Chest CT Scan Should Be Used As Preoperative Routine Examination In T2 RCC

Objectives:By discussing the preoperative diagnostic methods in T2 stage Renal Cell Carcinoma (RCC) patients with pulmonary metastases. to improve the survival rate of the patients.Method:We have collected clinical data from 70 patients of T2 stage primary RCC for retrospective analysis. There are 54 males and 16 females. Their ages distribute from 20 to 75, with an average of 55. All patients had chest X-ray check and chest CT scans before operation. The preoperative diagnosis of all the patients is T2 stage according to the new TNM staging standard by UICC/AJCC in 2009, in which 59 patients belong to T2aN0 stage and 11 patients belong to T2bN0 stage.67 patients had radical nephrectomy in Cancer Hospital, and the rest 3 had renal tumor puncture biopsy under type-B ultrasound guidance insead of operation. All the patients got pathological results.2 patients had subsequent operation to resect lung metastases, and the lung nodules were proved to be clear cell renal cell carcinoma by pathology. In the end, we calculate the value of Kappa by reliable statistical analysis.Results:70 pathological sections are diagnosed by pathology department of Cancer Hospital:64 cases belong to clear cell renal cell carcinoma,3 cases belong to papillary renal cell carcinoma, and 3 cases belong to chromophobe renal cell carcinoma.21 cases,30% of total 70 cases, diagnosed lung metastasis by chest X-ray and CT scan. Among 21 cases,19 cases account for 32,2% in the total 59 T2aN0 stage cases, and 2 cases account for 18.2% in the total 11 T2bN0 stage cases. The chest X-ray results of 59 patients are consistent with their CT scans, in which 49 patients had two negative results-no lung metastasis both in X-ray and CT, and 10 patients (8 T2aN0 stage,2 T2bN0 stage)had two positive results-find lung metastasis both in X-ray and CT. The other 11 patients’ X-ray rusults are not consistent with their chest CT scans-their X-ray results are normal but CT found lung metastasis. All of the 11 belong to T2aN0 stage. Conversely, none of the patients had positive X-ray results and negative CT results. In total, the patients with negative X-ray results and positive CT results account for 15.7% in 70 patients -the value of Kappa is 0.56, mezzo consistency. There are 11 cases (18.6%) with negative X-ray results but positive CT results in 59 T2aN0 stage patients. All the pathological results of 21 patients with lung metastasis found by chest CT scans were clear cell renal cell carcinoma.Conclusion:Comparing with chest X-ray examination, chest CT scan can obviously improve the accuracy of diagnosis in pulmonary metastases. It is necessary to take chest CT scan to judge whether pulmonary metastases exist, in turn to classify preoperative stage of T2N0 RCC patients. Therefore, we recommend chest CT scan as preoperative routine examination for T2N0 stage RCC patients.