METHODS: Children with a renal tumour undergoing surgery within the SIOP-RTSG 2016-UMBRELLA protocol were prospectively included between May 2021 and 2023. In the case of a total nephrectomy, a patient-specific cutting guide based on the neoadjuvant MR was 3D-printed, allowing a correlation between imaging and histopathology. Whole-tumour volumes and ADC values were statistically compared with the Mann-Whitney U-test. Direct correlation on the microscopic slide level was analysed through mixed model analysis.
RESULTS: Fifty-nine lesions of 54 patients (58% male, median age 3.0 years (range 0-17.7 years)) were included. Forty-four lesions involved a WT. Stromal type WT showed the lowest median decrease in volume after neoadjuvant chemotherapy (48.1 cm3, range 561.5-(+)332.7 cm3, p = 0.035). On a microscopic slide level (n = 240 slides) after direct correlation through the cutting guide, stromal areas showed a significantly higher median ADC value compared to epithelial and blastemal foci (p < 0.001). With a cut-off value of 1.195 * 10-3 mm2/s, sensitivity, and specificity were 95.2% (95% confidence interval 87.6-98.4%) and 90.5% (95% confidence interval 68.2-98.3%), respectively.
CONCLUSIONS: Correlation between histopathology and MR-DWI through a patient-specific 3D-printed cutting guide resulted in significant discrimination of stromal type WT from epithelial and blastemal subtypes.
CONCLUSIONS: Stromal Wilms\' tumours could be discriminated from epithelial- and blastemal lesions based on high apparent diffusion coefficient values and limited decrease in volume after neoadjuvant chemotherapy. This may aid in future decision-making, especially concerning discrimination between low- and high-risk neoplasms.
CONCLUSIONS: MR-DWI shows potential value as a non-invasive biomarker in paediatric renal tumours. The patient-specific cutting guide leads to a correlation between apparent diffusion coefficient values and Wilms\' tumour subtype. Stromal areas could be discriminated from epithelial and blastemal foci in Wilms\' tumours based on apparent diffusion coefficient values.
方法:在SIOP-RTSG2016-UMBRELLA方案中接受手术的肾肿瘤儿童被前瞻性纳入2021年5月至2023年。在全肾切除术的情况下,基于新辅助MR的患者特定切割指南是3D打印的,允许成像和组织病理学之间的相关性。用曼-惠特尼U检验对整个肿瘤体积和ADC值进行统计学比较。通过混合模型分析分析了显微镜载玻片水平上的直接相关性。
结果:54例患者的59个病变(58%为男性,纳入中位年龄3.0岁(范围0~17.7岁).44个病变涉及WT。基质型WT在新辅助化疗后显示出最低的中位体积减少(48.1cm3,范围561.5-(+)332.7cm3,p=0.035)。在通过切割指南直接相关后,在微观幻灯片水平(n=240张幻灯片)上,与上皮和囊胚灶相比,基质区显示出显著较高的中位ADC值(p<0.001)。截止值为1.195*10-3mm2/s,灵敏度,特异性分别为95.2%(95%置信区间87.6-98.4%)和90.5%(95%置信区间68.2-98.3%),分别。
结论:通过患者特定的3D打印切割指导,组织病理学与MR-DWI之间的相关性导致基质型WT与上皮和胚丝亚型的显着区分。
结论:基于高的表观扩散系数值和新辅助化疗后有限的体积减少,可以将基质肾母细胞瘤与上皮和胚细胞病变区分开。这可能有助于未来的决策,特别是关于低和高风险肿瘤之间的区别。
结论:MR-DWI显示出作为儿科肾脏肿瘤非侵入性生物标志物的潜在价值。患者特定的切割指导导致表观扩散系数值与Wilms\'肿瘤亚型之间的相关性。根据表观扩散系数值,可以将基质区域与Wilms肿瘤中的上皮和囊胚灶区分开。