.: ORİJİNAL ARAŞTIRMA
The Relationship Between Hounsfield Unit Fuhrman Grades and Subtypes of Renal Cancers: Descriptive Research
Hounsfield Ünitesi Fuhrman Gradeleri ve Renal Kanserlerin Subtipleri Arasındaki İlişki: Tanımlayıcı Araştırma
J Reconstr Urol. 2023;13(3):81-7
doi: 10.5336/urology.2023-97574
Makale Dili: EN
Tam Metin
ABSTRACT
Objective: To determine whether predicting tumor pathology and Fuhrman grade with Hounsfield Unit (HU) increase in computed tomography (CT) is possible. Material and Methods: The study was based on a retrospective evaluation of 71 patients who underwent radical nephrectomy or nephron-sparing surgery due to kidney tumors between May 2013 and May 2016. The patients were divided into 2 groups based on the HU change in the unenhanced and contrastenhanced CT tumor images, namely the ''0-30 HU'' group and the ''>30 HU'' group. Pathological grading was performed in line with the 2010 American Joint Committee on Cancer TNM system, based on the phase of the tumor, size of the tumor, necrosis, and fat invasion. Results: Evaluation of the tumors'' histological type revealed that 31 (43.7%) patients had non-clear cell renal cell carcinoma (RCC), while 40 (56.3%) had clear cell RCC. Twenty-two (61.1%) of the 36 patients with a 0-30 increase in HU had non-clear cell RCC, while 14 (38.9%) had clear cell RCC. Of the 35 patients who had >30 HU increase following the administration of the contrast agent, 9 (25.7%) patients were diagnosed with non-clear cell RCC, versus 26 patients (74.3%) were diagnosed with clear cell RCC (p=0.003). Values above 30 HU, which were considered as the threshold value, pointed out to clear cell RCC with 88.4% sensitivity, 89.3% specificity. Conclusion: The study's results suggested that a HU value greater than 30 indicated Fuhrman Grade 2-4 pathology and a clear-cell RCC pathology in a ratio of approximately 3:4.
Keywords: Computed tomography; renal tumors; pathological conditions; signs and symptoms
Objective: To determine whether predicting tumor pathology and Fuhrman grade with Hounsfield Unit (HU) increase in computed tomography (CT) is possible. Material and Methods: The study was based on a retrospective evaluation of 71 patients who underwent radical nephrectomy or nephron-sparing surgery due to kidney tumors between May 2013 and May 2016. The patients were divided into 2 groups based on the HU change in the unenhanced and contrastenhanced CT tumor images, namely the ''0-30 HU'' group and the ''>30 HU'' group. Pathological grading was performed in line with the 2010 American Joint Committee on Cancer TNM system, based on the phase of the tumor, size of the tumor, necrosis, and fat invasion. Results: Evaluation of the tumors'' histological type revealed that 31 (43.7%) patients had non-clear cell renal cell carcinoma (RCC), while 40 (56.3%) had clear cell RCC. Twenty-two (61.1%) of the 36 patients with a 0-30 increase in HU had non-clear cell RCC, while 14 (38.9%) had clear cell RCC. Of the 35 patients who had >30 HU increase following the administration of the contrast agent, 9 (25.7%) patients were diagnosed with non-clear cell RCC, versus 26 patients (74.3%) were diagnosed with clear cell RCC (p=0.003). Values above 30 HU, which were considered as the threshold value, pointed out to clear cell RCC with 88.4% sensitivity, 89.3% specificity. Conclusion: The study's results suggested that a HU value greater than 30 indicated Fuhrman Grade 2-4 pathology and a clear-cell RCC pathology in a ratio of approximately 3:4.
Keywords: Computed tomography; renal tumors; pathological conditions; signs and symptoms
ÖZET
Amaç: Bu çalışmanın amacı, bilgisayarlı tomografide (BT) Hounsfield Ünitesi (HU) artışı ile tümör patolojisini ve Fuhrman derecesini öngörmenin mümkün olup olmadığını belirlemektir. Gereç ve Yöntemler: Çalışma, Mayıs 2013 ile Mayıs 2016 tarihleri arasında böbrek tümörü nedeniyle radikal nefrektomi veya nefron koruyucu cerrahi uygulanan 71 hastanın retrospektif olarak değerlendirilmesine dayanmaktadır. Hastalar, kontrastsız ve kontrastlı BT tümör görüntülerindeki HU değişimine göre ''0-30 HU'' grubu ve ''>30HU'' grubu olmak üzere 2 gruba ayrılmıştır. Patolojik derecelendirme, 2010 Amerikan Kanser Ortak Komitesi TNM sistemi ile uyumlu olarak, tümörün fazı, tümörün boyutu, nekroz ve yağ invazyonu temelinde yapıldı. Bulgular: Tümörlerin histolojik tipi değerlendirildiğinde, 31 (%43,7) hastada berrak hücreli olmayan renal hücreli karsinom (RHK), 40 (%56,3) hastada ise berrak hücreli RHK olduğu görüldü. HU'da 0-30 artış olan 36 hastanın 22'sinde (%61,1) berrak hücreli olmayan RHK, 14'ünde (%38,9) berrak hücreli RHK vardı. Kontrast madde verilmesini takiben >30HU artışı olan 35 hastadan 9'na (%25,7) berrak hücreli olmayan RHK tanısı konurken, 26 hastaya (%74,3) berrak hücreli RHK tanısı konmuştur (p=0,003). Eşik değer olarak kabul edilen 30 HU üzerindeki değerler %88,4 duyarlılık, %89,3 özgüllük ile berrak hücreli RHK'ye işaret etmiştir. Sonuç: Çalışmanın sonuçları, 30'dan büyük HU değerinin yaklaşık 3:4 oranında Fuhrman Grade 2-4 patolojisine ve berrak hücreli RHK patolojisine işaret ettiğini göstermiştir.
Anahtar Kelimeler: Bilgisayarlı tomografi; böbrek tümörleri; patolojik durumlar; belirti ve semptomlar
Amaç: Bu çalışmanın amacı, bilgisayarlı tomografide (BT) Hounsfield Ünitesi (HU) artışı ile tümör patolojisini ve Fuhrman derecesini öngörmenin mümkün olup olmadığını belirlemektir. Gereç ve Yöntemler: Çalışma, Mayıs 2013 ile Mayıs 2016 tarihleri arasında böbrek tümörü nedeniyle radikal nefrektomi veya nefron koruyucu cerrahi uygulanan 71 hastanın retrospektif olarak değerlendirilmesine dayanmaktadır. Hastalar, kontrastsız ve kontrastlı BT tümör görüntülerindeki HU değişimine göre ''0-30 HU'' grubu ve ''>30HU'' grubu olmak üzere 2 gruba ayrılmıştır. Patolojik derecelendirme, 2010 Amerikan Kanser Ortak Komitesi TNM sistemi ile uyumlu olarak, tümörün fazı, tümörün boyutu, nekroz ve yağ invazyonu temelinde yapıldı. Bulgular: Tümörlerin histolojik tipi değerlendirildiğinde, 31 (%43,7) hastada berrak hücreli olmayan renal hücreli karsinom (RHK), 40 (%56,3) hastada ise berrak hücreli RHK olduğu görüldü. HU'da 0-30 artış olan 36 hastanın 22'sinde (%61,1) berrak hücreli olmayan RHK, 14'ünde (%38,9) berrak hücreli RHK vardı. Kontrast madde verilmesini takiben >30HU artışı olan 35 hastadan 9'na (%25,7) berrak hücreli olmayan RHK tanısı konurken, 26 hastaya (%74,3) berrak hücreli RHK tanısı konmuştur (p=0,003). Eşik değer olarak kabul edilen 30 HU üzerindeki değerler %88,4 duyarlılık, %89,3 özgüllük ile berrak hücreli RHK'ye işaret etmiştir. Sonuç: Çalışmanın sonuçları, 30'dan büyük HU değerinin yaklaşık 3:4 oranında Fuhrman Grade 2-4 patolojisine ve berrak hücreli RHK patolojisine işaret ettiğini göstermiştir.
Anahtar Kelimeler: Bilgisayarlı tomografi; böbrek tümörleri; patolojik durumlar; belirti ve semptomlar
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