肾肿瘤超声漏诊影响因素分析

Analysis of influencing factors for ultrasonic missed diagnosis of kidney neoplasm

目的探讨肾肿瘤超声漏诊的影响因素。方法回顾性分析2013年1月至2021年10月山西省肿瘤医院2033例术后病理诊断为肾肿瘤且病历完整的患者的临床资料,分析其术前超声诊断结果、临床资料、CT/磁共振成像(MRI)结果等,计算超声漏诊率。采用χ^(2)检验及多因素logistic回归从肿瘤的解剖学特征分析超声漏诊肾肿瘤的影响因素。结果肾肿瘤超声漏诊率为1.87%(38/2033),其中肾实质肿瘤超声漏诊率为1.33%(25/1874),肾盂肿瘤超声漏诊率为8.18%(13/159)。多因素logistic回归分析结果显示,患者体质量指数(BMI)≥24 kg/m^(2)(OR=2.805,95%CI 1.030~7.641)、病灶小(OR=0.425,95%CI 0.293~0.617)、病灶位于左肾(OR=0.307,95%CI 0.113~0.834)、病灶位于肾体部(肾上极比肾体部:OR=0.344,95%CI 0.124~0.956;肾下极比肾体部:OR=0.239,95%CI 0.069~0.834)、病灶位于肾背侧(OR=0.409,95%CI 0.172~0.970)是超声漏诊肾实质肿瘤的独立影响因素(均P<0.05);患者BMI≥24 kg/m^(2)(OR=10.464,95%CI 1.042~105.087)、合并输尿管和(或)膀胱尿路上皮癌(OR=32.937,95%CI 4.017~270.063)及病灶小(OR=0.216,95%CI 0.081~0.577)是超声漏诊肾盂肿瘤的独立影响因素(均P<0.05)。结论患者肥胖、病灶小及病灶位于左肾、病灶位于肾体部、病灶位于肾背侧可能是造成超声漏诊肾实质肿瘤的主要原因。患者肥胖、合并输尿管和(或)膀胱尿路上皮癌及病灶小可能是造成超声漏诊肾盂肿瘤的主要原因。

Objective To investigate the influencing factors of ultrasonic missed diagnosis of kidney neoplasm.Methods The clinical data of 2033 patients pathologically diagnosed with kidney neoplasm after operation and with complete medical record in Shanxi Province Cancer Hospital from January 2013 to October 2021 were retrospectively analyzed.Preoperative ultrasound diagnosis,clinical data,CT/magnetic resonance imaging(MRI)were analyzed,and ultrasound missed diagnosis rate was calculated.Chi-square test and multivariate logistic regression were used to analyze the influencing factors of ultrasonic missed diagnosis of kidney neoplasm mainly based on the anatomic characteristics of neoplasm.Results The ultrasonic missed diagnosis rate of kidney neoplasm was 1.87%(38/2033),among which the ultrasonic missed diagnosis rate of renal parenchymal neoplasm was 1.33%(25/1874)and the ultrasonic missed diagnosis rate of renal pelvis neoplasm was 8.18%(13/159).The results of multivariate logistic regression analysis showed that the patients'body mass index(BMI)≥24 kg/m^(2)(OR=2.805,95%CI 1.030-7.641),the small lesion(OR=0.425,95%CI 0.293-0.617),the lesion located on the left kidney(OR=0.307,95%CI 0.113-0.834),the lesion located on the body(OR=0.344,95%CI 0.124-0.956 compared to lesions in the upper pole of the kidney;OR=0.239,95%CI 0.069-0.834 compared to lesions in the lower pole of the kidney)and the lesion located on the dorsal side(OR=0.409,95%CI 0.172-0.970)were independent influencing factors for ultrasound missed diagnosis of renal parenchymal neoplasms(all P<0.05).Patients with BMI≥24 kg/m^(2)(OR=10.464,95%CI 1.042-105.087),concurrent ureteral or(and)bladder urothelial carcinoma(OR=32.937,95%CI 4.017-270.063),and small lesion size(OR=0.216,95%CI 0.081-0.577)were independent influencing factors for ultrasound missed diagnosis of renal pelvis neoplasms(all P<0.05).Conclusions Obesity,small focus,focus on the left kidney,focus on the body,and focus on the back may be the main reasons for ultrasonic missed diagnosis of renal parenchymal neoplasms.Obesity,concurrent ureteral or/and bladder urothelial carcinoma and small lesions may be the main reasons for ultrasonic missed diagnosis of renal pelvis neoplasms.