| 摘要: |
| 目的 报告1例超声漏诊小肾癌患者，并通过文献回顾探讨超声诊断小肾癌的方法及漏诊、误诊原因。方法 报告1例超声漏诊小肾癌病例的诊治过程，回顾1995年1月1日至2020年8月30日国内超声诊断小肾癌的相关文献，总结小肾癌的超声诊断方法及漏诊、误诊原因。结果 患者首次超声检查漏诊右肾占位，仅检出左肾占位，首次超声复查未改变检查设备仅改善检查条件仍未检出右肾占位，后连续2次更换成像质量更高的超声设备，同时改善检查条件，最终超声诊断为双肾占位，恶性可能。术后病理双肾占位均诊断为肾透明细胞癌。检索共获得37篇超声诊断小肾癌相关文献，计1 611个小肾癌病例。小肾癌超声回声类型以高回声[39.4%（329/836）]和低回声[39.0%（326/836）]为主，血流分布以病灶实质内树枝状血流信号最常见[44.7%（220/492）]，超声造影具有“快进快出”的特点，且不同病理类型的小肾癌其超声造影表现差异有统计学意义（χc2=37.58，P=0.01）。常规超声诊断小肾癌的灵敏性与超声造影、CT平扫+增强、MRI平扫+增强相比差异无统计学意义（χ2=0.30，P=0.96）。小肾癌常规超声误诊率、漏诊率分别为15.3%（139/908）、1.8%（17/919），误诊疾病以肾错构瘤最常见[47.3%（52/110）]，漏诊因素主要包括超声设备图像质量、小肾癌的相对位置、操作医师因素和患者自身因素等。结论 小肾癌的回声类型、血流特点、造影剂充填和消退速度均呈现不同特点。超声设备条件可能影响小肾癌的筛查效果，超声医师充分了解设备性能并全面把握患者的临床、影像及病理特点，有助于提高对小肾癌的诊断准确率。 |
| 关键词: 超声检查 肾肿瘤 小肾癌 透明细胞癌 漏诊 误诊 |
| DOI：10.16781/j.0258-879x.2021.12.1438 |
| 投稿时间：2020-09-27 |
| 基金项目:海军军医大学（第二军医大学）长征医院金字塔人才工程（1009） |
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| Missed diagnosis of small renal carcinoma by ultrasonography: a case report and domestic literature review |
| LU Chang1,ZHAO Jia-qi1*,ZHANG Zheng-wei2 |
(1. Department of Ultrasound, Changzheng Hospital, Naval Medical University (Second Military Medical University), Shanghai 200003, China;
2. Department of Pathology, Changzheng Hospital, Naval Medical University (Second Military Medical University), Shanghai 200003, China
*Corresponding author) |
| Abstract: |
| Objective To report a case of missed diagnosis of small renal carcinoma by ultrasonography, and to explore the diagnosis methods and the causes of misdiagnosis and missed diagnosis of small renal carcinoma by ultrasonography through literature review.Methods The diagnosis and treatment process of 1 case of small renal carcinoma missed by ultrasonography was reported, the relevant domestic literatures from Jan. 1, 1995 to Aug. 30, 2020 were reviewed, and the ultrasound diagnosis methods and the causes of missed diagnosis and misdiagnosis of small renal carcinoma were summarized.Results The right renal space occupying of the patient was missed in the first ultrasound examination, and only the left renal space occupying was detected. Without any change of the examination equipment, only with improved examination conditions, the ultrasound reexamination still failed to detect the right renal space occupying. After replacing the ultrasound equipment with higher imaging quality ones for 2 consecutive times and with improved examination conditions, the case was diagnosed as bilateral renal space occupying, with a high probability of malignancy. Postoperative pathology confirmed renal clear cell carcinoma in both renal masses. A total of 37 literatures related to ultrasound diagnosis of small renal carcinoma were retrieved, including 1 611 cases. The ultrasound echo types of small renal carcinoma were mainly hyperechoic (39.4%[329/836]) and hypoechoic (39.0%[326/836]). The dendritic blood flow signal in the parenchyma (44.7%[220/492]) was the most visible color Doppler flow signal in small renal carcinoma. Small renal carcinoma had the characteristic of "fast in and fast out" by contrast-enhanced ultrasound, and there were significant differences in contrast-enhanced ultrasound of different pathological types of small renal carcinoma (χc2=37.58, P=0.01). The sensitivity of conventional ultrasound in the diagnosis of small renal carcinoma was not significantly different from that of contrast-enhanced ultrasound, plain CT+enhanced CT or plain MRI+enhanced MRI (χ2=0.30, P=0.96). The misdiagnosis rate and missed diagnosis rate of small renal carcinoma by conventional ultrasound were 15.3% (139/908) and 1.8% (17/919), respectively. Renal hamartoma was the most common misdiagnosis disease (47.3%[52/110]). The factors of missed diagnosis mainly included the image quality of ultrasound equipment, the relative position of small renal carcinoma, the factors of the operator and the patients' conditions.Conclusion The echo type, blood flow, filling of contrast agent and regression speed of small renal carcinoma show different characteristics. The quality of ultrasound equipment may affect the screening of small renal carcinoma. Ultrasound physicians who fully understand the performance of the equipment and fully understand the clinical, imaging and pathological characteristics of patients, are helpful to improve the diagnosis accuracy of small renal carcinoma. |
| Key words: ultrasonography kidney neoplasms small renal carcinoma clear cell carcinoma missed diagnosis misdiagnosis |
