Evaluation of focal renal lesions with contrast enhanced ultrasonography (CEUS) using a new microbubble contrast agent (sonovue)

537 THE USEFULNESS OF POSITRON EMISSION TOMOGRAPHY (PET) FOR INDICATING SURGERY IN RECURRENT RENAL CELL CARCINOMA WHEN A SOLITARY METASTASIS OR AN ISOLATED RENAL FOSSA RECURRENCE IS SUSPECTED

EVALUATION OF FOCAL RENAL LESIONS WITH CONTRAST ENHANCED ULTRASONOGRAPHY (CEUS) USING A NEW MICROBUBBLE CONTRAST AGENT (SONOVUE)

lborra I.‘, ~olsona E.‘, Rubio J.‘. Rices J.V.‘, Monros J.L.‘, Dumont R.‘, Casanova J.L.',Ramlrez D.‘, Ortega F.’

Feuchtner G.‘, Frauscher

11~0,Urology, Valencia, Spain, ‘Ivo, Nuclear Medicine, Valencia, Spain

‘University Innsbruck, Radiology, Urology, Innsbruck, Austria

INTRODUCTION & OBJECTIVES: PET is a new, non-invasive imaging technique in Nuclear Medicine. A disadvantage associated with PET imaging to determine primary renal cancer is the excretion of the contrast medium desoxifluor-glucose, while the procedure is being carried out. PET may therefore be more suited for the follow-up of nephrectomized renal cancer. The main role of surgery in recurrent renal cancer would be the treat solitary metastasis or isolated renal fossa recurrences, being both very uncommon situations. The objective is to determine in a prospective way the usefulness of PET m the re-staging of previously nephrectomized renal cancer patients, when a solitary metastasis or an isolated renal fossa recurrence was suspected. MATERIAL & METHODS: From August 2000 to July 2002, 9 patients were diagnosed of a solitary renal fossa recurrences or a single metastasis by conventional methods: CT scan and/or MRI, in all cases a whole body PET was performed with an ECAT EXACT 47 camera (Siemens). RESULTS: In all cases PET detected the previously suspected lesiyn. In one case PET allowed us to reject surgery detecting two new lesions, one of them histologically confirmed by PAAF. In 3 doubtful cases of being in the presence of another primary or a postoperative sequel, PET diagnosed I primary cerebral tumour, 1 true renal fossa recurrence and 1 inflammatory process. Eight cases were surgically treated: 1 cerebral meningioma, 1 contralateral adrenal metastasis, I contralateral psoas metastasis and 5 isolated renal fossa recurrences, 1of them was an inflammatory process, and in one other case an unsuspected intraoperative hepatic metastasis was detected. In the immediate follow-up, 2 patients developed hepatic metastasis at 3 month, and 1 metastasised in the skull at 6 months, 5 are free of recurrence between 3 and 21 months. CONCLUSIONS: PET was able to detect all previously suspected lesions, and allowed us to reject surgery in one case, but did not detect an intraoperativc hepatic metastasis. PET did not precede other methods in the cases of very rapid metastasis. PET was useful in discriminating doubtful cases.

F.‘, Klauser A.‘, Pelrer A.', Peschl R.‘, Bartsch G.’ Innsbruck,

Austria,

‘University

Innsbruck,

INTRODUCTION & OBJECTIVES: To assess the value of contrast enhanced ultrasonography (CEIJS) with a new microbubble contrast agent (Sonovue; Bracco) in differential diagnosis and delineation of focal renal lesions. MATERIAL & METHODS: 25 focal renal lesions were examined prospectively with CEUS using Sonovue (Bracco, Italy) performing bolus injection (2.5 ml) and an Acuson Sequoia, Mountain View, CA (4H2, low MI =0.3; pulse- inversion imaging). Diagnosis was based on CT and/or Histology (renal cell carcinoma (RCC) n-l 1; transitional cell cancer (TCC) n=2, angiosarcoma n=l; cystic lesion Bosniak II-IV n=5; hypertrophic columna n=l; regenerating

nodule n=3).

RESULTS: RCCs showed a high contrast agent uptake during arterial phase and a contrast agent “wash out” during venous phase. TCCs demonstrated a low, increasing enhancement during arterial and venous phase. Benign lesions (hypertrophic columna and regenerating nodule) showed contrast enhancement equal to the renal cortex. These enhancement patterns were associated with the either benign or malign nature of the lesion (p=O.O2; Chi Quadrate test). CONCLUSIONS: CEUS with Sonovue improves lesion delineation and lesion detection of small renal masses. The enhancement pattern of a lesion yielded important information for the differential diagnosis between benign and malign focal renal lesions.

539 DIAGNOSIS

AND

CHANGING

MANAGEMENT

EVOLUTION

OF RENAL

TUMOURS:

THE

OVER A PERIOD OF 17 YEARS

Patard J.‘, Rodriguez A.‘, Tazi H.‘, Vincendcau

S.‘. Bensalah K.‘, Rioux-Leclercq

N.‘, Manunta A.‘, Guillc F.‘, Lobe1 B.’ ‘Pontachaillou

University

Hospital,

University Hospital. Pathology, INTRODUCTION diagnosed

Urology,

Renncs,

France,

‘Pontachaillou

Rennes, France

& OBJECTIVES:

& METHODS:

of the following parameters

To study the evolution of renal tumours

We reviewed the data of 630 patients surgically

was registered: mode of detection, age at diagnosis,

tumour size, stage (TNM 1997), percent of malignant accessible

nephrectomy 1997-200

to partial surgery

(54cm),

tumours, the percent of

the type of treatment

(radical

versus partial surgery), and the percent of patients with metastasis

at presentation.

Three periods

were considered:

1984.1990,

1991-1996,

and

I (periods 1.2, and 3).

RESULTS: The following were not modified along time: mean age at diagnosis, T stage (with great stability of the’percent of Tl: 35.2 % in period 1 and 36% in period 3), patients presenting metastasis at diagnosis following

(I 6.6% versus 14.3%). The

changed along time (period 1 versus 3): mean tumour size (8 versus percent of benign tumours (3.2 versus 7%), percent of tumours 54cm

(13 versus

24.2%),

percent

of tumours

discovered

47.5%), and percent of radical nephrectomies CONCLUSIONS: discovery

wR.,

Pfcifcr A., Van Randenborgh

OF PAPILLARY

AND CLEAR

CELL

H., Kiibler H., Hartung R

of Urology,Munich,

Germany

INTRODUCTION & OBJECTIVES: There arc contradictory reports regarding prognosis of different types of renal cell carcinoma. Papillary renal tumours are thought to demonstrate better prognosis in this regard. We evaluated retrospectively the prognostic differences in papillary and clear cell type renal cancers in a large number of patients.

along a period of 17 years as well as their form of management,

MATERIAL

7.lcm),

PROGNOSTIC DIFFERENCES TYPE RENAL CARCINOMA

TU Munich, Dept.

treated due to a renal tumour between 1984 and 2001. The evolution along time

tumours

540

Today we are confronting

that brings

up, more frequently

incidentally

(23.2 versus

(96.2 versus 78.8%). small size tumours of incidental than before, the question

nature as well as the problem of selecting a conservative

management

of their option.

MATERIAL & METHODS: In a retrospective analysis we evaluated 561 patients with renal ccl1 carcinoma and obtained a follow up of these patients and analysed outcome by Kaplan-Meier-analysis and LogRank-test. Additional statistical tests were performed using Chi-Square-test and Mann-Whitney-U test and logistic regression analysis. RESULTS: From 561 patients 13 I (23.4%) demonstrated papillary growth pattern and 430 (76.6%) clear cell type renal cancer. We evaluated by univariate and multivariate analysis the differences in the distribution and prognosis of patients of these subgroups. There was no statistical difference for tumour size (p=O.13), age (p=O.84), M-Stage (p=O.45), grading (p=O.21), tumour localization (~~0.59) and side (p=O.57). We noted statistically significant differences for pT-stage (p=O.O2), pN-stage (p=O.O2) and venous involvement (p=O.O03). Kaplan-Meier analysis showed no difference in progression free survival for papillary and clear cell tumours (p=O.79), also there was no statistical difference if analysis was performed by grouping this test for pT-, pN-, M-stage as well as grading, venous involvement, tumour side, tumour location and age. CONCLUSIONS: In our subgroup analysis of renal cell cancers with papillary type and clear cell type tumours we did not find any prognostic difference between these two histological growth patterns. We noted a difference in the distribution in the sense that papillary type tumours were more often organ confined and not invading into renal veins. Therefore we conclude that discrepancies in the literature regarding prognosis may be due to the fact that papillary tumours are found more often in earlier stages than clear cell cancers. European

Urology

Supplements

2 (2003) No. 1, pp. 137