Clinical application of preoperative and intraoperative ultrasonography for small renal masses with maximum diameter ≤1.5 cm

doi:10.3877/cma.j.issn.2095-3216.2023.01.004

Abstract

Abstract:

Objective

To investigate the value of preoperative and intraoperative ultrasonography for small renal masses (SRMs) with maximum diameter ≤1.5 cm.

Methods

Forty-two patients with pathologically confirmed renal tumors of maximum diameter ≤1.5 cm were included from September 2018 to March 2022. All the patients underwent preoperative conventional ultrasound and contrast-enhanced ultrasonography (CEUS), among whom 8 cases with endogenic renal masses received intraoperative ultrasonography due to being unable to be located accurately during the operations.

Results

Of the 42 patients with SRMs, 8 (19.1%) were detected by preoperative CEUS, but not by preoperative conventional ultrasound (P=0.005). During the operation, all the 8 SRMs missed by conventional ultrasound were able to be detected by ultrasound, clearly showing the boundary, shape and blood supply of the SRMs. Among them, 7 patients were diagnosed as malignant tumors and underwent intraoperative ultrasound-assisted partial nephrectomy. Postoperative pathology diagnosed 1 case of clear cell papillary cell carcinoma, 5 cases of clear cell renal cell carcinoma, and 1 case of chromophobe renal cell carcinoma. The cutting-edge of tumors was negative for tumor cells. No recurrence or metastasis of the tumors was found in the follow-up of 6 months after operation.

Conclusion

For SRMs with maximum diameter ≤ 1.5 cm, preoperative ultrasound has a certain rate of missed diagnosis, CEUS could significantly reduce the rate of missed diagnosis, while intraoperative ultrasound could detect all the endogenous SRMs. Intraoperative ultrasound may play an important role in guiding the complete removal of tumors, protecting the integrity of tumor envelope, and adequately preserving the residual nephrons.

Key words: Ultrasound, Contrast-enhanced ultrasonography, Intraoperative ultrasound, Small renal masses

Jianing Zhu, Ping Zhao, Nan Li, Lianhua Zhu, Jingbo Li, Yukun Luo, Qiuyang Li. Clinical application of preoperative and intraoperative ultrasonography for small renal masses with maximum diameter ≤1.5 cm[J]. Chinese Journal of Kidney Disease Investigation(Electronic Edition), 2023, 12(01): 20-25.

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References 23

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超声特征	检出(n＝34) [例(%)]	未检出(n＝8) [例(%)]
病灶位置
外生型	18(52.9)	0(0.0)
实质内	14(41.1)	5(62.5)
内生型	2(5.9)	3(37.5)
纵向定位
上极/上部	19(55.9)	2(25.0)
下极/下部	13(38.2)	3(37.5)
中部	2(5.9)	3(37.5)
前-后定位
背侧	14(41.2)	6(75.0)
腹侧	20(58.8)	2(25.0)
回声
高回声	16(47.1)	0(0.0)
等回声	7(20.6)	3(37.5)
低回声	11(32.4)	5(62.5)
边界
清楚	24(70.6)	2(25.0)
不清	10(29.4)	6(75.0)
形态
规则	32(94.2)	3(37.5)
不规则	2(5.9)	5(62.5)
血流信号
有	28(82.3)	2(25.0)
无	6(17.6)	6(75.0)

超声特征	检出(n＝34) [例(%)]	未检出(n＝8) [例(%)]
病灶位置
外生型	18(52.9)	0(0.0)
实质内	14(41.1)	5(62.5)
内生型	2(5.9)	3(37.5)
纵向定位
上极/上部	19(55.9)	2(25.0)
下极/下部	13(38.2)	3(37.5)
中部	2(5.9)	3(37.5)
前-后定位
背侧	14(41.2)	6(75.0)
腹侧	20(58.8)	2(25.0)
回声
高回声	16(47.1)	0(0.0)
等回声	7(20.6)	3(37.5)
低回声	11(32.4)	5(62.5)
边界
清楚	24(70.6)	2(25.0)
不清	10(29.4)	6(75.0)
形态
规则	32(94.2)	3(37.5)
不规则	2(5.9)	5(62.5)
血流信号
有	28(82.3)	2(25.0)
无	6(17.6)	6(75.0)

超声造影征象	恶性			良性
超声造影征象	透明细胞癌(n＝31)	透明细胞乳头状细胞癌(n＝1)	嫌色细胞癌(n＝1)	嗜酸性细胞瘤(n＝2)	血管平滑肌脂肪瘤(n＝6)	肾素瘤(n＝1)
皮质期
快进	24(77.4)	1(100.0)	1(100.0)	2(100.0)	2(33.3)	0(0.0)
同进	7(22.6)	0(0.0)	0(0.0)	0(0.0)	4(66.7)	1(100.0)
慢进	0(0.0)	0(0.0)	0(0.0)	0(0.0)	0(0.0)	0(0.0)
峰值强度
高增强	28(90.3)	1(100.0)	0(0.0)	2(100.0)	2(33.3)	0(0.0)
等增强	1(3.2)	0(0.0)	0(0.0)	0(0.0)	2(33.3)	1(100.0)
低增强	2(6.4)	0(0.0)	1(100.0)	0(0.0)	2(33.3)	0(0.0)
髓质期及延迟期
快退	1(3.2)	0(0.0)	0(0.0)	0(0.0)	0(0.0)	1(100.0)
同退	0(0.0)	0(0.0)	1(100.0)	2(100.0)	6(100.0)	0(0.0)
慢退	30(96.8)	1(100.0)	0(0.0)	0(0.0)	0(0.0)	0(0.0)
增强均匀性
均匀	6(19.4)	0(0.0)	1(100.0)	1(50.0)	4(66.7)	0(0.0)
非均匀	25(80.6)	1(100.0)	0(0.0)	1(50.0)	2(33.3)	1(100.0)
高增强环
有	24(77.4)	1(100.0)	1(100.0)	2(100.0)	2(33.3)	0(0.0)
无	7(22.6)	0(0.0)	0(0.0)	0(0.0)	4(66.7)	1(100.0)
无灌注区
有	26(83.9)	1(100.0)	1(100.0)	1(50.0)	4(66.7)	0(0.0)
无	5(16.1)	0(0.0)	0(0.0)	1(50.0)	2(33.3)	1(100.0)

超声造影征象	恶性			良性
超声造影征象	透明细胞癌(n＝31)	透明细胞乳头状细胞癌(n＝1)	嫌色细胞癌(n＝1)	嗜酸性细胞瘤(n＝2)	血管平滑肌脂肪瘤(n＝6)	肾素瘤(n＝1)
皮质期
快进	24(77.4)	1(100.0)	1(100.0)	2(100.0)	2(33.3)	0(0.0)
同进	7(22.6)	0(0.0)	0(0.0)	0(0.0)	4(66.7)	1(100.0)
慢进	0(0.0)	0(0.0)	0(0.0)	0(0.0)	0(0.0)	0(0.0)
峰值强度
高增强	28(90.3)	1(100.0)	0(0.0)	2(100.0)	2(33.3)	0(0.0)
等增强	1(3.2)	0(0.0)	0(0.0)	0(0.0)	2(33.3)	1(100.0)
低增强	2(6.4)	0(0.0)	1(100.0)	0(0.0)	2(33.3)	0(0.0)
髓质期及延迟期
快退	1(3.2)	0(0.0)	0(0.0)	0(0.0)	0(0.0)	1(100.0)
同退	0(0.0)	0(0.0)	1(100.0)	2(100.0)	6(100.0)	0(0.0)
慢退	30(96.8)	1(100.0)	0(0.0)	0(0.0)	0(0.0)	0(0.0)
增强均匀性
均匀	6(19.4)	0(0.0)	1(100.0)	1(50.0)	4(66.7)	0(0.0)
非均匀	25(80.6)	1(100.0)	0(0.0)	1(50.0)	2(33.3)	1(100.0)
高增强环
有	24(77.4)	1(100.0)	1(100.0)	2(100.0)	2(33.3)	0(0.0)
无	7(22.6)	0(0.0)	0(0.0)	0(0.0)	4(66.7)	1(100.0)
无灌注区
有	26(83.9)	1(100.0)	1(100.0)	1(50.0)	4(66.7)	0(0.0)
无	5(16.1)	0(0.0)	0(0.0)	1(50.0)	2(33.3)	1(100.0)

	超声造影前[例(%)]	超声造影后[例(%)]	χ²值	P值
回声
高回声	16(38.1)	23(54.7)	25.1	<0.01
等回声	10(23.8)	13(30.9)
低回声	16(38.1)	6(14.3)
边界
清楚	28(66.7)	35(83.3)	4.8	0.04
不清	14(33.3)	7(16.7)
形态
规则	35(83.3)	41(97.6)	5.1	0.16
不规则	7(16.7)	1(2.4)

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