Magnetna rezonancija tehnikom „zadržavanja daha“ u dijagnostici i preoperativnoj procjeni proširenosti malignih tumora bubrega [Magnetic resonance imaging in diagnosis and preoperative staging of renal cell carcinoma using “breath-hold” technique]

Abstract

Renal cell carcinoma is the most common primary malignant neoplasm of the kidney and accounts for 2-3% of all cancer diagnosed. Its incidence is constantly increasing over the last three decades. The aim of this study was to assess the sensitivity, specificity, accuracy, positive and negative and positive predictive value of MRI in diagnosis and preoperative staging of renal cell carcinoma using the 2002 TNM staging system, with pathological staging as the gold standard. Fifty-five patients, mean age 56.3 years, with 64 renal tumors underwent MRI for diagnosis and preoperative staging. MRI detected 51 solid and 7 cystic renal tumors, 3 complex cysts, 3 doubtful findings. MRI tumor mean size was 45.7 mm. MRI staged 53 tumors as T1, 5 as T2, and 6 as T3 stage: (3/6 T3a, 3/6 T3b). Sixty-two tumors were staged N0, two were staged N2. 1/64 was staged M1 (distant liver metastases), 63/64 were staged M0. Pathological findings revealed 6 benign and 58 malignant renal tumors. Pathologic tumor mean size was 43.7 mm. Pathologist staged 51 tumors as T1, 3 as T2, 4 tumors as T3 stage. One tumor was staged N2 and one was staged M1, all the rest were staged N0 and M0. In our study most of the patients were staged T1N0M0 by MRI and pathological findings, and kappa test revealed excellent agreement between all three classes of the TNM staging system. Sensitivity of the MRI in preoperative staging of renal cell carcinoma is 93.1%, specificity is 100%, accuracy is 93.7%, positive predictive value is 100%, negative predictive value is 60%. In conclusion, the role of MRI in renal imaging has changed over time and it has become an important modality for evaluating renal masses and for staging patients with RCC