The potential and limitations of computed tomography in the assessment of lymph node metastases in the patients with renal cell carcinoma.

Introduction and Objectives. This study aims to present performance and limitations of computed tomography (CT) in detecting and characterizing the lymph node involvement in patients with renal cell carcinoma (RCC), in an attempt to support the urologic team in choosing the best surgical approach. Material and Methods. This is retrospective study conducted on a total of 94 patients (63 men and 31 women, age range 33-79 years, mean age 55.7) that underwent radical nephrectomy associated with extensive lymph node dissection in Center for Uronefrology and Renal Transplantation, Fundeni Clinical Institute, from January 1^st 2014 to December 31^st 2014 for renal cell carcinoma confirmed on histopathology, that performed preoperative contrast-enhanced CT. CT results were compared with surgical and pathological findings. Results. Considering the 10 mm size as the normal limit value of the nodal short-axis diameter, we found a suboptimal value of CT specificity (CT specificity = 65.07%) in diagnosing lymph node metastases in patients with renal cell carcinoma Instead, we found a good value of CT sensitivity (CT sensitivity = 80.6%) in the detection of regional lymphatic metastasis of renal cell carcinoma. Conclusions. CT has a limited value in characterizing the nature of lymph node hyperplasia (tumor versus inflammatory) in patients with renal cell carcinoma, especially in the presence of tumor necrosis, most likely due to the pronounced immune reaction caused by the primary cancer and the presence of necrosis. [ABSTRACT FROM AUTHOR]