Open Access

ARTICLE

Utility of ultrasonography in preoperative assessment of tumor thrombi in kidney cancer

Reza Nabavizadeh^1,*, Grace Lee^1,*, Katherine Bobrek¹, Dattatraya Patil¹, Mehrdad Alemozaffar², Courtney Moreno³, Viraj A. Master^1,4

1 Department of Urology, Emory University School of Medicine, Atlanta, Georgia, USA
2 Department of Urology, Kaiser Permanente Orange County, Orange County, California, USA
3 Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia, USA
4 Winship Cancer Institute, Emory University, Atlanta, Georgia, USA
Address correspondence to Dr. Reza Nabavizadeh, Dept. of Urology, Emory University, 1365 Clifton Road NE, Building B, Room 5107, Atlanta, GA 30322 USA

Canadian Journal of Urology 2022, 29(5), 11300-11306.

Abstract

Introduction: This study examined the clinical accuracy of ultrasonography compared to magnetic resonance imaging (MRI) and intraoperative findings for evaluation of tumor thrombi level in patients with renal cell carcinoma.
Materials and methods: We retrospectively identified 38 patients at our institution who underwent both ultrasonography and MRI before undergoing open radical nephrectomy with tumor thrombectomy between 2010 and 2019. We compared tumor thrombus level findings of both ultrasonography and MRI, as well as the diagnostic accuracy of each to intraoperative findings. Agreement between ultrasonography, MRI, and surgery was tested with kappa. Logistic regression models identified factors that predict a mismatched thrombus level between an imaging modality and surgical findings.
Results and Conclusions: Tumor thrombus levels determined by ultrasonography matched with MRI in 26 (68.4%) cases. Compared to operative findings, ultrasonography accurately identified the cephalad extent of thrombi in 30 (79.0%) cases, under-staged five (13.2%) cases, and over-staged three (7.9%). Magnetic resonance imaging agreed with operative findings in 30 (79.0%) cases, under-staged five (13.2%) and over-staged three (7.9%) cases. On univariable regression assessment, M1 stage was predictive of a mismatched result between MRI and surgery (OR: 6.0, 95% CI: 1.02-35.3, p = 0.047), but this association did not hold-up in a multivariable model. Ultrasonography and magnetic resonance imaging identified the preoperative tumor thrombus level at a rate of 79%. Ultrasonography is an effective preoperative imaging modality for evaluating tumor thrombi associated with kidney cancer, notably as an adjunct to magnetic resonance imaging.

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Keywords

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