THE COMPARATIVE ANALYSIS OF RENAL INDEX EVALUATION BY RADIOLOGISTS AND UROLOGISTS IN PREDICTING PERIOPERATIVE OUTCOMES OF ORGAN-PRESERVING
INTERVENTIONS IN PATIENTS WITH LOCALIZED KIDNEY PARENCHYMAL CANCER
Izmailova A.A., Sirota E.S., Alyaev Yu.G., Adzhiev A.R., Puzakov K.B., Zholdubaev A.A.
I.M. Sechenov First Moscow State Medical University (Sechenov University). Moscow, Russia.
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urpose. Comparative analysis of R.E.N.A.L. Nephrometry Score (RENAL), Preoperative Aspects and Dimensions Used for an Anatomical (PADUA), Centrality index scoring (C-index) evaluations using radiological methods by radiologists and urologists in predicting perioperative outcomes of organ-preserving surgeries for patients with localized kidney parenchymal cancer.
Materials and Methods. The study analyzed laparoscopic resection results in 70 patients with kidney parenchymal neoplasms. RENAL, PADUA, and C-index calculations were performed by a radiologist using multislice computed tomography (MSCT) data and by a urologist based on 3D reconstructions preoperatively. The average age of patients was 55.27 (48-62) years. The mean duration of the operation was 124.7 (90-150) minutes, mean warm ischaemic time was 10.07 (0-16.2) minutes, and blood loss volume was 193.5 (100-300) ml. Postoperative complications were observed in 6 (8.6%) patients. The preoperative glomerular filtration rate (GFR) was 75.85 (62-92.5) ml/min/1.73m², and after 24 hours, it was 72.05 (58.75-83.25) ml/min/1.73m². The possibility of using nephrometry index calculations by radiologists and urologists as statistically significant predictors for warm ischaemic time <20 minutes or ≥20 minutes; operation duration <120 minutes or ≥120 minutes; blood loss volume <100 ml or ≥100 ml was assessed using univariate and multivariate logistic regression analysis.
Results. Comparative analysis of nephrometry indices using MSCT data and 3D models revealed a statistically significant difference (p < 0.0001) - average scores: RENAL3D - 7.21 (6-9), RENALMSCT - 7.82 (6-9); PADUA3D - 8.34 (7-10), PADUAMSCT - 9.38 (8-11); C-index3D - 2.98 (1.69-4.12), C-indexMSCT - 1.48 (0.8-1.8).
PADUA3D showed statistical significance in univariate (p=0.009) and multivariate (p=0.035) analysis in predicting ischaemic time ≥20 minutes. None of the indices, calculated from MSCT and 3D models, demonstrated statistical significance in univariate and multivariate analysis for predicting operation duration <120 minutes or ≥120 minutes and blood loss volume <100 ml or ≥100 ml.
Discussion. The reason for the differences in scoring between radiologists and urologists, in our opinion, is due to the fact that the calculation of some variable nephrometry indices, such as tumor size, relation to the elements of the collecting system and sinus based on 3D, is more accurate in determining compared with MSCT analysis.
Conclusion. Scoring of nephrometry indices (RENAL, PADUA, C-index) by radiology experts using 2D MSCT and by urologists based on 3D reconstructions showed statistically significant differences. The PADUA3D index exhibited better prognostic significance in predicting ischaemic time ≥20 minutes. None of the indices were statistically significant in predicting operation duration and blood loss volume. The usage of 3D reconstructions for nephrometric index calculations facilitates and simplifies scoring across all three nephrometric scales.
Keywords: multislice computed tomography; nephrometry indices; kidney cancer; 3D technologies; laparoscopy.
Corresponding author: Izmailova A.A., e-mail: Этот e-mail адрес защищен от спам-ботов, для его просмотра у Вас должен быть включен Javascript
For citation: Izmailova A.A., Sirota E.S., Alyaev Yu.G., Adzhiev A.R., Puzakov K.B., Zholdubaev A.A. The comparative analysis of renal index evaluation by radiologists and urologists in predicting perioperative outcomes of organ-preserving interventions in patients with localized kidney parenchymal cancer. REJR 2024; 14(1):110-120. DOI: 10.21569/2222-7415-2024-14-1-110-120.
Received: 19.11.23 Accepted: 18.03.24