Three-dimensional virtual imaging of renal tumours: a new tool to improve the accuracy of nephrometry scores. in BJU international / BJU Int. 2019 Dec;124(6):945-954. doi: 10.1111/bju.14894. Epub 2019 Sep 27.
2019
AOU San Luigi di Orbassano
Tipo pubblicazione
Journal Article
Autori/Collaboratori (9)Vedi tutti...
Ficarra V
Urological Section, Department of Human and Paediatric Pathology, University of Messina, Messina, Italy.
Autorino R
Division of Urology, VCU Health, Richmond, VA, USA.
Migliaretti G
Department of Public Health and Paediatric Sciences, School of Medicine, University of Turin, Orbassano (Turin), Italy.
et alii...
Abstract
OBJECTIVES: To apply the standard PADUA and RENAL nephrometry score variables to three-dimensional (3D) virtual models (VMs) produced from standard bi-dimensional imaging, thereby creating three-dimensional (3D)-based (PADUA and RENAL) nephrometry scores/categories for the reclassification of the surgical complexity of renal masses, and to compare the new 3D nephrometry score/category with the standard 2D-based nephrometry score/category, in order to evaluate their predictive role for postoperative complications. MATERIALS AND METHODS: All patients with localized renal tumours scheduled for minimally invasive partial nephrectomy (PN) between September 2016 and September 2018 underwent 3D and 2D nephrometry score/category assessments preoperatively. After nephrometry score/category evaluation, all the patients underwent surgery. Chi-squared tests were used to evaluate the individual patients' grouping on the basis of the imaging tool (3D VMs and 2D imaging) used to assess the nephrometry score/category, while Cohen's ? coefficient was used to test the concordance between classifications. Receiver-operating characteristic curves were produced to evaluate the sensitivity and specificity of the 3D nephrometry score/category vs the 2D nephrometry score/category in predicting the occurrence of postoperative complications. A general linear model was used to perform multivariable analyses to identify predictors of overall and major postoperative complications. RESULTS: A total of 101 patients were included in the study. The evaluation of PADUA and RENAL nephrometry scores via 3D VMs showed a downgrading in comparison with the same scores evaluated with 2D imaging in 48.5% and 52.4% of the cases. Similar results were obtained for nephrometry categories (29.7% and 30.7% for PADUA risk and RENAL complexity categories, respectively). The 3D nephrometry score/category demonstrated better accuracy than the 2D nephrometry score/category in predicting overall and major postoperative complications (differences in areas under the curve for each nephrometry score/category were statistically significant comparing the 3D VMs with 2D imaging assessment). Multivariable analyses confirmed 3D PADUA/RENAL nephrometry category as the only independent predictors of overall (P = 0.007; P = 0.003) and major postoperative complications (P = 0.03; P = 0.003). CONCLUSIONS: In the present study, we showed that 3D VMs were more precise than 2D standard imaging in evaluating the surgical complexity of renal masses according to nephrometry score/category. This was attributable to a better perception of tumour depth and its relationships with intrarenal structures using the 3D VM, as confirmed by the higher accuracy of the 3D VM in predicting postoperative complications.
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PMID : 31390140
DOI : 10.1111/bju.14894
Keywords
renal cell carcinoma; postoperative complication; nephrometry scores; #kcsm; 3D virtual imaging; HA3D; minimally invasive partial nephrectomy; #KidneyCancer; Treatment Outcome; Prospective Studies; Middle Aged; Nephrectomy; Postoperative Complications; Male; Kidney Neoplasms/diagnostic imaging/pathology/surgery; Kidney/diagnostic imaging/pathology/surgery; Humans; Imaging, Three-Dimensional/methods; Female; Carcinoma, Renal Cell/diagnostic imaging/pathology/surgery; Aged;