肾盂癌的超声诊断及漏诊原因分析

Diagnostic value of ultrasound on transitional cell cancer pelvis and the factors that result in misdiagnose

目的评估超声对肾盂癌的诊断价值,探讨漏诊原因。方法回顾性分析经病理证实的肾盂移行细胞癌80例,比较超声和增强CT诊断的准确性,并分析漏诊病灶大小,是否合并其他肾脏疾病,是否同时患膀胱癌。结果超声与增强CT对肾盂癌诊断的敏感性分别为67.5%(54/80)与89.5%(60/67),增强CT诊断的敏感性明显高于超声,差异有统计学意义(P<.05)。超声提示肾盂占位的54例病灶长径平均为(4.63±3.80)cm,超声漏诊的26例病灶长径平均(2.67±1.46)cm,二者差异有统计学意义(P<0.05)。漏诊病例中合并慢性肾功能不全、膀胱癌及肾盂积水者分别为6例、4例及6例,诊断为肾结石者7例。结论超声对肾盂癌诊断的敏感性较增强CT低,但超声能够提示大部分肾盂占位,可作为筛查肾盂癌的方法。当病灶小或合并肾结石,慢性肾功能不全及膀胱癌时容易漏诊,因此对无痛性肉眼血尿患者,超声检查如未探及肾脏肿块应建议其他影像学检查,以除外肾盂占位。

Objective To evaluate the diagnostic value of ultrasound on renal pelvic carcinoma and to investigate the factors that result in misdiagnosis. Methods Eighty cases with renal pelvic carcinoma which were proved pathologically were analyzed retrospectively. The sensitivity of ultrasound was compared with that of enhanced CT. The factors that result in misdiagnose including the size of the tumor and whether complicating with other renal disease or bladder cancer simultaneously or not were analyzed. Results The diagnostic sensitivity of enhanced CT and ultrasound was 67.5% （54/80）and 89.5% （60/67）respectively, and enhanced CT was superior to ultrasound in diagnosis of renal pelvic carcinoma （ P 〈0.05）. The mean size of the tumor diagnosed as lesion and misdiagnose was 4.63 ± 3,80 cm and 2.67± 1.46 cm respectively, and there is significant difference between them（ P =0.029）. Among the cases of misdiagnosis and missed diagnosis, there were 6 cases with chronic renal failure, 7 cases with renal stone, 4 cases with bladder cancer and 7cases with hydronephrosis simultaneously. Conclusion Ultrasound can be used for screening transitional cell cancer pelvis although enhanced CT is superior to ultrasound. Chronic renal failure or renal stone or bladder cancer simultaneously are the factors that result in misdiagnosis. Therefore, other examinations should be proposed in order to exclude renal mass when ultrasound showed nothing abnormal in patient with painless hematuria.