[985] Venous Invasion in Renal Cell Carcinoma: Preoperative Imaging-Gross Correlation.

Cynthia X Zhao, Kunle O Ojemakinde, Ami Bhalodia, Maureen Heldmann, Donald Elmajian, Stephen M Bonsib. Louisiana State University Health Sciences Center-Shreveport, Shreveport

Background: Renal sinus vein (SV) invasion is the principal invasive pathway for most renal cell carcinomas(RCC). Emphasis on nephron sparing surgery requires accurate preoperative imaging to optimize surgical strategies. Computed tomography (CT) and magnetic resonance imaging (MRI) are the most sensitive studies for preoperative imaging of RCC. Their accuracy in imaging sinus involvement in RCC has not been investigated.
Design: Fifteen cases of RCC were retrospectively selected and staged by 2010 TNM (3-pT1/2, 10-pT3a and 2-pT3b). The original radiology reports were obtained (11 LSUHSC/4 outside hospitals). A radiologist with expertise in urologic imaging received a brief tutorial on sinus invasive properties of RCC and re-examined the CT/MRI images for sinus invovlement. These interpretations were correlated with RCC gross photos.
Results: The mean tumor sizes were 8.7, 8.9, and 8.2cm by original radiologist, expert radiologist and patholgosist gross examination, respectively. SV invasion was not mentioned in any original CT/MRI reports (0/15) but was present in 12/15 cases by pathology review. Upon re-review of CT/MRI by radiology expert following tutorial, SV involvement was identified in 9/15.

RCC Tumor Stage Frequencies

Interpretation	pT1/2	pT3
		SV	MRV
Original Radiologist	14	0	1
Expert Radiologist	6	3	6
Pathologist	3	3	9

Main renal vein (MRV) involvement was noted in 6/15 cases by expert radiologist but in 9/15 by patholgists. The 3 discrepant cases involved the left kidney.

When compared with radiology images the 3 involved veins were large primary tributaries of the MRV.
Conclusions: 1) Sinus involvement is not routinely mentioned by radiologists 2) Sinus involvement is usually detectable by CT/MRI (9/12) when present 3) Unrecognized sinus invasion by radiologists may lead to overestimate of tumor size and understaging that can be corrected by education on pathologic features of RCC 4) Discrepant MRV involvement by radiologists versus pathologists affecting the left kidney is due to differing definitions of what constitutes the MRV.
Category: Genitourinary (including renal tumors)

Monday, February 28, 2011 9:30 AM

Poster Session I Stowell-Orbison/Surgical Pathology/Autopsy Awards Poster Session # 117, Monday Morning