Direct correlation of MR-DWI and histopathology of Wilms’ tumours through a patient-specific 3D-printed cutting guide

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2024年8月8日

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Justine N. van der Beek,
Matthijs Fitski,
Ronald R. de Krijger,
Marijn A. Vermeulen,
Peter G. J. Nikkels,
Arie Maat,
Myrthe A. D. Buser,
Marc H. W. A. Wijnen,
Jeroen Hendrikse,
Marry M. van den Heuvel-Eibrink,
Alida F. W. van der Steeg,
Annemieke S. Littooij

摘要

Objectives

The International Society of Paediatric Oncology-Renal Tumour Study Group (SIOP-RTSG) discourages invasive procedures to determine the histology of paediatric renal neoplasms at diagnosis. Therefore, the histological subtype of Wilms’ tumours (WT) is unknown at the start of neoadjuvant chemotherapy. MR-DWI shows potential value as a non-invasive biomarker through apparent diffusion coefficients (ADCs). This study aimed to describe MR characteristics and ADC values of paediatric renal tumours to differentiate subtypes.

Materials and methods

Children with a renal tumour undergoing surgery within the SIOP-RTSG 2016-UMBRELLA protocol were prospectively included between May 2021 and 2023. In the case of a total nephrectomy, a patient-specific cutting guide based on the neoadjuvant MR was 3D-printed, allowing a correlation between imaging and histopathology. Whole-tumour volumes and ADC values were statistically compared with the Mann-Whitney U-test. Direct correlation on the microscopic slide level was analysed through mixed model analysis.

Results

Fifty-nine lesions of 54 patients (58% male, median age 3.0 years (range 0–17.7 years)) were included. Forty-four lesions involved a WT. Stromal type WT showed the lowest median decrease in volume after neoadjuvant chemotherapy (48.1 cm³, range 561.5–(+)332.7 cm³, p = 0.035). On a microscopic slide level (n = 240 slides) after direct correlation through the cutting guide, stromal areas showed a significantly higher median ADC value compared to epithelial and blastemal foci (p < 0.001). With a cut-off value of 1.195 * 10⁻³ mm²/s, sensitivity, and specificity were 95.2% (95% confidence interval 87.6–98.4%) and 90.5% (95% confidence interval 68.2–98.3%), respectively.

Conclusion

Correlation between histopathology and MR-DWI through a patient-specific 3D-printed cutting guide resulted in significant discrimination of stromal type WT from epithelial and blastemal subtypes.

Clinical relevance statement

Stromal Wilms’ tumours could be discriminated from epithelial- and blastemal lesions based on high apparent diffusion coefficient values and limited decrease in volume after neoadjuvant chemotherapy. This may aid in future decision-making, especially concerning discrimination between low- and high-risk neoplasms.

Key Points

MR-DWI shows potential value as a non-invasive biomarker in paediatric renal tumours.

The patient-specific cutting guide leads to a correlation between apparent diffusion coefficient values and Wilms’ tumour subtype.

Stromal areas could be discriminated from epithelial and blastemal foci in Wilms’ tumours based on apparent diffusion coefficient values.