Premium
Three‐dimensional virtual imaging of renal tumours: a new tool to improve the accuracy of nephrometry scores
Author(s) -
Porpiglia Francesco,
Amparore Daniele,
Checcucci Enrico,
Manfredi Matteo,
Stura Ilaria,
Migliaretti Giuseppe,
Autorino Riccardo,
Ficarra Vincenzo,
Fiori Cristian
Publication year - 2019
Publication title -
bju international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.773
H-Index - 148
eISSN - 1464-410X
pISSN - 1464-4096
DOI - 10.1111/bju.14894
Subject(s) - medicine , nephrectomy , concordance , radiology , renal tumor , surgery , kidney
Objectives To apply the standard PADUA and RENAL nephrometry score variables to three‐dimensional (3D) virtual models ( VM s) produced from standard bi‐dimensional imaging, thereby creating three‐dimensional (3D)‐based ( PADUA and RENAL ) nephrometry scores/categories for the reclassification of the surgical complexity of renal masses, and to compare the new 3D nephrometry score/category with the standard 2D‐based nephrometry score/category, in order to evaluate their predictive role for postoperative complications. Materials and Methods All patients with localized renal tumours scheduled for minimally invasive partial nephrectomy ( PN ) between September 2016 and September 2018 underwent 3D and 2D nephrometry score/category assessments preoperatively. After nephrometry score/category evaluation, all the patients underwent surgery. Chi‐squared tests were used to evaluate the individual patients’ grouping on the basis of the imaging tool (3 D VM s and 2D imaging) used to assess the nephrometry score/category, while Cohen's κ coefficient was used to test the concordance between classifications. Receiver‐operating characteristic curves were produced to evaluate the sensitivity and specificity of the 3D nephrometry score/category vs the 2D nephrometry score/category in predicting the occurrence of postoperative complications. A general linear model was used to perform multivariable analyses to identify predictors of overall and major postoperative complications. Results A total of 101 patients were included in the study. The evaluation of PADUA and RENAL nephrometry scores via 3D VM s showed a downgrading in comparison with the same scores evaluated with 2D imaging in 48.5% and 52.4% of the cases. Similar results were obtained for nephrometry categories (29.7% and 30.7% for PADUA risk and RENAL complexity categories, respectively). The 3D nephrometry score/category demonstrated better accuracy than the 2D nephrometry score/category in predicting overall and major postoperative complications (differences in areas under the curve for each nephrometry score/category were statistically significant comparing the 3 D VM s with 2D imaging assessment). Multivariable analyses confirmed 3D PADUA / RENAL nephrometry category as the only independent predictors of overall ( P = 0.007; P = 0.003) and major postoperative complications ( P = 0.03; P = 0.003). Conclusions In the present study, we showed that 3 D VM s were more precise than 2D standard imaging in evaluating the surgical complexity of renal masses according to nephrometry score/category. This was attributable to a better perception of tumour depth and its relationships with intrarenal structures using the 3D VM, as confirmed by the higher accuracy of the 3D VM in predicting postoperative complications.