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Publications

Journal Article Epublish

PubMed: 42719604 DOI: 10.1002/bco2.70203

Low diagnostic yield of routine preoperative chest CT in patients undergoing partial nephrectomy: A national cohort study using UroCCR data (UroCCR n°216).

BJUI Compass 7(9):e70203

Authors: Ali Bourgi, Gaëlle Margue, Pierre Bigot, Norbert De Brek, Louis Surlemont, Martin Lorette, Nicolas Branger, Thomas Prudhomme, Aurélien Adypagavane, Véra Chatain, Thibaut Waeckel, Alexis Fontenil, Victor Gaillard, Jean-Jacques Patard, Constance Michel, Julien Guillotreau, Olivier Belas, Maxime Vallée, Stéphane De Vergie, Jean-Baptiste Beauval, Clément Sarrazin, Benjamin Delattre, Frédéric Panthier, Lionel Hoquetis, Romain Boissier, Julien Anract, Marie Chicaud, Alexandre Marsaud, Richard Mallet, Quentin-Côme Le Cerlc, Khalil Chalhoub, Idir Ouzaid, Jean-Christophe Bernhard, Franck Bruyère

Affiliations

  • CHRU Tours Service d'Urologie Tours France.
  • Hôpital Pellegrin - CHU Bordeaux/Icare Bordeaux Service d'Urologie Bordeaux France.
  • CHU Angers Service d'Urologie Angers France.
  • Hôpital Européen Georges Pompidou - APHP Service d'Urologie Paris France.
  • CHU Rouen Service d'Urologie Rouen France.
  • CHU Lille Service d'Urologie Lille France.
  • Institut Paoli-Calmettes Service d'Urologie Marseille France.
  • CHU Rangueil - Toulouse Service d'Urologie Toulouse France.
  • Hôpital Bicêtre - APHP Service d'Urologie Le Kremlin-Bicêtre France.
  • Hôpital Lyon Sud - Hospices Civils de Lyon Service d'Urologie Oullins-Pierre-Bénite France.
  • CHU Caen Normandie Service d'Urologie Caen France.
  • CHU Nîmes Service d'Urologie Nîmes France.
  • CHRU Strasbourg Service d'Urologie Strasbourg France.
  • CH Mont-de-Marsan Service d'Urologie Mont-de-Marsan France.
  • Hôpital Paris Saint-Joseph Service d'Urologie Paris France.
  • Clinique Pasteur - Toulouse Service d'Urologie Toulouse France.
  • Pôle Santé Sud - Le Mans Service d'Urologie Le Mans France.
  • CHU Poitiers Service d'Urologie Poitiers France.
  • CHU Nantes Service d'Urologie Nantes France.
  • Clinique La Croix du Sud Service d'Urologie Quint-Fonsegrives France.
  • CHU Grenoble Service d'Urologie Grenoble France.
  • CHU Dijon Service d'Urologie Dijon France.
  • Hôpital Tenon - APHP Service d'Urologie Paris France.
  • Clinique Nantes Atlantis - Saint-Herblain Service d'Urologie Saint-Herblain France.
  • CHU La Conception - Marseille (APHM) Service d'Urologie Marseille France.
  • Hôpital Cochin - Port-Royal - APHP Service d'Urologie Paris France.
  • CHU Limoges Service d'Urologie Limoges France.
  • Clinique Saint-George Service d'Urologie Nice France.
  • Hôpital Privé Francheville Service d'Urologie Périgueux France.
  • Clinique Santé Atlantique - Nantes Service d'Urologie Saint-Herblain France.
  • CH Kourou Service d'Urologie Kourou France.
  • Hôpital Bichat - APHP Service d'Urologie Paris France.

Abstract

OBJECTIVE

The aim of this study was to evaluate the diagnostic yield and downstream clinical impact of routine preoperative chest CT in patients undergoing partial nephrectomy (PN) for localized renal cell carcinoma.

METHODS

We conducted a retrospective multicentre study using data from the French Urological Cancer Comprehensive Cohort (UroCCR) registry. Adult patients who underwent PN for localized renal masses between 2010 and 2024 and had preoperative chest CT within 30 days before surgery were included. The primary endpoint was the detection rate of synchronous pulmonary metastases. Secondary endpoints included characteristics of metachronous metastases and diagnostic or scheduling consequences of preoperative imaging.

RESULTS

Among 7351 patients, 6679 underwent surgery and 5016 had a preoperative chest CT. Of these, 4483 (89.4%) had clinical T1 tumours. Synchronous pulmonary metastases were identified in only 17 patients (0.38%), all with larger or higher grade tumours. These patients had significantly higher rates of positive surgical margins (17.6% vs. 6.1%, p = 0.04), but no significant difference in age, sex or comorbidity profile. Among 6075 patients with postoperative follow-up, 191 (3.14%) developed metachronous pulmonary metastases. Of these, 14 (7.3%) had a previously negative preoperative CT, with a median time to progression of 52.6 months. Importantly, 166 (3.7%) patients underwent additional, ultimately non-contributive thoracic investigations, and 2.1% experienced surgical delays due to incidental or equivocal CT findings.

CONCLUSIONS

The diagnostic yield of routine preoperative chest CT in patients with clinical T1 RCC is exceedingly low (<0.5%). These data support the omission of routine chest CT in asymptomatic, low-risk cT1 RCC, potentially sparing over 95% of patients from unnecessary imaging, additional tests and surgical delays. A risk-adapted, symptom-guided strategy may optimize patient care while reducing radiation exposure and healthcare costs.

MeSH

Margins Of Excision, Cohort Studies, Nephrectomy, Carcinoma, Renal Cell, Diagnostic Imaging, Neoplasm Metastasis