Frequency and radiological characteristics of previously overlooked renal cell carcinoma

• Background: A majority of renal tumors are incidentally detected and may therefore have been previously radiologically overlooked. Purpose: To investigate the frequency of previously radiologically overlooked renal cell carcinoma (RCC), identify tumor characteristics and imaging factors that contribute to misdiagnoses and to investigate its consequences. Material and Methods: All RCCs identified in a regional cancer registry over one year were retrieved (n = 87). All preceding radiological examinations were re-analyzed for overlooked RCCs. Results: RCCs had been previously overlooked in 18 (21%) of the 87 patients (on 26 examinations: computed tomography [CT] = 16, magnetic resonance imaging [MRI] = 5, urography = 3, ultrasound = 2) or 18 (43%) of the 42 patients who had earlier radiological examinations. Overlooked RCCs were smaller than non-overlooked RCCs (median = 23 mm; range = 10–45 mm vs. 65 mm; range = 13–207 mm) (P < 0.0001), more frequently located in upper pole, 50% vs. 26% (P = 0.0836), and more frequently homogenous, 50% vs. 9% (P = 0.0003). There was no difference in exophytic growth (60% vs. 60%) (P = 0.74). Overlooked RCCs displayed poorer visualization on CT/MRI in all image planes (axial, coronal, sagittal) compared to non-overlooked tumors (P = 0.004, P = 0.001, P < 0.0001, respectively). Overlooked tumors had interval size progression of median 12 mm (range = 0–65 mm) to clinical detection (median = 1033 days). Conclusions: RCCs are frequently overlooked at imaging in the clinical routine. Overlooked tumors were smaller and displayed poorer visualization in all image planes compared to non-overlooked tumors. Substantial delay to clinical diagnosis and variable size progression was noted. Careful attention to the kidneys in multiple image planes seems warranted, irrespective of clinical indication. © The Foundation Acta Radiologica 2019.

Ämnesord

MEDICIN OCH HÄLSOVETENSKAP  -- Klinisk medicin -- Radiologi och bildbehandling (hsv//swe)

MEDICAL AND HEALTH SCIENCES  -- Clinical Medicine -- Radiology, Nuclear Medicine and Medical Imaging (hsv//eng)

Nyckelord

Carcinoma

diagnostic errors

incidental findings

radiology

renal cell

tomography

X-ray computed

Diagnosis

Magnetic resonance imaging

Tumors

Ultrasonic applications

Visualization

Computerized tomography

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