Rationale and Objectives
To assess whether r__2 \* values can be used to determine the nuclear grade of clear cell renal cell carcinomas (CRCC).
Materials and Methods
A total of 26 patients with pathologically proven CRCCs underwent blood oxygen level-dependent magnetic resonance imaging. r__2 \* values were determined for the solid components of CRCC lesions. Histological nuclear grade was determined for each lesion. All patients were divided into low- and high-grade groups. r__2 \* values were compared between different grades and between low- and high- grade groups. Receiver operating characteristic curve was drawn to establish the cutoff point for r__2 \* values. The correlation between r__2 \* values and pathological groups was assessed.
Results
Low-grade group (grades I + II) contained 17 cases and high-grade group (grades III + IV) contained nine cases. The intraclass correlation coefficient for r__2 \* values was 0.89. Significant difference was seen between different grades ( P < .005). r__2 \* values of the high-grade group were higher than the low-grade group ( P < .005). A sensitivity of 78% and a specificity of 100% were achieved with a cutoff of 31.87 seconds −1 . r__2 \* values directly correlated with pathological groups ( P < .005).
Conclusion
r__2 \* values of CRCCs could be employed as a noninvasive biomarker to help classify the nuclear grade of CRCC.
Introduction
Renal cell carcinoma (RCC) is the most common type of primary renal malignancy in adults, responsible for approximately 85%–90% of cases . Clear cell renal cell carcinoma (CRCC) is the most common histological subtype of RCCs, accounting for 75%–88% of RCCs . Patients with CRCC tend to have a worse prognosis than patients with other subtypes of RCC .
Tumor stage and nuclear grade are two different approaches used to predict prognosis of CRCC. Tumor stage correlates with 5-year recurrence-free survival rate, but it cannot predict prognosis of patients within the same stage . Because more early-stage RCCs are being discovered incidentally with modern imaging techniques, differentiating tumors with aggressive behavior at an early stage is very crucial. Fuhrman nuclear grade is the most widely used to determine histological grade of RCC and correlates closely with growth rate and prognosis of CRCCs . Five-year survival rates of RCCs decrease stepwise in ascending order of Fuhrman nuclear grade . In addition, in cases of extensive nonresectable tumors, nuclear grades are necessary for deciding targeted therapy .
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Materials and methods
Ethics Statement
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Subjects
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MRI Examinations
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Imaging Analysis
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r2⋆=1/T2⋆ r
2
⋆
=
1
/
T
2
⋆
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Histological Analysis
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Statistical Analyses
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Results
Histological Results
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Size
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Table 1
Tumor Sizes Distributed according to Fuhrman Grade
Tumor Sizes Fuhrman Grade I II III IV ≤4 cm 3 7 3 1 >4 cm but ≤7 cm 2 2 2 0 >7 cm but ≤10 cm 0 3 2 0 >10 cm 0 0 1 0
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r 2 \* Results
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Table 2
r__2 \* Values of Different Tumor Grades (seconds −1 )
Pathological Grade Number of Cases_r__2_ \* Value; Mean ± SD (95% CI) Observer 1 Observer 2 I 5 17.50 ± 5.18 (11.06–23.93) 14.27 ± 4.85 (8.29–20.30) II 12 22.77 ± 7.20 (18.20–27.35) 22.92 ± 7.58 (13.51–32.34) III 8 36.98 ± 8.68 (29.73–44.25) 30.78 ± 9.73 (18.70–42.86) IV 1 63.93 68.49 Low grade 17 21.22 ± 6.96 (17.64–24.80) 17.73 ± 7.44 (12.01–23.46) High grade 9 39.98 ± 12.11 (30.67–49.29) 37.65 ± 14.09 (26.82–48.49)
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Discussion
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