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Background <p>Clear cell sarcoma of the kidney is a rare primary renal malignancy in children and its differentiation from other renal tumors, particularly Wilms’ tumor, poses significant diagnostic challenges. Notably, clear cell sarcoma of the kidney is associated with a poorer prognosis than Wilms’ tumor, making the preoperative presumptive diagnosis critical for optimizing surgical resection and appropriate chemotherapy regimens.</p> Objective <p>We conducted a feasibility study to evaluate the diagnostic utility of <sup>18</sup>F-fluorodeoxyglucose positron emission tomography/computed tomography (<sup>18</sup>F-FDG PET/CT) in distinguishing clear cell sarcoma of the kidney from Wilms’ tumor.</p> Materials and methods <p>This study included 19 patients diagnosed with clear cell sarcoma of the kidney and 84 patients with Wilms’ tumor. Among these, 11/19 patients with clear cell sarcoma of the kidney and 28/84 patients of Wilms’ tumor displayed positive findings on <sup>18</sup>F-FDG PET/CT imaging, which were subsequently validated as tumor lesions by histologic examination, conventional imaging, or clinical follow-up. A retrospective analysis of the imaging features of clear cell sarcoma of the kidney and Wilms’ tumor lesions on <sup>18</sup>F-FDG PET/CT scans was conducted. Receiver operating characteristic (ROC) curve analyses were performed to determine the optimal cutoff of the maximum standardized uptake value (SUVmax) for diagnostic prediction.</p> Results <p>The mean SUVmax for all lesions of clear cell sarcoma of the kidney was significantly lower than that of Wilms’ tumors (3.9 vs. 7.4;<i> P</i>&lt;0.001). When analyzed separately, primary lesions (3.6 vs. 6.6; <i>P</i>=0.042) and metastatic lesions (4.0 vs. 7.8; <i>P</i>=0.011) both had lower SUVmax in clear cell sarcomas of the kidney compared with Wilms’ tumors. ROC curve analysis revealed a cutoff SUVmax of 4.3, which effectively supported the diagnosis of clear cell sarcoma of the kidney over Wilms’ tumor, with a sensitivity of 75.0% and a specificity of 87.5%.</p> Conclusions <p>Clear cell sarcomas of the kidney exhibited a significantly lower SUVmax on <sup>18</sup>F-FDG PET/CT when compared to Wilms’ tumor lesions, with a proposed threshold SUVmax of 4.3 serving as an effective criterion for differentiation. Consequently, <sup>18</sup>F-FDG PET/CT demonstrated potential in distinguishing clear cell sarcoma of the kidney from Wilms’ tumor in cases involving large renal masses.</p> Graphical Abstract <p></p>

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18F-Fluorodeoxyglucose positron emission tomography/computed tomography in distinguishing pediatric clear cell sarcoma of the kidney from Wilms’ tumor

  • 期刊论文

  • 发表日期：

    2025年5月5日

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  • Hui Sun,
  • Zhiyong Yang,
  • Hongfu Jin,
  • Yanfen Cui,
  • Yafu Yin,
  • Suyun Chen,
  • Chenglai Fu,
  • Hui Wang,
  • Weiwei Cheng

摘要

Background

Clear cell sarcoma of the kidney is a rare primary renal malignancy in children and its differentiation from other renal tumors, particularly Wilms’ tumor, poses significant diagnostic challenges. Notably, clear cell sarcoma of the kidney is associated with a poorer prognosis than Wilms’ tumor, making the preoperative presumptive diagnosis critical for optimizing surgical resection and appropriate chemotherapy regimens.

Objective

We conducted a feasibility study to evaluate the diagnostic utility of 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) in distinguishing clear cell sarcoma of the kidney from Wilms’ tumor.

Materials and methods

This study included 19 patients diagnosed with clear cell sarcoma of the kidney and 84 patients with Wilms’ tumor. Among these, 11/19 patients with clear cell sarcoma of the kidney and 28/84 patients of Wilms’ tumor displayed positive findings on 18F-FDG PET/CT imaging, which were subsequently validated as tumor lesions by histologic examination, conventional imaging, or clinical follow-up. A retrospective analysis of the imaging features of clear cell sarcoma of the kidney and Wilms’ tumor lesions on 18F-FDG PET/CT scans was conducted. Receiver operating characteristic (ROC) curve analyses were performed to determine the optimal cutoff of the maximum standardized uptake value (SUVmax) for diagnostic prediction.

Results

The mean SUVmax for all lesions of clear cell sarcoma of the kidney was significantly lower than that of Wilms’ tumors (3.9 vs. 7.4; P<0.001). When analyzed separately, primary lesions (3.6 vs. 6.6; P=0.042) and metastatic lesions (4.0 vs. 7.8; P=0.011) both had lower SUVmax in clear cell sarcomas of the kidney compared with Wilms’ tumors. ROC curve analysis revealed a cutoff SUVmax of 4.3, which effectively supported the diagnosis of clear cell sarcoma of the kidney over Wilms’ tumor, with a sensitivity of 75.0% and a specificity of 87.5%.

Conclusions

Clear cell sarcomas of the kidney exhibited a significantly lower SUVmax on 18F-FDG PET/CT when compared to Wilms’ tumor lesions, with a proposed threshold SUVmax of 4.3 serving as an effective criterion for differentiation. Consequently, 18F-FDG PET/CT demonstrated potential in distinguishing clear cell sarcoma of the kidney from Wilms’ tumor in cases involving large renal masses.

Graphical Abstract