Surgical margin follow-up after nephron-sparing surgery: the possible role of CEUS
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ORIGINAL ARTICLE
Surgical margin follow‑up after nephron‑sparing surgery: the possible role of CEUS Elena Bertelli1,2 · Laura Mercatelli1 · Elena Savi1 · Alessandro Pili3 · Silvia Verna1 · Alberto Palombella1 · Davide Caramella4 · Andrea Minervini3 · Sergio Serni3 · Simone Agostini1 · Vittorio Miele1 Received: 16 August 2019 / Accepted: 25 October 2019 © Società Italiana di Ultrasonologia in Medicina e Biologia (SIUMB) 2019
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
Introduction Renal tumors are the third most frequent malignant cancers in urologic patients, representing 2–3% of all cancers in Western countries. Incidence peak is between 60 and 70 years old, with male prevalence (1.5:1). Specific risk * Elena Bertelli [email protected] 1
Department of Radiology, Careggi University Hospital, Florence, Italy
2
Clinical and Translational Sciences, University of Pisa, Florence, Italy
3
Department of Urologic Robotic Surgery and Renal Transplantation, Careggi Hospital, University of Florence, Florence, Italy
4
Diagnostic and Interventional Radiology, University of Pisa, Florence, Italy
factors associated with renal cell cancer have not yet been determined, though some environmental factors, smoking and obesity have been strongly correlated [1]. Genetic syndromes have been recognized as leading to an elevated incidence for specific forms of RCCs [2]. The most frequent sp
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