Does Preoperative Doppler Ultrasound and Resistive Index Measurement Predict the Solid Renal Masses Histopathology?
Iraqi Postgraduate Medical Journal,
2020, Volume 19, Issue 4, Pages 310-316
Renal masses have different histologic types and subtypes, aggressiveness and metastatic potential, depending on the changes in angiogenesis.
To differentiate between benign and malignant renal masses and predicate renal tumors histopathological subtypes by using non invasive methods (Doppler ultrasound and resistive index).
PATIENTS AND METHODS:
Sixty-eight patients with a renal mass prepared for surgical intervention were involved in this prospective study. Every patient was underwent Doppler ultrasonography by single operator. By gray and color Doppler ultrasound the site, location, dimensions, echogenicity and the vascularity of the renal mass were assessed. Then by spectral Doppler ultrasound specific vascular wave parameters from intra tumor vessels which include a Peak systolic velocity, end diastolic velocity and Resistive index was checked. All those patients underwent partial or radical nephrectomy and the histopathological result, were collected.
It had been found that the mean RI in patients with clear RCC was 0.59 ± 0.09 and it was significantly higher than that of Wilms tumor (mean = 0.49 ± 0.05, (P. value = 0.029), and significantly higher than oncocytoma (0.42 ± 0.06) (P. value = 0.025).
Patients with malignant renal mass had significantly higher mean RI than that of benign renal mass, 0.58±0.11vs 0.42±0.06,(P-Value =0.021) . The optimal cutoff point of RI was 0.47 which gives the higher sensitivity and specificity of 88.9% and 100% respectively with an accuracy of 94.5%, (PPV) was 100% and (NPV) was 90%.
The usage of color spectral Doppler US parameter (Resistive index) is considered as an excellent predictor to differentiate between benign and malignant renal masses, but failed to differentiate and predicate the malignant renal tumors subtypes.
- Kang SK, Huang WC, Pandharipande PV, Chandarana H. Solid renal masses: what the numbers tell us. American Journal of Roentgenology. 2014 Jun;202(6):1196-206.
- Jamis-Dow CA, Choyke PL, Jennings SB, Linehan WM, Thakore KN, Walther MM. Small (< or= 3-cm) renal masses: detection with CT versus US and pathologic correlation. Radiology. 1996 Mar;198(3):785-8.
- Sidhar K, McGahan JP, Early HM, Corwin M, Fananapazir G, Gerscovich EO. Renal cell carcinomas: sonographic appearance depending on size and histologic type. Journal of ultrasound in medicine. 2016 Feb;35(2):311-20.
- Hartman DS, Goldman SM, Friedman AC, Davis Jr CJ, Madewell JE, Sherman JL. Angiomyolipoma: ultrasonic-pathologic correlation. Radiology. 1981 May;139(2):451-8.
- Wu Y, Du L, Li F, Zhang H, Cai Y, Jia X. Renal Oncocytoma: Contrast‐Enhanced Sonographic Features. Journal of Ultrasound in Medicine. 2013 Mar;32(3):441-8.
- Jakobsen J. Echo-enhancing agents in the renal tract. Clinical radiology. 1996 Feb;51:40.
- Setola SV, Catalano O, Sandomenico F, Siani A. Contrast-enhanced sonography of the kidney. Abdominal imaging. 2007 Feb 1;32(1):21-8.
- Tamai H, Takiguchi Y, Oka M, Shingaki N, Enomoto S, Shiraki T, Furuta M, Inoue I, Iguchi M, Yanaoka K, Arii K. Contrast enhanced ultrasonography in the diagnosis of solid renal tumors. Journal of ultrasound in medicine. 2005 Dec 1;24(12):1635-40.
- Barr RG, Peterson C, Hindi A. Evaluation of indeterminate renal masses with contrast-enhanced US: a diagnostic performance study. Radiology. 2013 Nov 18;271(1):133-42.
- Kazmierski B, Deurdulian C, Tchelepi H, Grant EG. Applications of contrast-enhanced ultrasound in the kidney. Abdominal Radiology. 2017 Aug 30:1-9.
- Jinzaki M, Ohkuma K, Tanimoto A, Mukai M, Hiramatsu K, Murai M, Hata JI. Small solid renal lesions: usefulness of power Doppler US. Radiology. 1998 Nov;209(2):543-50.
- Hsiao W, Shrewsberry AB, Moses KA, Malek-Jones M, Baumgarten D, Master VA, Ogan K. Intra-tumor Doppler flow patterns do not predict malignancy of renal masses in a United States population. The Canadian journal of urology. 2011 Aug;18(4):5831-5.
- Lee SW, Choi HY, Baek SY, Lim SM. Role of color and power Doppler imaging in differentiating between malignant and benign solid breast masses. Journal of clinical ultrasound. 2002 Oct;30(8):459-64.
- del Cura JL, Elizagaray E, Zabala R, Legórburu A, Grande D. The use of unenhanced Doppler sonography in the evaluation of solid breast lesions. American Journal of Roentgenology. 2005 Jun;184(6):1788-94.
- Ueland FR, DePriest PD, Pavlik EJ, Kryscio RJ, van Nagell Jr JR. Preoperative differentiation of malignant from benign ovarian tumors: the efficacy of morphology indexing and Doppler flow sonography. Gynecologic oncology. 2003 Oct 1;91(1):46-50.
- Marret H, Sauget S, Giraudeau B, Body G, Tranquart F. Power Doppler vascularity index for predicting malignancy of adnexal masses. Ultrasound in Obstetrics and Gynecology: The Official Journal of the International Society of Ultrasound in Obstetrics and Gynecology. 2005 May;25(5):508-13.
- Wu TJ, Shiao JS, Lu JY. A novel Doppler spectral index for differentiating benign from malignant lung tumors. Journal of Clinical Ultrasound. 2011 Jun;39(5):256-62.
- Gandhi R, Nayyar AS, Bhowate R, Gandhi S, Dongerwar G. Color Doppler ultrasonography in oral squamous cell carcinoma: Making ultrasonography more meaningful. Clinical Cancer Investigation Journal. 2015 Sep 1;4(5):595.
- Sureka B, Lal A, Khandelwal N, Joshi K, Singh SK, Agarwal MM, Mittal A. Dynamic computed tomography and Doppler findings in different subtypes of renal cell carcinoma with their histopathological correlation. Journal of cancer research and therapeutics. 2014 Jul 1;10(3):552.
- Kier R, Taylor KJ, Feyock AL, Ramos IM. Renal masses: characterization with Doppler US. Radiology. 1990 Sep;176(3):703-7.
- Turkbey B, Kobayashi H, Ogawa M, Bernardo M, Choyke PL. Imaging of tumor angiogenesis: functional or targeted?. American journal of roentgenology. 2009 Aug;193(2):304-13.
- Folkman J. Role of angiogenesis in tumor growth and metastasis. InSeminars in oncology 2002 Dec 16 (Vol. 29, No. 6, pp. 15-18). WB Saunders.
- Article View: 48
- PDF Download: 54