腎細胞癌のStage診断 --術前評価と手術所見の比較検討--

Abstract

1973年1月より11年間に当科で手術し病理組織学的にstageの確認された腎細胞癌のうち遠隔転移症例を除く52例を対象として, 腎動脈造影(49例), CTスキャン(19例), エコー(15例)による術前stage診断と手術病理所見によるstage診断とを比較検討した.1)被膜の浸潤の診断にはCTスキャンがもっとも有効である.2)静脈浸潤の診断にはCTスキャン, エコーが有用である.腎動脈造影も詳細に読影すれば高率に判定可能である.3)局所リンパ節転移に関してはCTスキャン, リンパ管造影に頼らざるを得ない.4)局所的なstage診断についてはCTスキャンのみで診断可能と考える.診断率をあげるためには補助診断として各種検査を併用した方が良い

Fifty-two cases of renal cell carcinoma (cases with metastatic episode during follow-up period excluded) operated on and whose pathohistological staging had been established at our department clinic during a period of 11 years from January 1973 to December 1983 were studied. Renal arteriography i.e., selective renal arteriography, aortography, was performed on 49 cases, and CT scan and ultrasonic examination were performed on 19 and 15 cases, respectively for analytical comparison of the preoperative staging with the postoperative staging as based on the operative or pathological findings (Robson et al.). Staging was found correct in 33 of the 49 cases (67.3%) by arteriography and 16 of the 19 cases (84.2%) by CT scan. In the current study, ultrasonic assessment was possible only in those cases of venous infiltrations i.e., tumor embolism affecting the renal vein or the vena cava inferior. Most effective in the cases with extracapsular infiltrations or localized lymph node metastases was the CT scan. Correct diagnosis was also possible in 6 of the 8 cases (75%) with venous infiltrations if the arteriograms had been analysed in detail, and both the CT scan and the ultrasonic examination proved effective in this type of cases as well. These findings may suggest that the CT scan alone is sufficient for making a localized staging.