Adult Sporadic Multifocal Renal Cell Carcinoma: Helical CTand Pathology Correlations in a Recent and Consecutive Set ofPatients Assessed with a Multidisciplinary Approach

Background and aims: to assess helical ct sensitivity in detecting preoperatively multifocal renal cell carcinoma(mfrcc) and clinical occult multifocality in a contemporary and consecutive set of patients accordingto a multidisciplinary approach.methods: the renal masses were assessed preoperatively by volumetric multislice helical ct with the objectiveto detect multifocality. renal cells carcinoma (rccs) were classified as unifocal (uf) or multifocal (mf). mfrccswere selected in 2 groups including ct detected (ct+) and ct undetected (ct-). rccs were classified in uf andmf. mfrccs were selected in 2 groups including ct+ and ct-. ct and pathologic findings of mfrccs werecorrelated and ct sensitivity was assessed. statistical methods were performed in order to compare the ctsensitivity with the overall mean sensitivity calculated from the reported literature, to assess statistical inferencebetween uf and mf – rccs; and to detect statistical significance between ct(+) and ct(-) mfrccs .results: over a period of 24 months, 116 kidney units (ku) of 111 patients were surgically treated for rcc.multifocality was assessed in 13/116 ku of 12 patients (10.8%). helical ct detected preoperative multifocalityin 8/111 patients (7.2%) and preoperative occult multifocality was assessed in 4 (3.6%), as well. helicalct sensitivity difference between our (66.7%) and the reported literature experience (22.9%) was significant(p <0.0001). significant predictors for multifocality were tumor size (p = 0.007), laterality (p = 0.002), pt (p =0.008) and surgery (p = 0.0002). primary tumor size (p = 0.05) and satellite tumor size (p = 0.01) were significantlycorrelated to ct-undetected (ct-) multifocal tumors.conclusions: in our experience, helical ct was effective in improving preoperative detection of sporadic primarymrcc as well as in lowering clinical occult multifocality. clinical predictors of multifocality including bilateralityand primary tumor size as well as technical and methodological improvements in performing helical ctwill improve its sensibility in detecting renal massesless than 0.5 cm. ct preoperative detection of clinicalmultifocality may help in planning effective preoperativesurgical treatment as well as lowering local recurrenceafter nephron sparing surgery.