[The observed and chance-corrected agreement of the computed tomographic and histological staging results in renal-cell carcinoma].
OBJECTIVE
To assess the diagnostic value of abdominal computed tomography in the preoperative staging of renal cell carcinoma.


METHODS
Computed tomograms of 87 renal cell carcinomas were classified according to the TNM-System. The results were correlated with the histopathological categories. The usual parameters for diagnostic tests were calculated and chance correction of the observed agreement was performed using Cohen's Kappa (kappa) test.


RESULTS
T-category staging showed an overall accuracy of 60% (kappa = 0.44). The pT1 category was correctly predicted in all cases. For perirenal invasion, an accuracy of 60% (kappa = 0.27), a sensitivity of 90.5%, and a specificity of 51% were found. For venous involvement, accuracy was 92% (kappa = 0.59), sensitivity 86%, and specificity 92%. All inconspicuous adrenals on CT were histologically normal as well. An accuracy of 80% for lymphadenopathy staging was attributable to chance (kappa = 0.04). 7 distant metastases were detected in the scanned volume.


CONCLUSIONS
Good CT staging results are obtained with discrimination between T1 tumors and higher categories, the assessment of venous invasion, the exclusion of adrenal involvement, and the detection of metastatic spread to abdominal organs. Insufficient results are seen with lymphadenopathy staging and the distinction of organ-confined and invasive tumors.
Schubert
R A
RA
Institut für Diagnostische und Interventionelle Radiologie, Friedrich-Schiller-Universität Jena. rschubert@bach.med.uni-jena.de
Schleicher
C
C
Mentzel
H J
HJ
Wunderlich
H
H
Schubert
J
J
Kaiser
W A
WA
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002292:Carcinoma, Renal Cell / Q000000981:diagnostic imaging* / Q000473:pathology*; D005260:Female; D006801:Humans; D007668:Kidney / Q000000981:diagnostic imaging / Q000473:pathology; D007680:Kidney Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology*; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed / Q000295:instrumentation / Q000379:methods / Q000706:statistics & numerical data