超声造影在肾透明细胞癌与尿路上皮癌鉴别诊断中的价值

doi:10.11958/20222041

天津医药 ›› 2023, Vol. 51 ›› Issue (5): 540-543.doi: 10.11958/20222041

超声造影在肾透明细胞癌与尿路上皮癌鉴别诊断中的价值

冯连云¹^,²(), 田晶¹^,^△(), 王光霞³, 刘甚佳¹, 王红², 庞丽娜²

1.天津医科大学第二医院（邮编300211）
2.天津市河东区中山门街社区卫生服务中心
3.天津市南开医院

收稿日期:2022-12-08 修回日期:2023-01-16 出版日期:2023-05-15 发布日期:2023-05-05
通讯作者: △E-mail:13821777622@163.com
作者简介:冯连云（1981），女，硕士在读，主要从事泌尿系统超声方面研究。E-mail：fenglianyun1111@163.com

Value of contrasten hanced ultrasound in the differential diagnosis of renal clear cell carcinoma and urothelial carcinoma

FENG Lianyun¹^,²(), TIAN Jing¹^,^△(), WANG Guangxia³, LIU Shenjia¹, WANG Hong², PANG Lina²

1. The Second Hospital of Tianjin Medical University, Tianjin 300211, China
2. Zhongshanmenjie Community Health Service Center, Hedong Districct of Tianjin
3. Tianjin Nankai Hospital

Received:2022-12-08 Revised:2023-01-16 Published:2023-05-15 Online:2023-05-05
Contact: △E-mail:13821777622@163.com

冯连云, 田晶, 王光霞, 刘甚佳, 王红, 庞丽娜. 超声造影在肾透明细胞癌与尿路上皮癌鉴别诊断中的价值[J]. 天津医药, 2023, 51(5): 540-543.

FENG Lianyun, TIAN Jing, WANG Guangxia, LIU Shenjia, WANG Hong, PANG Lina. Value of contrasten hanced ultrasound in the differential diagnosis of renal clear cell carcinoma and urothelial carcinoma[J]. Tianjin Medical Journal, 2023, 51(5): 540-543.

摘要/Abstract

摘要：

目的应用超声造影观察肾内型肾透明细胞癌与尿路上皮癌的血流灌注特点，探讨其鉴别诊断价值。方法收集经病理证实的肾内恶性肿瘤患者105例，其中肾透明细胞癌57例，尿路上皮癌48例。对患者进行常规超声及超声造影检查，比较2组间常规超声下的长径和回声特点；超声造影的增强时间差、增强达峰时间差、增强模式及增强强度；采用受试者工作特征（ROC）曲线分析增强时间差、增强达峰时间差对肾内肿瘤的诊断价值。结果肾透明细胞癌组最大长径长于尿路上皮癌组（P<0.01）,常规超声均以低回声为主；肾透明细胞癌组增强时间差和增强达峰时间差短于尿路上皮癌组（P<0.05）。2组造影后肿物增强模式均以快进快退为主，2组增强强度差异有统计学意义（P<0.01）。ROC曲线提示增强时间差鉴别诊断肾透明细胞癌与尿路上皮癌的效能优于增强达峰时间差（Z=3.600，P<0.01）。结论超声造影可以作为常规超声在鉴别肾透明细胞癌和尿路上皮癌的重要补充。

关键词: 癌,肾细胞, 尿道肿瘤, 超声造影, 鉴别诊断

Abstract:

Objective To observe blood perfusion characteristics of renal clear cell carcinoma and urothelial carcinoma by contrasten hanced ultrasound, and to explore their differential diagnostic value. Methods A total of 105 patients with renal malignant tumor confirmed by pathology were collected, including 57 cases of renal clear cell carcinoma and 48 cases of urothelial carcinoma. Conventional ultrasound and contrast-enhanced ultrasound were performed to compare the length diameter and echo characteristics of conventional ultrasound between the two groups. Enhancement time difference, enhancement peak time difference, enhancement mode and enhancement intensity of contrast-enhanced ultrasound were also compared between the two groups. Receiver operating characteristic curve (ROC) was used to analyze the diagnostic value of enhanced time difference and enhanced peak time difference for intrarenal tumors. Results The mean length diameter of the renal clear cell carcinoma group was longer than that of the urothelial carcinoma group (P<0.01). The enhancement time difference was shorter in the renal clear cell carcinoma group than that in the urothelial carcinoma group, and the enhancement peak time difference was shorter than that in the urothelial carcinoma group (P<0.05). There was no significant difference in the enhancement pattern between the two groups after angiography. The enhancement pattern of the tumor after angiography was mainly rapid advance and rapid retreat in the two groups. There was significant difference in enhancement intensity between the two groups (P<0.01). The ROC curve suggested that enhanced time difference was more effective than enhanced time difference in the differential diagnosis of renal clear cell carcinoma and uroepithelial carcinoma (Z=3.600，P<0.01). Conclusion Contrast enhanced ultrasound can be used as an important supplement to conventional ultrasound in differentiating renal clear cell carcinoma from urothelial carcinoma.

Key words: carcinoma, renal cell, urethral neoplasms, ultrasound contrast, differential diagnosis

中图分类号:

R692.9，R445.1

图/表 4

表1 2组超声造影肿物增强模式比较

Tab.1 Comparison of enhancement patterns of contrast enhanced ultrasound between the clear cell carcinoma group and the urothelial carcinoma group

组别	n	快进快退	等进快退	慢进快退	快进慢退
肾透明细胞癌组	57	38（66.7）	11（19.3）	6（10.5）	2（3.5）
尿路上皮癌组	48	35（72.9）	2（4.2）	9（18.8）	2（4.2）
χ²	6.228

表2 2组超声造影肿物增强强度比较

Tab.2 Comparison of contrast enhanced ultrasound intensity between the clear cell carcinoma group and the urothelial carcinoma group

组别	n	低增强	等增强	高增强
肾透明细胞癌组	57	4（7.0）	26（45.6）	27（47.4）
尿路上皮癌组	48	27（56.3）	13（27.1）	8（16.7）
χ²	31.170^＊＊

图1 肾透明细胞癌与尿路上皮癌超声造影图像表现肾透明细胞癌突向肾窦内，压迫肾窦（左图）；尿路上皮癌向心性生长侵及肾实质（右图）

Fig.1 Contrast-enhanced ultrasound imaging of renal clear cell carcinoma and urothelial carcinoma

图2 超声造影指标对肾透明细胞癌与尿路上皮癌鉴别诊断的ROC曲线

Fig.2 ROC curve of contrast enhanced ultrasound index in differential diagnosis of renal clear cell carcinoma and urothelial carcinoma

参考文献 20

[1]	RICJETTS C J, CROOKS D R, SOURBIER C, et al. SnapShot:Renal cell carcinoma[J]. Cancer Cell, 2016, 29(4):610-610.e1. doi:10.1016/j.ccell.2016.03.021.
[2]	WANG Y, JI H, ZHU B, et al. Molecular subtypes based on metabolic genes are potential biomarkers for predicting prognosis and immune responses of clear cell renal cell carcinoma[J]. Eur J Immunol, 2023, 53(1):e202250105. doi:10.1002/eji.202250105.
[3]	DING Y, XIONG S, CHEN X, et al. HAPLN3 inhibits apoptosis and promotes EMT of clear cell renal cell carcinoma via ERK and Bcl-2 signal pathways[J]. J Cancer Res Clin Oncol, 2023, 149(1):79-90. doi:10.1007/s00432-022-04421-3.
[4]	程金庆, 李文贵. MDCT在肾盂癌和肾癌鉴别诊断中的价值[J]. 国际医学放射学杂志, 2019, 42(1):41-44.
	CHENG Q J, LI W G. Value of multidetector CT in differentiating renal pelvic carcinoma and renal carcinoma[J]. Int J Med Radiol, 2019, 42(1):41-44. doi:10.19300/j.2019.L6231.
[5]	晏琦旻, 阎倩, 魏晓. 腹腔镜肾部分切除术和肾癌根治术治疗T1b期肾癌患者的临床效果比较[J]. 国际泌尿系统杂志, 2022, 42(4):620-623.
	YAN Q W, YAN Q, WEI X. Comparison of clinical effects of laparoscopic partial nephrectomy and radical nephrectomy in patients with stage T1b renal cancer[J]. International Journal of Urology and Nephrology, 2022, 42(4):620-623. doi:10.3760/cma.j.cn431460-20201109-00167.
[6]	TAKARA M, KUMAGAI M, TSUBATA Y, et al. A surgical case of high-grade urothelial carcinoma of the renal pelvis complicated with giant hydronephrosis,giving rise to diagnostic difficulties on a cytological examination[J]. Diagn Pathol, 2022, 17(1):47. doi:10.1186/s13000-022-01227-2.
[7]	王淑颖, 王运兰, 陈耀康, 等. 肾实质型肾盂癌多层螺旋CT增强扫描的影像表现[J]. 医学信息, 2020, 33(24):97-100.
	WANG S Y, WANG Y L, CHEN Y K, et al. The imaging manifestations of enhanced multi-slice spiral CT in renal parenchymal renal pelvis carcinoma[J]. Medical Information, 2020, 33(24):97-100. doi:10.3969/j.issn.1006-1959.2020.24.026.
[8]	魏海彬, 缪嘉, 张琦, 等. 单机位机器人辅助腹腔镜下肾盂癌根治术治疗肾盂肿瘤的效果观察[J]. 中华全科医学, 2022, 20(1):39-42,71.
	WEI H B, MIU J, ZHANG Q, et al. Clinical observation of single-docking robot-assisted laparoscopic radical nephroureterectomy for renal pelvic carcinoma[J]. Chinese Journal of General Practice, 2022, 20(1):39-42,71. doi:10.16766/j.cnki.issn.1674-4152.002271.
[9]	胡晓明. 128层螺旋CT增强检查对肾癌及肾盂癌的诊断及鉴别[J]. 中国继续医学教育, 2021, 13(2):130-132.
	HU X M. Diagnosis and differential diagnosis of renal carcinoma and renal pelvis carcinoma by 128 slice spiral CT[J]. China Continuing Medical Education, 2021, 13(2):130-132. doi:10.3969/j.issn.1674-9308.2021.02.035.
[10]	钟文成, 牛浩. 计算机断层扫描多期扫描诊断及鉴别肾占位性病变的效果[J]. 深圳中西医结合杂志, 2021, 31(16):104-105.
	ZHONG W C, NIU H. The effect of multiphase computed tomography in the diagnosis and differentiation of renal space occupying lesions[J]. Shenzhen Journal of Integrated Traditional Chinese and Western Medicine, 2021, 31(16):104-105. doi:10.16458/j.cnki.1007-0893.2021.16.043.
[11]	吴江锋, 赵安莉, 葛丽芳, 等. 超声造影对小肾肿瘤诊断价值的Meta分析[J]. 临床超声医学杂志, 2019, 21(6):430-434.
	WU J F, ZHAO A L, GE L F, et al. Diagnostic value of contrast-enhanced ultrasound for small renal masses:a Meta-analysis[J]. J Clin Ultrasound in Med, 2019, 21(6):430-434. doi:10.16245/j.cnki.issn1008-6978.2019.06.010.
[12]	ROUPRÊT M, BABJUK M, BURGER M, et al. European Association of Urology Guidelines on Upper Urinary Tract Urothelial Carcinoma:2020 Update[J]. Eur Urol, 2021, 79(1):62-79. doi:10.1016/j.eururo.2020.05.042.
[13]	程力. 不同类型肾脏占位病变的超声造影特征及其诊断价值探讨[J]. 放射学实践, 2016, 31(1):89-92.
	CHENG L. Characteristics and diagnostic value of contrast enhanced ultrasonography in various kidney space occupying lesions[J]. Radiolol Practice, 2016, 31(1):89-92. doi:10.13609/j.cnki.1000-0313.2016.01.021.
[14]	李秋洋, 李楠, 王一茹, 等. 超声造影在泌尿系统肿瘤诊断中的应用[J]. 中华肾病研究电子杂志, 2018, 7(5):220-223.
	LI Q Y, LI N, WANG Y R, et al. Application of contrast-enhanced ultrasound in the diagnosis of urinary tumors[J]. Chin J Kidney Dis Invest(Electronic Edition), 2018, 7(5):220-223. doi:10.3887/cma.j.issn.2095-3216.2018.05.007.
[15]	李秋洋. 超声在肾脏肿瘤等疾病诊治中的应用[J]. 中华肾病研究电子杂志, 2021, 10(5):300.
	LI Q Y. Application of ultrasound in diagnosis and treatment of renal tumors and other diseases[J]. Chin J Kidney Dis Invest(Electronic Edition), 2021, 10(5):300. doi:10.3877/cma.j.issn.2095-3216.2021.05.013.
[16]	张豪亭, 陈龙龙, 杨银涛. 不同手术方式治疗肾盂、输尿管癌的疗效对比[J]. 实用癌症志, 2022, 37(7):1161-1164.
	ZHANG H T, CHEN L L, YANG Y T. Efficacy comparison of different surgical methods in the treatment of renal pelvis and ureteral cancer[J]. The Practical Journal of Cancer, 2022, 37(7):1161-1164. doi:10.3969/j.issn.1001-5930.2022.07.029.
[17]	孙丽华, 陈蕴宝, 程刚, 等. 常规超声联合超声造影对肾盂癌患者的诊断价值[J]. 医疗装备, 2015, 28(17):6-7.
	SUN L H, CHEN Y B, CHENG G, et al. Diagnostic value of conventional ultrasound combined with contra-enhanced ultrasound in patients with renal pelvis cancer[J]. Medical Equipment, 2015, 28(17):6-7. doi:10.3969/j.issn.1006-1959.2020.24.026.
[18]	MANINI C, LÓPEZ J I. Pathology and the evolutionary dynamics of clear cell renal cell carcinoma[J]. Transl Oncol, 2023, 27:101601. doi:10.1016/j.tranon.2022.101601.
[19]	汪朝阳, 黄鹏飞, 张晴, 等. 常规超声结合超声造影诊断肾占位性病变的价值[J]. 东南国防医药, 2021, 23(5):479-483.
	WANG C Y, HUANG P F, ZHANG Q, et al. The value of conventional ultrasound combined with contrast-enhanced ultrasound in the diagnosis of renal space occupying lesions[J]. Military Medical Journal of Southeast China, 2021, 23(5):479-483. doi:10.3969/j.issn.1672-271X.2021.05.007.
[20]	王元元, 朱嘉宁, 李静波, 等. 常规超声及超声造影诊断小肾肿瘤的价值[J]. 中国超声医学杂志, 2022, 38(7):803-806.
	WANG Y Y, ZHU J N, LI J B, et al. The value of ultrasonography and contrast-enhanced ultrasonography in the diagnosis of small renal masses[J]. Chin J of Ultrasound Med, 2022, 38(7):803-806. doi:10.3969/j.issn.1002-0101.2022.07.024.

超声造影在肾透明细胞癌与尿路上皮癌鉴别诊断中的价值

Value of contrasten hanced ultrasound in the differential diagnosis of renal clear cell carcinoma and urothelial carcinoma

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