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Kwon, Kim, Park, Kim, and Chang: Effectiveness of Computed Tomography for Predicting the Nuclear Grade of Renal Cell Carcinoma
Original Article
Urological Oncology
Korean Journal of Urology

Korean Journal of Urology 2009; 50(10): 942-946.

Published online: 22 October 2009

DOI: https://doi.org/10.4111/kju.2009.50.10.942

Effectiveness of Computed Tomography for Predicting the Nuclear Grade of Renal Cell Carcinoma

Young Kee Kwon, Byung Hoon Kim, Choal Hee Park, Chun Il Kim, Hyuk Soo Chang

Department of Urology, Keimyung University School of Medicine, Daegu, Korea.

Correspondence to: Hyuk Soo Chang. Department of Urology, Dongsan Medical Center, Keimyung University School of Medicine, 194, Dongsan-dong, Jung-gu, Daegu 700-712, Korea. TEL: 053-250-7023, FAX: 053-250-7643, sangraal@dsmc.or.kr

Received 25 March 2009       Accepted 10 September 2009

Copyright © The Korean Urological Association, 2009

Abstract

Purpose

Nuclear grade is one of the independent prognostic factors for renal cell carcinoma (RCC). We investigated the effectiveness of a preoperative CT scan for predicting the nuclear grade of clear cell RCC.

Materials and Methods

We retrospectively reviewed the medical records of patients who underwent surgery for renal lesions between January 2002 and December 2007. We analyzed the pathologic and radiologic reports of 65 patients who underwent radical nephrectomy for RCC and were diagnosed with clear cell RCC. The Hounsfield unit (HU) of the area with maximum enhancement (M) and the total area of the RCC (T) were measured during CT. Ratio values by nuclear grade were calculated by using formulas (M HU/aorta HU, T HU/aorta HU) to eliminate differences between individuals.

Results

A total of 65 cases of clear cell RCCs were classified according to Fuhrman nuclear grade. Five cases were grade I, 33 were grade II, 15 were grade III, and 12 were grade IV. There was a significant difference in CT enhancement between each nuclear grade, and lower nuclear grades tended to have an increased ratio of maximum enhancement (p=0.020). Fuhrman nuclear grade was divided into two groups: low (Fuhrman grades I, II) and high (Fuhrman grades III, IV). The ratio of enhancement for the M area was significantly higher in the low Fuhrman nuclear grade group than in the high group (p=0.033).

Conclusions

CT enhancement is inversely related to the nuclear grade of clear cell RCC. This study found that measuring the area of maximum enhancement in CT may be a useful method for presuming the pathologic nuclear grade of RCC, especially when the Fuhrman nuclear grade is divided into low and high groups.

Keywords: Renal cell carcinoma, Spiral computed tomography

Figures and Tables

Fig. 1
The maximum area of Hounsfield units (HU) was measured by tracing the highest HU of the localized circular portion, which was defined by 25% of the total area of the carcinoma at the largest diameter. (A) an example of measuring maximum area of HU in well enhanced small size carcinoma by localized circle. (B) an example of measuring maximum area of HU in heterogeneous large size carcinoma by localized circle.
kju-50-942-g001
Fig. 2
Hounsfield units (HU) of the total area of the carcinoma were measured by delineating around the lesion at the largest diameter. (A) an example of measuring the total area of HU in a well-enhanced, small-sized carcinoma. (B) an example of measuring the total area of HU in a heterogeneous enhanced large-sized carcinoma.
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Table 1
Comparison between HU degree by nuclear grade
kju-50-942-i001

HU: Hounsfield unit, M: maximum area of Hounsfield unit which was defined by 25% of total area of carcinoma at the largest diameter, T: total area of carcinoma at the largest diameter, A: aorta at the largest diameter of carcinoma

Table 2
Comparison between HU degree by high & low Fuhrman nuclear grade groups
kju-50-942-i002

HU: Hounsfield unit, M: maximum area of Hounsfield unit which was defined by 25% of total area of carcinoma at the largest diameter, T: total area of carcinoma at the largest diameter

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