Surgical margin follow-up after nephron-sparing surgery: the possible role of CEUS.

To evaluate the possible role of CEUS in the management of patients who underwent nephron-sparing surgery (NSS) and presented questionable findings on the surgical margins at the CECT follow-up exam.

In our retro-prospective study, we included 952 patients with small renal masses (SRMs) treated with NSS between 2012 and 2015 and followed with CECT for at least 3 years at Careggi University Hospital. Twenty-two of them presented solid masses on the site of surgery with questionable enhancement at CECT and were further studied with CEUS. This examination was followed by a quantitative analysis of the enhancement pattern.

Out of the 22 masses, 18 were considered possible granulomas, presenting slow wash-in and low enhancement peaks compared to the surrounding parenchyma and persistent delayed wash-out at CEUS. Four lesions presented a suspicious malignant enhancement pattern, with rapid wash-in, high peak and rapid wash-out. In accordance with instructions from the urologist, the first group of 18 patients was strictly monitored, revealing that the mass dimensions and enhancement pattern were stable for at least 3 years of follow-up, while the other 4 patients underwent a second intervention and their masses were confirmed as tumor recurrence at the histopathological evaluation.

CEUS can play a key role in the surgical margin follow-up after NSS when a suspicious enhancing mass is detected by CECT, giving an accurate depiction of the enhancement pattern and thus helping the clinician in the management of the patient.

Journal of ultrasound. 2019 Nov 18 [Epub ahead of print]

Elena Bertelli, Laura Mercatelli, Elena Savi, Alessandro Pili, Silvia Verna, Alberto Palombella, Davide Caramella, Andrea Minervini, Sergio Serni, Simone Agostini, Vittorio Miele

Department of Radiology, Careggi University Hospital, Florence, Italy. ., Department of Radiology, Careggi University Hospital, Florence, Italy., Department of Urologic Robotic Surgery and Renal Transplantation, Careggi Hospital, University of Florence, Florence, Italy., Diagnostic and Interventional Radiology, University of Pisa, Florence, Italy.