Evaluation of contrast-enhanced ultrasound for predicting tumor grade in small (≤4 cm) clear cell renal cell carcinoma: Qualitative and quantitative analysis

Article type: Research Article

Authors: Liang, Ming^{a; b} | Qiu, Haolin^{a; b} | Ou, Bing^{a; b} | Wu, Jiayi^{a; b} | Zhao, Xinbao^{a; b; 1} | Luo, Baoming^{a; b; 1; *}

Affiliations: [a] Department of Ultrasound, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, Guangdong, China | [b] Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Medical Research Center, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China

Correspondence: [*] Correspondence to: Luo Baoming. Department of Ultrasound, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, No. 107 Yanjiang Road West, Guangzhou, 510120, China. Tel.: +86 18922182816; E-mail: [email protected].

Note: [1] Xinbao Zhao and Baoming Luo are considered co-corresponding authors.

Abstract: OBJECTIVE:The study aimed to evaluate the utility of qualitative and quantitative analysis employing contrast-enhanced ultrasound (CEUS) in predicting the WHO/ISUP grade of small (≤4 cm) clear cell renal cell carcinoma (ccRCCs). METHODS:Patients with small ccRCCs, confirmed by histological examination, underwent preoperative CEUS and were classified into low- (grade I/II) and high-grade (grade III/IV) groups. Qualitative and quantitative assessments of CEUS were conducted and compared between the two groups. Diagnostic performance was assessed using receiver operating characteristic curves. RESULTS:A total of 72 patients were diagnosed with small ccRCCs, comprising 23 individuals in the high-grade group and 49 in the low-grade group. The low-grade group exhibited a significantly greater percentage of hyper-enhancement compared to the high-grade group (79.6% VS 39.1%, P < 0.05). The low-grade group showed significantly higher relative index values for peak enhancement, wash-in area under the curve, wash-in rate, wash-in perfusion index, and wash-out rate compared to the high-grade group (all P < 0.05). The AUC values for qualitative and quantitative parameters in predicting the WHO/ISUP grade of small ccRCCs ranged from 0.676 to 0.756. CONCLUSIONS:Both qualitative and quantitative CEUS analysis could help to distinguish the high- from low-grade small ccRCCs.

Keywords: Contrast-enhanced ultrasound, WHO/ISUP grade, clear cell renal cell carcinoma, quantitative analysis, small renal mass

DOI: 10.3233/CH-231990

Journal: Clinical Hemorheology and Microcirculation, vol. 88, no. 3, pp. 351-362, 2024