腎癌ステージングにおける血管像の意義

Abstract

Radiographic findings were analyzed in 51 cases of renal cell carcinoma. There were found 2 cases (3.9%) of calcified tumor, 4 cases (7.8%) of non-functioning kidney, 4 cases (7.8%) of arteriographically observed avascular tumor and 10 cases (19.6%) of massive arteriovenous fistula, and the rate of accurate diagnosis obtained by collective X-ray examinations including arteriography was 96.1% (49 cases). The clinical stage judged preoperatively by angiography was compared with the pathological stage determined postoperatively in 46 cases and an agreement between them was observed in 58.7 per cent of the cases. Tumor invasion of the renal capsule (Stage II) was demonstrated only in 42.1 per cent of the cases in which parasitic arteries appeared, and the reliability of the sign of parasitic arteries on the renal capsular invasion proved to be low as previously reported by other authors. However, from the fact that the survival rate of the overdiagnosed patients were tended to be lower than that of the patients who were pathologically diagnosed to be in Stage I, it was considered that prognostic meaning of parasitic arteries should be investigated further. An appearance of collateral veins or the striated vascular pattern coincided with the spread of renal carcinoma into the renal vein and vena cava in 85.7 per cent of the case, and angiographic manifestation were considered to be significant in the judgment of Stage III.