Surgical margin follow-up after nephron-sparing surgery: the possible role of CEUS
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.
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.
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.
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.
KeywordsCEUS Nephron-sparing surgery (NSS) Small renal masses (SRM) Kidney Cancer Granuloma
No funding was used for this study.
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
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 was obtained from all individual participants included in the study.
- 9.Sheth S, Scatarige JC, Horton KM et al. (2001) Current concepts in the diagnosis and management of renal cell carcinoma: role of multidetector ct and three-dimensional CT. Radiographics. 21 Spec No: S237–54Google Scholar
- 10.Hertzberg BS, Middleton WD (2015) Ultrasound: the Requisites, 3rd edn. Elsevier, NetherlandsGoogle Scholar
- 11.Dinney CPN, Awad SA, Gajewski JB et al (1992) Analysis of imaging modalities, staging systems, and prognostic indicators for renal cell carcinoma. Urology 36:22–29Google Scholar
- 20.Dabestani S, Beisland C, Stewart GD et al (2018) Long-term outcomes of follow-up for initially localised clear cell renal cell carcinoma: RECUR database analysis. Eur Urol Focus S2405–4569(18):30072–30075Google Scholar
- 39.Mueller-Peltzer K, Rübenthaler J, Fischereder M et al (2017) The diagnostic value of contrast-enhanced ultrasound (CEUS) as a new technique for imaging of vascular complications in renal transplants compared to standard imaging modalities. Clin Hemorheol Microcirc 67(3–4):407–413CrossRefGoogle Scholar