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Surgical margin follow-up after nephron-sparing surgery: the possible role of CEUS

  • Elena BertelliEmail author
  • Laura Mercatelli
  • Elena Savi
  • Alessandro Pili
  • Silvia Verna
  • Alberto Palombella
  • Davide Caramella
  • Andrea Minervini
  • Sergio Serni
  • Simone Agostini
  • Vittorio Miele
Original Article

Abstract

Purpose

To evaluate the possible role of CEUS in the management of patients who underwent nephron-sparing surgery (NSS) and presented questionable findings on the surgical margins at the CECT follow-up exam.

Methods

In our retro-prospective study, we included 952 patients with small renal masses (SRMs) treated with NSS between 2012 and 2015 and followed with CECT for at least 3 years at Careggi University Hospital. Twenty-two of them presented solid masses on the site of surgery with questionable enhancement at CECT and were further studied with CEUS. This examination was followed by a quantitative analysis of the enhancement pattern.

Results

Out of the 22 masses, 18 were considered possible granulomas, presenting slow wash-in and low enhancement peaks compared to the surrounding parenchyma and persistent delayed wash-out at CEUS. Four lesions presented a suspicious malignant enhancement pattern, with rapid wash-in, high peak and rapid wash-out. In accordance with instructions from the urologist, the first group of 18 patients was strictly monitored, revealing that the mass dimensions and enhancement pattern were stable for at least 3 years of follow-up, while the other 4 patients underwent a second intervention and their masses were confirmed as tumor recurrence at the histopathological evaluation.

Conclusions

CEUS can play a key role in the surgical margin follow-up after NSS when a suspicious enhancing mass is detected by CECT, giving an accurate depiction of the enhancement pattern and thus helping the clinician in the management of the patient.

Keywords

CEUS Nephron-sparing surgery (NSS) Small renal masses (SRM) Kidney Cancer Granuloma 

Notes

Funding

No funding was used for this study.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

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Copyright information

© Società Italiana di Ultrasonologia in Medicina e Biologia (SIUMB) 2019

Authors and Affiliations

  • Elena Bertelli
    • 1
    • 2
    Email author
  • Laura Mercatelli
    • 1
  • Elena Savi
    • 1
  • Alessandro Pili
    • 3
  • Silvia Verna
    • 1
  • Alberto Palombella
    • 1
  • Davide Caramella
    • 4
  • Andrea Minervini
    • 3
  • Sergio Serni
    • 3
  • Simone Agostini
    • 1
  • Vittorio Miele
    • 1
  1. 1.Department of RadiologyCareggi University HospitalFlorenceItaly
  2. 2.Clinical and Translational SciencesUniversity of PisaFlorenceItaly
  3. 3.Department of Urologic Robotic Surgery and Renal TransplantationCareggi Hospital, University of FlorenceFlorenceItaly
  4. 4.Diagnostic and Interventional RadiologyUniversity of PisaFlorenceItaly

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