Abstract OBJECTIVES: (1) to apply the use of standard PADUA and RENAL nephrometry parameters to three-dimensional virtual models (3DVMs) produced by the standard bi-dimensional imaging, creating 3D-based (PADUA and RENAL) nephrometry scores/categories (3D-NS/NC), to reclassify the surgical complexity of the renal masses; (2) to compare the new 3D-NS/NC with the standard 2D-based nephrometry scores (2D-NS/NC), in order to evaluate their predictive role for postoperative complications. MATERIALS AND METHODS: for all the patients with localized renal tumors scheduled for minimally invasive partial nephrectomy (mi-PN) from September 2016 - 2018, 3D- and 2D-NS/NC assessments were performed preoperatively. After NS/NC evaluation, all the patients underwent surgery. Chi-square test evaluated the different patient's distribution on the basis of the imaging tool (3DVMs and 2D imaging) used to assess the NS/NC, while Cohen's k coefficient tested the concordance between classifications. ROC curves have been produced to evaluate sensitivity and specificity of the 3D-NS/NC vs 2D-NS/NC in predicting the occurrence of postoperative complications. General linear model was used to perform multivariable analyses, looking for predictors of overall and major postoperative complications. RESULTS: 101 patients were included in the study. The evaluation of PADUA and RENAL scores via 3DVMs 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 NC (29.7% and 30.7% for PADUA risk and RENAL complexity categories). 3D-NS/NC demonstrated better accuracy than 2D-NS/NC in predicting overall and major postoperative complications (differences in AUCs for each NS/NC reaching statistical significance comparing 3DVMs vs 2D imaging assessment). Multivariable analyses confirmed the 3D-PADUA/RENAL NC 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 demonstrated that 3DVMs seem to be more precise than 2D standard imaging in evaluating the surgical complexity of the renal masses via NS/NC, due to a better perception of tumor depth and its relationships with intrarenal structures, as confirmed by the higher accuracy in predicting postoperative complications. This article is protected by copyright. All rights reserved.

Three-dimensional virtual imaging of renal tumours: a new tool to improve the accuracy of nephrometry scores.

Porpiglia, Francesco
First
;
Amparore, Daniele;Checcucci, Enrico;Manfredi, Matteo;Stura, Ilaria;Migliaretti, Giuseppe
Co-last
;
Fiori, Cristian
Last
2019-01-01

Abstract

Abstract OBJECTIVES: (1) to apply the use of standard PADUA and RENAL nephrometry parameters to three-dimensional virtual models (3DVMs) produced by the standard bi-dimensional imaging, creating 3D-based (PADUA and RENAL) nephrometry scores/categories (3D-NS/NC), to reclassify the surgical complexity of the renal masses; (2) to compare the new 3D-NS/NC with the standard 2D-based nephrometry scores (2D-NS/NC), in order to evaluate their predictive role for postoperative complications. MATERIALS AND METHODS: for all the patients with localized renal tumors scheduled for minimally invasive partial nephrectomy (mi-PN) from September 2016 - 2018, 3D- and 2D-NS/NC assessments were performed preoperatively. After NS/NC evaluation, all the patients underwent surgery. Chi-square test evaluated the different patient's distribution on the basis of the imaging tool (3DVMs and 2D imaging) used to assess the NS/NC, while Cohen's k coefficient tested the concordance between classifications. ROC curves have been produced to evaluate sensitivity and specificity of the 3D-NS/NC vs 2D-NS/NC in predicting the occurrence of postoperative complications. General linear model was used to perform multivariable analyses, looking for predictors of overall and major postoperative complications. RESULTS: 101 patients were included in the study. The evaluation of PADUA and RENAL scores via 3DVMs 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 NC (29.7% and 30.7% for PADUA risk and RENAL complexity categories). 3D-NS/NC demonstrated better accuracy than 2D-NS/NC in predicting overall and major postoperative complications (differences in AUCs for each NS/NC reaching statistical significance comparing 3DVMs vs 2D imaging assessment). Multivariable analyses confirmed the 3D-PADUA/RENAL NC 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 demonstrated that 3DVMs seem to be more precise than 2D standard imaging in evaluating the surgical complexity of the renal masses via NS/NC, due to a better perception of tumor depth and its relationships with intrarenal structures, as confirmed by the higher accuracy in predicting postoperative complications. This article is protected by copyright. All rights reserved.
2019
945
954
3D virtual imaging; HA3D; minimally-invasive partial nephrectomy; nephrometry scores; postoperative complications; renal cell carcinoma
Porpiglia, Francesco; Amparore, Daniele; Checcucci, Enrico; Manfredi, Matteo; Stura, Ilaria; Migliaretti, Giuseppe; Autorino, Riccardo; Ficarra, Vincenzo; Fiori, Cristian
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/2318/1711053
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