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European Radiology
Published in: European Radiology 1/2020

01-01-2020 | Kidney Cancer | Urogenital

Papillary vs clear cell renal cell carcinoma. Differentiation and grading by iodine concentration using DECT—correlation with microvascular density

Authors: Julian Marcon, Anno Graser, David Horst, Jozefina Casuscelli, Annabel Spek, Christian G. Stief, Maximilian F. Reiser, Johannes Rübenthaler, Alexander Buchner, Michael Staehler

Published in: European Radiology | Issue 1/2020

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Abstract

Objectives

Various imaging methods have been evaluated regarding non-invasive differentiation of renal cell carcinoma (RCC) subtypes. Dual-energy computed tomography (DECT) allows iodine concentration (IC) analysis as a correlate of tissue perfusion. Microvascular density (MVD) in histopathology specimens is evaluated to determine intratumoral vascularization. The objective of this study was to assess the potential of IC and MVD regarding the differentiation between papillary and clear cell RCC and between well- and dedifferentiated tumors. Further, we aimed to investigate a possible correlation between these parameters.

Methods

DECT imaging series of 53 patients with clear cell RCC (ccRCC) and 15 with papillary RCC (pRCC) were analyzed regarding IC. Histology samples were stained using CD31/CD34 monoclonal antibodies; MVD was evaluated digitally. Statistical analysis included performance of Mann-Whitney U test, ROC analysis, and Spearman rank correlation.

Results

Analysis of IC demonstrated significant differences between ccRCC and pRCC (p < 0.001). A cutoff value of ≤ 3.1 mg/ml at IC analysis allowed identification of pRCC with an accuracy of 86.8%. Within the ccRCC subgroup, G1/G2 tumors could significantly be differentiated from G3/G4 carcinomas (p = 0.045). A significant positive correlation between IC and MVD could be determined for the entire RCC cohort and the ccRCC subgroup. Limitations include the small percentage of pRCCs.

Conclusions

IC analysis is a useful method to differentiate pRCC from ccRCC. The significant positive correlation between IC and MVD indicates valid representation of tumor perfusion by DECT.

Key Points

• Analysis of iodine concentration using DECT imaging could reliably distinguish papillary from clear cell subtypes of renal cell cancer (RCC).
• A cutoff value of 3.1 mg/ml allowed a distinction between papillary and clear cell RCCs with an accuracy of 86.8%.
• The positive correlation with microvascular density in tumor specimens indicates correct display of perfusion by iodine concentration analysis.
Appendix
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Literature
1.
Ljungberg B, Campbell SC, Choi HY et al (2011) The epidemiology of renal cell carcinoma. Eur Urol 60(4):615–621CrossRef
2.
Muglia VF, Prando A (2015) Renal cell carcinoma: histological classification and correlation with imaging findings. Radiol Bras 48(3):166–174CrossRef
3.
Capitanio U, Cloutier V, Zini L et al (2009) A critical assessment of the prognostic value of clear cell, papillary and chromophobe histological subtypes in renal cell carcinoma: a population-based study. BJU Int 103(11):1496–1500CrossRef
4.
Ljungberg B, Bensalah K, Canfield S et al (2015) EAU guidelines on renal cell carcinoma: 2014 update. Eur Urol 67(5):913–924CrossRef
5.
Novara G, Martignoni G, Artibani W, Ficarra V (2007) Grading systems in renal cell carcinoma. J Urol 177(2):430–436CrossRef
6.
Nico B, Benagiano V, Mangieri D, Maruotti N, Vacca A, Ribatti D (2008) Evaluation of microvascular density in tumors: pro and contra. Histol Histopathol 23(5):601–607
7.
Meert AP, Paesmans M, Martin B et al (2002) The role of microvessel density on the survival of patients with lung cancer: a systematic review of the literature with meta-analysis. Br J Cancer 87(7):694–701CrossRef
8.
Vikram R, Ng CS, Tamboli P et al (2009) Papillary renal cell carcinoma: radiologic-pathologic correlation and spectrum of disease. Radiographics. 29(3):741–754 discussion 755–747CrossRef
9.
Young JR, Margolis D, Sauk S, Pantuck AJ, Sayre J, Raman SS (2013) Clear cell renal cell carcinoma: discrimination from other renal cell carcinoma subtypes and oncocytoma at multiphasic multidetector CT. Radiology. 267(2):444–453
10.
Hotker AM, Mazaheri Y, Wibmer A et al (2017) Differentiation of clear cell renal cell carcinoma from other renal cortical tumors by use of a quantitative multiparametric MRI approach. AJR Am J Roentgenol 208(3):W85–W91CrossRef
11.
Graser A, Johnson TR, Chandarana H, Macari M (2009) Dual energy CT: preliminary observations and potential clinical applications in the abdomen. Eur Radiol 19(1):13–23CrossRef
12.
Graser A, Becker CR, Staehler M et al (2010) Single-phase dual-energy CT allows for characterization of renal masses as benign or malignant. Invest Radiol 45(7):399–405CrossRef
13.
Weidner N, Semple JP, Welch WR, Folkman J (1991) Tumor angiogenesis and metastasis--correlation in invasive breast carcinoma. N Engl J Med 324(1):1–8CrossRef
14.
15.
Kroeger N, Choueiri TK, Lee JL et al (2014) Survival outcome and treatment response of patients with late relapse from renal cell carcinoma in the era of targeted therapy. Eur Urol 65(6):1086–1092CrossRef
16.
Ascenti G, Mileto A, Krauss B et al (2013) Distinguishing enhancing from nonenhancing renal masses with dual-source dual-energy CT: iodine quantification versus standard enhancement measurements. Eur Radiol 23(8):2288–2295CrossRef
17.
Lubner MG, Stabo N, Abel EJ, Del Rio AM, Pickhardt PJ (2016) CT textural analysis of large primary renal cell carcinomas: pretreatment tumor heterogeneity correlates with histologic findings and clinical outcomes. AJR Am J Roentgenol 207(1):96–105CrossRef
18.
Mileto A, Marin D, Alfaro-Cordoba M et al (2014) Iodine quantification to distinguish clear cell from papillary renal cell carcinoma at dual-energy multidetector CT: a multireader diagnostic performance study. Radiology. 273(3):813–820CrossRef
19.
Hsieh JJ, Purdue MP, Signoretti S et al (2017) Renal cell carcinoma. Nat Rev Dis Primers 3:17009CrossRef
20.
Apfaltrer P, Meyer M, Meier C et al (2012) Contrast-enhanced dual-energy CT of gastrointestinal stromal tumors: is iodine-related attenuation a potential indicator of tumor response? Invest Radiol 47(1):65–70CrossRef
21.
Hellbach K, Sterzik A, Sommer W et al (2016) Dual energy CT allows for improved characterization of response to antiangiogenic treatment in patients with metastatic renal cell cancer. Eur Radiol 27:2532–2537
22.
Cheng SH, Liu JM, Liu QY et al (2014) Prognostic role of microvessel density in patients with renal cell carcinoma: a meta-analysis. Int J Clin Exp Pathol 7(9):5855–5863PubMedPubMedCentral
23.
Zocchi MR, Poggi A (2004) PECAM-1, apoptosis and CD34+ precursors. Leuk Lymphoma 45(11):2205–2213CrossRef
24.
Jinzaki M, Tanimoto A, Mukai M et al (2000) Double-phase helical CT of small renal parenchymal neoplasms: correlation with pathologic findings and tumor angiogenesis. J Comput Assist Tomogr 24(6):835–842CrossRef
25.
Jiang Y, Li J, Wang J et al (2016) Assessment of vascularity in hepatic alveolar echinococcosis: comparison of quantified dual-energy CT with histopathologic parameters. PLoS One 11(2):e0149440CrossRef
26.
Young JR, Coy H, Douek M et al (2017) Type 1 papillary renal cell carcinoma: differentiation from type 2 papillary RCC on multiphasic MDCT. Abdom Radiol (NY) 42(7):1911–1918CrossRef
27.
Graser A, Johnson TR, Hecht EM et al (2009) Dual-energy CT in patients suspected of having renal masses: can virtual nonenhanced images replace true nonenhanced images? Radiology. 252(2):433–440CrossRef
Metadata
Title
Papillary vs clear cell renal cell carcinoma. Differentiation and grading by iodine concentration using DECT—correlation with microvascular density
Authors
Julian Marcon
Anno Graser
David Horst
Jozefina Casuscelli
Annabel Spek
Christian G. Stief
Maximilian F. Reiser
Johannes Rübenthaler
Alexander Buchner
Michael Staehler
Publication date
01-01-2020
Publisher
Springer Berlin Heidelberg
Published in
European Radiology / Issue 1/2020
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI
https://doi.org/10.1007/s00330-019-06298-2

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