Papillary vs clear cell renal cell carcinoma. Differentiation and grading by iodine concentration using DECT—correlation with microvascular density

Abstract

Objectives

Various imaging methods have been evaluated regarding non-invasive differentiation of renal cell carcinoma (RCC) subtypes. Dual-energy computed tomography (DECT) allows iodine concentration (IC) analysis as a correlate of tissue perfusion. Microvascular density (MVD) in histopathology specimens is evaluated to determine intratumoral vascularization. The objective of this study was to assess the potential of IC and MVD regarding the differentiation between papillary and clear cell RCC and between well- and dedifferentiated tumors. Further, we aimed to investigate a possible correlation between these parameters.

Methods

DECT imaging series of 53 patients with clear cell RCC (ccRCC) and 15 with papillary RCC (pRCC) were analyzed regarding IC. Histology samples were stained using CD31/CD34 monoclonal antibodies; MVD was evaluated digitally. Statistical analysis included performance of Mann-Whitney U test, ROC analysis, and Spearman rank correlation.

Results

Analysis of IC demonstrated significant differences between ccRCC and pRCC (p < 0.001). A cutoff value of ≤ 3.1 mg/ml at IC analysis allowed identification of pRCC with an accuracy of 86.8%. Within the ccRCC subgroup, G1/G2 tumors could significantly be differentiated from G3/G4 carcinomas (p = 0.045). A significant positive correlation between IC and MVD could be determined for the entire RCC cohort and the ccRCC subgroup. Limitations include the small percentage of pRCCs.

Conclusions

IC analysis is a useful method to differentiate pRCC from ccRCC. The significant positive correlation between IC and MVD indicates valid representation of tumor perfusion by DECT.

Key Points

• Analysis of iodine concentration using DECT imaging could reliably distinguish papillary from clear cell subtypes of renal cell cancer (RCC).

• A cutoff value of 3.1 mg/ml allowed a distinction between papillary and clear cell RCCs with an accuracy of 86.8%.

• The positive correlation with microvascular density in tumor specimens indicates correct display of perfusion by iodine concentration analysis.

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Abbreviations

AUC:

Area under the curve

ccRCC:

Clear cell renal cell carcinoma

CD:

Cluster of differentiation

chRCC:

Chromophobe renal cell carcinoma

CT:

Computed tomography

DECT:

Dual-energy computed tomography

FOV:

Field of view

H&E:

Hematoxylin and eosin

HU:

Hounsfield unit

kVp:

Kilovoltage peak

MRI:

Magnetic resonance imaging

mTOR:

Mammalian target of rapamycin

MVD:

Microvascular density

pRCC:

Papillary renal cell carcinoma

RCC:

Renal cell carcinoma

ROC:

Receiver operating characteristic

VEGF:

Vascular endothelial growth factor

VNC:

Virtual non-contrast

VNE:

Virtual non-enhanced

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The authors state that this work has not received any funding.

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Correspondence to Julian Marcon.

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The scientific guarantor of this publication is Michael Staehler.

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The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.

Statistics and biometry

No complex statistical methods were necessary for this paper.

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Written informed consent was obtained from all subjects (patients) in this study.

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Institutional Review Board approval was obtained.

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• Retrospective

• Experimental

• Performed at one institution

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Marcon, J., Graser, A., Horst, D. et al. Papillary vs clear cell renal cell carcinoma. Differentiation and grading by iodine concentration using DECT—correlation with microvascular density. Eur Radiol 30, 1–10 (2020). https://doi.org/10.1007/s00330-019-06298-2

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Keywords

  • Carcinoma, renal cell
  • Kidney neoplasms
  • Neovascularization, pathologic
  • Cell differentiation
  • Tomography, X-ray computed