title: Correlation of CT imaging features and tumor size with Fuhrman grade of clear cell renal cell carcinoma.
abstract: Background Identification of clinical features to determine the aggressive potential of tumors is highly warranted to stratify patients for adequate treatment. Computed tomography (CT) imaging features of clear cell renal cell carcinoma (ccRCC) may contribute to personalized risk assessment. Purpose To assess the correlation between CT imaging features and Fuhrman grade of ccRCC, and to identify the predictors of high Fuhrman grade in conjunction with tumor size. Material and Methods CT scans of 169 patients with 173 pathologically proven ccRCCs were retrospectively reviewed in consensus by two radiologists for the presence of intratumoral necrosis and intratumoral cyst and tumor size. Histologic grade was classified as either low (Fuhrman grade I or II) or high (Fuhrman grade III or IV). Statistical significance was evaluated by using univariate, multivariate regression, receiver operating characteristic (ROC) curve, and Spearman correlation analyses. Results On CT, 20 of the 173 tumors had intratumoral cysts, 60 had intratumoral necrosis, and 93 showed entirely solid tumors. The odds of high grade were higher with intratumoral necrosis and entirely solid tumor than with intratumoral cyst ( P < 0.03). Intratumoral necrosis showed a significantly high odds ratio of 25.73 for high Fuhrman grade. The ROC curve showed a threshold tumor size of 36 mm to predict high Fuhrman grade for overall tumors (area under the ROC curve, 0.70). In ccRCCs with intratumoral necrosis or cyst, tumor size did not significantly correlate with Fuhrman grade. Conclusion Intratumoral necrosis on CT was a strong and independent predictor of biologically aggressive ccRCCs, irrespective of tumor size.
authors.affiliation: 1 Department of Radiology, Anam Hospital, Korea University College of Medicine, Seoul, Republic of Korea.
authors.forename: Saelin
authors.initials: S
authors.lastname: Oh
authors.affiliation: 1 Department of Radiology, Anam Hospital, Korea University College of Medicine, Seoul, Republic of Korea.
authors.forename: Deuk Jae
authors.initials: DJ
authors.lastname: Sung
authors.affiliation: 2 Department of Biostatistics, Korea University College of Medicine, Seoul, Republic of Korea.
authors.forename: Kyung Sook
authors.initials: KS
authors.lastname: Yang
authors.affiliation: 1 Department of Radiology, Anam Hospital, Korea University College of Medicine, Seoul, Republic of Korea.
authors.forename: Ki Choon
authors.initials: KC
authors.lastname: Sim
authors.affiliation: 1 Department of Radiology, Anam Hospital, Korea University College of Medicine, Seoul, Republic of Korea.
authors.forename: Na Yeon
authors.initials: NY
authors.lastname: Han
authors.affiliation: 1 Department of Radiology, Anam Hospital, Korea University College of Medicine, Seoul, Republic of Korea.
authors.forename: Beom Jin
authors.initials: BJ
authors.lastname: Park
authors.affiliation: 1 Department of Radiology, Anam Hospital, Korea University College of Medicine, Seoul, Republic of Korea.
authors.forename: Min Ju
authors.initials: MJ
authors.lastname: Kim
authors.affiliation: 1 Department of Radiology, Anam Hospital, Korea University College of Medicine, Seoul, Republic of Korea.
authors.forename: Sung Bum
authors.initials: SB
authors.lastname: Cho
mesh_terms: 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*; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D015203:Reproducibility of Results; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed / Q000379:methods*; D055815:Young Adult
keywords: Fuhrman grade; Multidetector computed tomography; clear cell renal cell carcinoma