Clinical application of conventional and contrast-enhanced ultrasound in the diagnosis of renal tumor with venous thrombus by “301 classification” system
LI Qiuyang1, LI Nan1, HUANG Qingbo2, PENG Cheng2, MA Xin2, ZHANG Xu2, LUO Yukun1, TANG Jie1
1Department of Ultrasound, Chinese PLA General Hospital, Beijing 100853, China; 2Department of Urology, Chinese PLA General Hospital
Abstract：objective： To explore the clinical value of conventional ultrasound and contrast-enhanced ultrasound in the diagnosis of renal tumors with venous thrombus by "301 classification system". Methods： A retrospective analysis was made on 80 cases of renal tumors with venous thrombus from January 2016 to December 2018. Among the 80 cases of renal tumors with venous thrombus, 62 were males and 18 were females, with a median age of 55.5 years (24-86 years). There were 30 cases of renal tumors on the left and 50 cases on the right. All patients were examined by conventional ultrasound and contrast-enhanced ultrasound before operation. All patients were graded according to "301 classification system" by conventional ultrasound. By contrast-enhanced ultrasound, whether venous tumor thrombus combined with thrombus or not was judged. Nineteen of the 80 patients received preoperative targeted therapy, and these patients were examined by conventional ultrasound and contrast-enhanced ultrasound before and after treatment. The size of primary tumors, the height of intravenous tumor thrombus and the necrosis of primary tumors and tumor thrombus were compared before and after treatment, and the efficacy of preoperative targeted therapy was evaluated. Results： The patients were graded according to "301 classification system" by conventional ultrasound. There were 5 cases of grade 0 (right), 4 cases of grade 0A (left), 3 cases of grade 0b (left), 22 cases of gradeⅠ, 33 cases of grade Ⅱ, 7 cases of grade Ⅲ and 46 cases of grade Ⅳ. By contrast-enhanced ultrasound, bland thrombus was found in 12 patients with vena cava tumor thrombus. The bland thrombus was located in the proximal end of the tumor thrombus in 4 cases and in the distal end of the tumor thrombus in 8 cases. Ultrasonography was performed on 19 patients receiving targeted therapy before and after treatment. The maximum diameter of tumor thrombus was reduced by 0.35 cm (0.29-1.45 cm), the height of tumor thrombus was reduced in 11 cases, the grade of tumor thrombus was reduced in 4 cases, and necrosis was seen in 14 cases of primary tumor and tumor thrombus. All patients recovered well and discharged after operation. Postoperative pathology revealed clear cell carcinoma in 60 cases, papillary cell carcinoma in 7 cases, angiomyolipoma in 4 cases and other types in 9 cases. Conclusion： Conventional ultrasound and contrast-enhanced ultrasound are of great significance in the diagnosis of renal tumors with venous tumor thrombus according to "301 classification system" and in the differential diagnosis of tumor thrombus and bland thrombus, as well as in the evaluation of therapeutic effect for patients receiving targeted therapy.
李秋洋, 李楠, 黄庆波, 彭程, 马鑫, 张旭, 罗渝昆, 唐杰. 常规超声与超声造影在肾肿瘤伴静脉瘤栓“301分级系统”诊断中的临床应用研究[J]. 微创泌尿外科杂志, 2019, 8(6): 365-370.
LI Qiuyang, LI Nan, HUANG Qingbo, PENG Cheng, MA Xin, ZHANG Xu, LUO Yukun, TANG Jie. Clinical application of conventional and contrast-enhanced ultrasound in the diagnosis of renal tumor with venous thrombus by “301 classification” system. JOURNAL OF MINIMALLY INVASIVE UROLOGY, 2019, 8(6): 365-370.
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