sonuçlanmıştır. Sonuç: Çalışmamız RTS'nin PTS ile karşılaştırıldığında fazla hesaplandığını buldu. Benzer şekilde, bir tümörün 3DTS'si PTS'ye kıyasla fazla hesaplandı. Ek olarak, yüksek dereceli tümörlerin düşük dereceli tümörlerden daha büyük olduğunu bulduk. Tümörün değerlendirilmesinde preoperatif olarak tümör boyutunun üç boyutlu ölçümü kullanılabilir. Bununla birlikte, üç boyutlu görüntüleme yöntemlerinin, patolojik örneklerle karşılaştırıldığında tümör boyutunu abartabileceği akılda tutulmalıdır.

Anahtar Kelimeler: Böbrek; karsinom, renal hücreli; görüntüleme, üç-boyutlu; tümör evrelemesi
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