• Faiza Akram Associate Professor, Department of Radiology, Ayub Medical College, Abbottabad
  • Arfa Mazhar Medical Officer, Radiology department- King Abdullah teaching hospital-Mansehra
  • Hamza Javed Medical Officer with Pakistan Red Crescent Society
  • Muhmmad Fayyaz Prosthodontics, Dentistry department Ayub Medical College
  • Ayub Khan Medical Officer, Health Department, Government of KP
  • Khalil Ahmad Free Lancer




Validity parameters, Diagnostic Accuracy, Renal cell carcinoma, Contrast enhanced CT, Histopathology


Background: Renal cell carcinoma being the commonest primary renal malignancy of adulthood accounts for approximately 80-90% renal malignant lesions. The purpose of radiological imaging modalities when devising the treatment options for renal masses is crucial as it significantly influence the clinical outcome and prognosis of the disease. Subjective impression by a radiologist for diagnosing a mass lesion is known to be critical and its precision is improved by contrast enhanced CT as demonstrated by certain retrospective analyses. We aimed to ascertain the diagnostic accuracy of contrast enhanced computed tomography to diagnose renal cell cancers by verifying through histopathology reported diagnoses. Methods: This Cross-sectional (validation) study was carried out in Radiology and Urology departments of Ayub Teaching Hospital; Abbottabad, from 1st November 2020 to 30th April 2022. The study population included all admitted symptomatic patients with age range 18-70 years of either gender. The patients were subjected to detailed clinical examination and history and an ultrasound and contrast enhanced CT abdomen and pelvis. CT scans were reported under supervision of single consultant radiologist. Data was analyzed in SPSS version 20.0. Result: Mean age of the patients was 38.88±11.62 years ranging from 18 to 70 years and mean duration of symptoms was 54.64±49.171 ranging from 3 to 180 days. All of the total 113 patients underwent contrast enhanced CT scan and later operated to confirm the diagnoses by histopathology. The comparison yielded true positive (TP) cases to be 67, True Negative (TN) 16, False Positive (FP) 26, and 04 False Negative (FN) as per CT scan diagnoses. CT scan had a diagnostic Accuracy of 73.45% with 94.37% sensitivity and 38.10% specificity. Conclusion: Contrast-enhanced CT has a high sensitivity for making the diagnosis of renal cell carcinoma; however, its specificity is low. A multidisciplinary approach is necessary to overcome the low specificity. Therefore, collaboration between radiologists and urologic oncologists should be considered while devising treatment plan for patients.

Author Biography

Faiza Akram, Associate Professor, Department of Radiology, Ayub Medical College, Abbottabad

Radiology Department


Surveillance Epidemiology and End Results. SEER Stat Fact Sheets. [Internet]. National Cancer Institute. [cited 2021 Feb 18]. Available from: http://seer.cancer.gov/statfacts/ html/kidrp.html

Ursprung S, Beer L, Bruining A, Woitek R, Stewart GD, Gallagher FA, et al. Radiomics of computed tomography and magnetic resonance imaging in renal cell carcinoma—a systematic review and meta-analysis. Eur Radiol 2020;30(6):3558–66.

Ljungberg B, Albiges L, Abu-Ghanem Y, Bensalah K, Dabestani S, Fernández-Pello S, et al. European association of urology guidelines on renal cell carcinoma: the 2019 update. Eur Urol 2019;75(5):799–810.

Coy H, Hsieh K, WU W, Nagarajan MB, Young JR, Douek ML, et al. Deep learning and radiomics: the utility of Google TensorFlow™ Inception in classifying clear cell renal cell carcinoma and oncocytoma on multiphasic CT. Abdom Radiol 2019;44(6):2009–20.

van Oostenbrugge TJ, Fütterer JJ, Mulders PFA. Diagnostic Imaging for Solid Renal Tumors: A Pictorial Review. Kidney Cancer 2018;2(2):79–93.

Deng Y, Soule E, Samuel A, Shah S, Cui E, Asare-Sawiri M, et al. CT texture analysis in the differentiation of major renal cell carcinoma subtypes and correlation with Fuhrman grade. Eur Radiol 2019;29(12):6922–9.

Nakashima K, Kitagawa Y, Izumi K, Mizokami A, Gabata T, Namiki M. Diagnostic accuracy of pre-operative imaging findings in presumed clinical T1a renal cell carcinomas. Oncol Lett 2016;11(5):3189–93.

Rossi SH, Prezzi D, Kelly-Morland C, Goh V. Imaging for the diagnosis and response assessment of renal tumours. World J Urol 2018;36(12):1927–42.

Sankineni S, Brown A, Cieciera M, Choyke PL, Turkbey B. Imaging of renal cell carcinoma. Urol Oncol 2016;34(3):147–55.

Schieda N, Lim RS, Krishna S, McInnes MD, Flood TA, Thornhill RE. Diagnostic accuracy of unenhanced CT analysis to differentiate low-grade from high-grade chromophobe renal cell carcinoma. Am J Roentgenol 2018;210(5):1079–87.

Schieda N, Lim RS, McInnes MD, Thomassin I, Renard-Penna R, Tavolaro S, et al. Characterization of small (< 4 cm) solid renal masses by computed tomography and magnetic resonance imaging: Current evidence and further development. Diagn Interv Imaging 2018;99(7-8):443–55.

Nie P, Yang G, Wang Z, Yan L, Miao W, Hao D, et al. A CT-based radiomics nomogram for differentiation of renal angiomyolipoma without visible fat from homogeneous clear cell renal cell carcinoma. Eur Radiol 2020;30(2):1274–84.

Pozzessere C, Bassanelli M, Ceribelli A, Rasul S, Li S, Prior JO, et al. Renal cell carcinoma: the oncologist asks, can PSMA PET/CT answer? Curr Urol Rep 2019;20(11):68.

Moch HP, Ulbright TM, Reuter V. WHO Classification of Tumours of the Urinary System and Male Genital Organs. Lyon, France: International Agency for Research on Cancer. Eur Urol 2016;70(1):93–105.

Moch H, Cubilla AL, Humphrey PA, Reuter VE, Ulbright TM. WHO Classification of Tumours of the Urinary System and Male Genital Organs. 4th Edition. Lyons, France: IARC, 2016; p.14–43.

Salameh JP, McInnes MD, McGrath TA, Salameh G, Schieda N. Diagnostic accuracy of dual-energy CT for evaluation of renal masses: systematic review and meta-analysis. Am J Roentgenol 2019;212(4):W100–5.

Sanchez A, Feldman AS, Hakimi AA. Current management of small renal masses, including patient selection, renal tumor biopsy, active surveillance, and thermal ablation. J Clin Oncol 2018;36(36):3591.

Sanyal SR, Arora A, Nisreen A, Mohamed K, Mohammad SK, Baruah D. Imaging Tips and Tricks in Management of Renal and Urothelial Malignancies. Indian J Radiol Imaging 2022;32(2):213–23.

Rosa F, Verardo I, Barbagallo S, Perugin G, Martinetti C, Basso L, et al. A practical guide for a correct staging of renal cancer: what urologists want to know. [Internet]. European Congress Radiology-ECR 2019/ C-1015 [cited 2021 Dec 28];2498 words. Available from: https://epos.myesr.org/esr/poster/10.26044/ecr2019/C-1015

Chiarello MA, Mali RD, Kang SK. Diagnostic accuracy of MRI for detection of papillary renal cell carcinoma: A systematic review and meta-analysis. AJR Am J Roentgenol 2018;211(4):812–21.

Wang ZJ, Westphalen AC, Zagoria RJ. CT and MRI of small renal masses. Br J Radiol 2018;91(1087):20180131.

Kim JH, Sun HY, Hwang J, Hong SS, Cho YJ, Doo SW, et al. Diagnostic accuracy of contrast-enhanced computed tomography and contrast-enhanced magnetic resonance imaging of small renal masses in real practice: sensitivity and specificity according to subjective radiologic interpretation. World J Surg Oncol 2016;14(1):260.

Vogel C, Ziegelmüller B, Ljungberg B, Bensalah K, Bex A, Canfield S, et al. Imaging in suspected renal-cell carcinoma: systematic review. Clin Genitourin Cancer 2019;17(2):e345–55.




Most read articles by the same author(s)