Diagnostic performance of CT for extrarenal fat invasion in renal cell carcinoma: a meta-analysis and systematic review.

IF 4.1 2区医学 Q1 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING Insights into Imaging Pub Date : 2025-01-15 DOI:10.1186/s13244-024-01889-0

Junchao Ma, Enyu Yuan, Shijian Feng, Jin Yao, Chunlei He, Yuntian Chen, Bin Song

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Abstract

Objectives: Renal cell carcinoma (RCC) with extrarenal fat (perinephric or renal sinus fat) invasion is the main evidence for the T3a stage. Currently, computed tomography (CT) is still the primary modality for staging RCC. This study aims to determine the diagnostic performance of CT in RCC patients with extrarenal fat invasion.

Methods: The PubMed, Web of Science, Cochrane Library, and EMBASE databases were systematically searched up to October 11, 2023. Study quality was assessed by the QUADAS-2 tool. Standard methods recommended for meta-analyses of diagnostic evaluation were used. Heterogeneity was analyzed through meta-regression analysis.

Results: Fifteen studies were included in this meta-analysis. Among them, six studies focused on perinephric fat invasion (PFI) only, four on renal sinus fat invasion (RSFI) only, and five on both. Pooled weighted estimates of sensitivity, specificity, area of SROC curve, PLR, and negative likelihood ratio (NLR) of CT for PFI were 0.69 (95% CI: 0.55-0.79), 0.82 (95% CI: 0.69-0.90), 0.81 (95% CI: 0.77-0.84), 3.85 (95% CI: 2.22-6.67), and 0.38 (95% CI: 0.27-0.55). Pooled weighted estimates of sensitivity, specificity, area of SROC curve, PLR, and NLR of CT for RSFI were 0.81 (95% CI: 0.76-0.85), 0.79 (95% CI: 0.66-0.88), 0.82 (95% CI: 0.78-0.85), 3.91 (95% CI: 2.26-6.77), and 0.24 (95% CI: 0.18-0.31).

Conclusion: CT has the ability to detect the PFI and RSFI in patients with RCC. However, the diagnostic performance of CT has suffered from the limitation of slightly lower accuracy, resulting from the low positive sample in the current studies. Additionally, the current PLR is low.

Critical relevance statement: This study provides radiologists and urologists with a systematic and comprehensive summary of CT and CT-related morphological features in assessing extrarenal fat invasion in patients with RCC.

Key points: CT can detect extrarenal fat invasion in patients with RCC, but the diagnostic performance is inconsistent. The diagnostic performance of CT is acceptable, but primarily affected by the low positive rate of included patients. Further large-scale trials are necessary to determine the true diagnostic capabilities of CT for extrarenal fat invasion.

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肾细胞癌肾外脂肪浸润的CT诊断：荟萃分析和系统回顾。

目的：肾细胞癌（RCC）合并肾外脂肪（肾周或肾窦脂肪）浸润是T3a期的主要证据。目前，计算机断层扫描（CT）仍然是RCC分期的主要方式。本研究旨在探讨CT对肾外脂肪浸润的RCC患者的诊断价值。方法：系统检索截至2023年10月11日的PubMed、Web of Science、Cochrane Library和EMBASE数据库。采用QUADAS-2工具评估研究质量。采用推荐用于诊断评价荟萃分析的标准方法。meta回归分析异质性。结果：本荟萃分析纳入了15项研究。其中，6项研究仅关注肾周脂肪侵犯（PFI）， 4项研究仅关注肾窦脂肪侵犯（RSFI）， 5项研究两者皆有。CT对PFI的敏感性、特异性、SROC曲线面积、PLR和阴性似然比（NLR）的合并加权估计分别为0.69 （95% CI: 0.55-0.79）、0.82 （95% CI: 0.69-0.90）、0.81 （95% CI: 0.77-0.84）、3.85 （95% CI: 2.22-6.67）和0.38 （95% CI: 0.27-0.55）。CT对RSFI的敏感性、特异性、SROC曲线面积、PLR和NLR的合并加权估计分别为0.81 （95% CI: 0.76-0.85）、0.79 （95% CI: 0.66-0.88）、0.82 （95% CI: 0.78-0.85）、3.91 （95% CI: 2.26-6.77）和0.24 （95% CI: 0.18-0.31）。结论：CT具有检测RCC患者PFI和RSFI的能力。然而，由于目前研究中阳性样本较少，CT的诊断精度略低。此外，当前的PLR很低。关键相关性声明：本研究为放射科医生和泌尿科医生提供了评估肾细胞癌患者肾外脂肪浸润的CT和CT相关形态学特征的系统和全面总结。重点：CT可以发现肾外脂肪浸润，但诊断表现不一致。CT的诊断性能是可以接受的，但主要受纳入患者的低阳性率的影响。需要进一步的大规模试验来确定CT对肝外脂肪浸润的真正诊断能力。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Insights into Imaging Medicine-Radiology, Nuclear Medicine and Imaging

CiteScore

7.30

自引率

4.30%

发文量

182

审稿时长

13 weeks

期刊介绍： Insights into Imaging (I³) is a peer-reviewed open access journal published under the brand SpringerOpen. All content published in the journal is freely available online to anyone, anywhere! I³ continuously updates scientific knowledge and progress in best-practice standards in radiology through the publication of original articles and state-of-the-art reviews and opinions, along with recommendations and statements from the leading radiological societies in Europe. Founded by the European Society of Radiology (ESR), I³ creates a platform for educational material, guidelines and recommendations, and a forum for topics of controversy. A balanced combination of review articles, original papers, short communications from European radiological congresses and information on society matters makes I³ an indispensable source for current information in this field. I³ is owned by the ESR, however authors retain copyright to their article according to the Creative Commons Attribution License (see Copyright and License Agreement). All articles can be read, redistributed and reused for free, as long as the author of the original work is cited properly. The open access fees (article-processing charges) for this journal are kindly sponsored by ESR for all Members. The journal went open access in 2012, which means that all articles published since then are freely available online.