Abstract：
OBJECTIVE: The International Society of Paediatric Oncology-Renal Tumour Study Group (SIOP-RTSG) discourages invasive procedures to determine the histology of paediatric renal neoplasms at diagnosis. Therefore, the histological subtype of Wilms\' tumours (WT) is unknown at the start of neoadjuvant chemotherapy. MR-DWI shows potential value as a non-invasive biomarker through apparent diffusion coefficients (ADCs). This study aimed to describe MR characteristics and ADC values of paediatric renal tumours to differentiate subtypes.
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.
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.
摘要：
目的：国际儿科肿瘤学会-肾肿瘤研究小组(SIOP-RTSG)不鼓励在诊断时采用侵入性方法来确定儿科肾肿瘤的组织学。因此,在新辅助化疗开始时，Wilms肿瘤（WT）的组织学亚型未知。MR-DWI通过表观扩散系数（ADC）显示出作为非侵入性生物标志物的潜在价值。这项研究旨在描述小儿肾脏肿瘤的MR特征和ADC值，以区分亚型。
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。
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。
