MRI for Preoperative Staging of Renal Cell Carcinoma Using the 1997 TNM Classification: Comparison with Surgical and Pathologic Staging

• Published in: American journal of roentgenology (1976) Vol. 182; no. 1; pp. 217 - 225
• Main Authors: Ergen, F. Bilge, Hussain, Hero K., Caoili, Elaine M., Korobkin, Melvyn, Carlos, Ruth C., Weadock, William J., Johnson, Timothy D., Shah, Rajal, Hayasaka, Satoru, Francis, Isaac R.
• Format: Journal Article Conference Proceeding
• Language: English
• Published: Leesburg, VA American Roentgen Ray Society 01.01.2004
• Subjects: Adolescent; Adult; Aged; Aged, 80 and over; Biological and medical sciences; Carcinoma, Renal Cell - classification; Carcinoma, Renal Cell - pathology; Carcinoma, Renal Cell - surgery; Female; Humans; Investigative techniques, diagnostic techniques (general aspects); Kidney Neoplasms - classification; Kidney Neoplasms - pathology; Kidney Neoplasms - surgery; Kidneys; Magnetic Resonance Imaging; Male; Medical sciences; Middle Aged; Neoplasm Staging; Nephrology. Urinary tract diseases; Preoperative Care; Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects); Reproducibility of Results; Retrospective Studies; Time Factors; Tumors of the urinary system; Nuclear medicine; Carcinoma; Intravenous administration; Cardiovascular disease; Gadolinium; Venous disease; Vascular disease; Accuracy; Surgery; Classification; Grawitz tumor; Venous thrombosis; Kidney disease; Human; Urinary system disease; Vein thrombosis; Malignant tumor; Method; Nuclear magnetic resonance imaging; Standards; TNM-System; Treatment; Follow up study; Radiology; Medical imagery; Preoperative; Laparotomy; Comparative study
• ISSN: 0361-803X; 1546-3141
• DOI: 10.2214/ajr.182.1.1820217

The purpose of our study was to determine the accuracy of MRI for preoperative staging of renal cell carcinoma using the 1997 TNM classification. We conducted a retrospective review of MRI performed in 40 consecutive patients with 42 renal cell carcinomas before radical (n = 35) or partial (n = 4) nephrectomy or exploratory laparotomy (n = 3). The interval between imaging and surgery ranged from 1 to 59 days (mean, 17.9 days). Imaging was performed with T1- and T2-weighted, dynamic gadolinium-enhanced, and time-of-flight sequences. MRI and surgical-pathologic staging was performed using the 1997 TNM staging system. MRI staging was compared with surgical-pathologic staging as the gold standard. Agreement between the two staging methods was assessed using the kappa statistic. Agreement between MRI and surgical-pathologic staging was good for T staging (kappa = 0.72 and 0.78 for reviewers 1 and 2 respectively), poor for N staging (kappa = 0.13, both reviewers), good for M staging (kappa = 0.66, both reviewers), and excellent for the assessment of venous involvement (kappa = 0.93, both reviewers). MRI overestimated the T stage in five patients and the N stage in five and underestimated the T stage in three, the N stage in four, the M stage in one, and the extent of venous thrombosis in two patients. MRI is a reliable method for preoperative staging of renal cell carcinoma using the 1997 TNM classification, in particular for assessing venous involvement.