Intracaval endovascular ultrasonography for large adrenal and retroperitoneal tumors.
BACKGROUND
An accurate diagnosis of inferior vena cava (IVC) invasion is important in deciding the surgical strategy for a large adrenal tumor. We investigated the diagnostic value of intracaval endovascular ultrasonography (ICEUS) for invasion of the IVC by a large adrenal tumor.


METHODS
Nine of 163 patients with adrenal and retroperitoneal tumors underwent ICEUS between 1993 and 2002. Intravascular ultrasonography was performed through the right femoral vein with the use of an 8Fr, 20-MHz transducer. The diagnostic criterion for detecting IVC invasion with ICEUS was identification of destruction of a single echogenic layer of the IVC wall or identification of an intracaval tumor mass. The ICEUS finding was confirmed by pathologic examination.


RESULTS
The mean diameter of the tumors in 9 patients undergoing ICEUS and resection was 12.6 cm (range, 8.6-16 cm). Pathologic diagnosis varied: adrenocortical carcinoma, 4; malignant pheochromocytoma, 1; leiomyosarcoma, 1; metastatic lung cancer, 1; paraganglioma, 1; and neurilemmoma, 1. Vascular invasion was identified in 2 patients by ICEUS and confirmed by examination of resected specimens. The sensitivity, specificity, and positive predictive values of ICEUS for the diagnosis of the IVC invasion were 100%, 100%, and 100%, respectively. However, these values for computed tomography were 100%, 14%, and 25%, respectively; and for cavography, 100%, 57%, and 40%, respectively.


CONCLUSIONS
ICEUS provides confirmatory information regarding tumor invasion of the IVC. This modality also can assist in formulating an operative strategy for large adrenal or retroperitoneal tumors.
Kikumori
Toyone
T
Department of Surgery II, Nagoya University School of Medicine, 65 Tsueumai-cho, Showa-ku, Nagoya 466-8550, Japan.
Imai
Tsuneo
T
Kaneko
Tetsuya
T
Sugimoto
Hiroyuki
H
Shibata
Arihiro
A
Hibi
Yatsuka
Y
Nakao
Akimasa
A
D000310:Adrenal Gland Neoplasms / Q000473:pathology*; D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D011237:Predictive Value of Tests; D012186:Retroperitoneal Neoplasms / Q000473:pathology*; D012189:Retrospective Studies; D013927:Thrombosis / Q000000981:diagnostic imaging; D018084:Ultrasonography, Interventional / Q000379:methods*; D014682:Vena Cava, Inferior / Q000000981:diagnostic imaging* / Q000473:pathology