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\begin{document}

\title{How accurate is radiological imaging for perirenal fat and renal vein
invasion in Renal Cell Carcinoma ?}



\author[1]{Oktay Ucer}%
\author[2]{Talha Muezzinoglu}%
\author[3]{Ender Ozden}%
\author[1]{Guven Aslan}%
\author[4]{Volkan Izol}%
\author[5]{Yıldırım Bayazıt}%
\author[6]{Mesut Altan}%
\author[6]{Bulent Akdogan}%
\author[6]{Haluk Ozen}%
\author[7]{Sinan Sözen}%
\author[8]{Serhat Çetin}%
\author[9]{Evren Suer}%
\author[9]{Baris Esen}%
\author[9]{Sumer  Baltacı}%
\affil[1]{Affiliation not available}%
\affil[2]{Celal Bayar University}%
\affil[3]{Ondokuz Mayıs Üniversitesi Tıp Fakültesi}%
\affil[4]{Cukurova University Faculty of Medicine}%
\affil[5]{Çukurova Üniversitesi Tıp Fakültesi}%
\affil[6]{Hacettepe University}%
\affil[7]{Gazi University}%
\affil[8]{Gazi Üniversitesi Tıp Fakültesi}%
\affil[9]{Ankara University Faculty of Medicine}%


\vspace{-1em}



  
  \date{May 16, 2024}


\begingroup
\let\center\flushleft
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\selectlanguage{english}
\begin{abstract}
Objective: To evaluate the accuracy of radiological staging, especially
renal venous and perirenal fat invasion, in renal cell carcinoma (RCC).
Material \& Methods: Data of 4823 renal tumor patients from Renal Tumor
Database of Association of Uro-oncology in Turkey were evaluated. Of
4823 patients, 3309 RCC patients had complete radiological and
histopathological data were included to this study. The Pearson
Chi-squared test (\selectlanguage{greek}χ\selectlanguage{english}2) was used to compare radiological and
histopathological stages. Results: The mean (SD) age of 3309 patients
was 58 (12.3). Preoperative radiological imaging was performed using
computed tomography (CT) (n=2510, 75.8\%) or magnetic resonance imaging
(MRI) (n=799, 24.2\%). There was a substantial concordance between
radiological and pathological staging (\selectlanguage{russian}к=0.52, p\textless{}0.001).
Sensitivities of radiological staging in stage I, II, III and IV were
90.7\%, 67.3\%, 27.7\% and 64.2\%, respectively. The sensitivity in
stage III was lower than the other stages. Sub-analysis of stage IIIa
cases revealed that, for perirenal fat invasion and renal vein invasion,
sensitivity values were 15.4\% and 11.3\%, respectively. Conclusions:
There was a substantial concordance between radiological (CT and/or MRI)
and pathological T staging in RCC. However, this is not true for T3
cases. Sensitivity of preoperative radiological imaging in patients with
pT3a tumors is insufficient and lower than the other stages.
Consequently, preoperative imaging in patients with T3 RCC has to be
improved, in order to better inform the patients regarding prognosis of
their disease.%
\end{abstract}\selectlanguage{russian}%



\sloppy


\textbf{How accurate is radiological imaging for perirenal fat and renal
vein invasion in Renal Cell Carcinoma ?}

\textbf{Abstract}

\textbf{Objective:} To evaluate the accuracy of radiological staging,
especially renal venous and perirenal fat invasion, in renal cell
carcinoma (RCC).

\textbf{Material \& Methods:} Data of 4823 renal tumor patients from
Renal Tumor Database of Association of Uro-oncology in Turkey were
evaluated. Of 4823 patients, 3309 RCC patients had complete radiological
and histopathological data were included to this study. The Pearson
Chi-squared test (\selectlanguage{greek}χ\selectlanguage{english}2) was used to compare radiological and
histopathological stages.

\textbf{Results:} The mean (SD) age of 3309 patients was 58 (12.3).
Preoperative radiological imaging was performed using computed
tomography (CT) (n=2510, 75.8\%) or magnetic resonance imaging (MRI)
(n=799, 24.2\%). There was a substantial concordance between
radiological and pathological staging (\selectlanguage{russian}к=0.52, p\textless{}0.001).
Sensitivities of radiological staging in stage I, II, III and IV were
90.7\%, 67.3\%, 27.7\% and 64.2\%, respectively. The sensitivity in
stage III was lower than the other stages. Sub-analysis of stage IIIa
cases revealed that, for perirenal fat invasion and renal vein invasion,
sensitivity values were 15.4\% and 11.3\%, respectively.

\textbf{Conclusions:} There was a substantial concordance between
radiological (CT and/or MRI) and pathological T staging in RCC. However,
this is not true for T3 cases. Sensitivity of preoperative radiological
imaging in patients with pT3a tumors is insufficient and lower than the
other stages. Consequently, preoperative imaging in patients with T3 RCC
has to be improved, in order to better inform the patients regarding
prognosis of their disease.

\textbf{What is already known about this topic?}

Radiological evaluation with computerized tomography (CT) and/or
magnetic resonance imaging (MRI) is used to characterize renal mass and
its TNM stage.

\textbf{What does this article add?}

The sensitivity of preoperative radiological imaging in patients with
pT3a tumors is insufficient and lower than the other stages.
Consequently, preoperative imaging in patients with T3 RCC has to be
improved, in order to better inform the patients regarding prognosis of
their disease.

\textbf{Introduction}

Renal Cell Carcinoma (RCC) is the most frequent malignant tumor of the
kidney in adults and its incidence has been increasing globally (1).
Radical or partial nephrectomy is the standard surgical treatment of
RCC. Both the surgical procedure and approach are decided according to
the stage of cancer and the tumor features such as location, size and
centrality. Prognostic factors of RCC are classified into anatomical,
histological, clinical, and molecular by European Association of Urology
(EAU) Guidelines on RCC. The anatomical prognostic factors consist of
the criteria in the TNM classification system (2). Radiological
evaluation with computerized tomography (CT) and/or magnetic resonance
imaging (MRI) is used to characterize renal mass and its TNM stage. This
information is then used for treatment planning and patient counselling.

Multi-phasic contrast-enhanced CT of abdomen and chest is recommended
for the diagnosis and staging of RCC by EAU Guidelines on RCC. The
Guidelines also recommend MRI because of some advantages such as better
evaluation of venous involvement, avoidance of intravenous CT contrast
medium and reduction of radiation (2). CT staging for RCC has been
variably accurate, and staging inaccuracies, usually under-staging (most
common with Stage T3a disease) in previous studies has been reported
(3,4). Two large studies reported that patients upstaged from clinical
stage T1 to pathologic stage T3a RCC showed shorter survival outcomes
than those without upstaging (5,6). Therefore, accuracy of radiological
staging is very important for the management of patients with RCC. The
aim of the present study is to investigate the accuracy of radiological
staging of RCC in every stage and especially in pT3a cases.

\textbf{Material and Method}

Data of 4823 patients who underwent radical or partial nephrectomy for
renal tumors during the period from 2000 to 2019 was obtained from
Turkish Urooncology Association-Urologic Cancer Database-Kidney (TUOA
UroCaD-K) by using Research Electronic Data Capture (REDCap) (7,8) in
Turkey. Of 4823 patients, 3309 RCC patients were found to have complete
radiological and histopathological data and were included to this study.
Exclusion criteria were incomplete radiological and/or histopathological
data, other malignant or benign renal tumors except RCC, incomplete
demographic data, patients less than 18 years of age and patients who
were performed other procedures without surgical resection such as
radiofrequency ablation and microwave ablation. Radiological and
pathological stages of the patients were recorded according to TNM 2017
classification system. Radiological evaluations were made with CT and/or
MRI.

\textbf{Statistical analysis}

The Pearson Chi-squared test (\selectlanguage{greek}χ\selectlanguage{english}2) was used to compare radiological and
pathological stages. The concordance between the radiological and
pathological stages was evaluated by using the \selectlanguage{russian}к statistic, which is a
measure of agreement between observers that corrects for chance
agreement. The grade of concordance has been defined as `fair', for a of
0--0.2, moderate for 0.21--0.45, substantial for 0.46--0.75 and almost
perfect for 0.76--0.99 {[}9{]}. Statistical analysis was performed using
SPSS software package version 22.0 (Statistical Package for Social
ScienceTM, Chicago, IL, USA) and p \textless{} 0.05 was considered to
indicate statistical significance.

\textbf{Results}

The mean (SD) age of study population was 58 (12.3). Of our patients,
2176 (65.8\%) were male and 1133 (34.2\%) were female. Radical and
partial nephrectomies were performed in 2099 (63.4\%) and 1210 (36.6\%)
patients, respectively. CT and MRI were performed in 2510 (75.8\%) and
799 (24.2\%) patients, respectively. The demographic and surgical data
of the patients are given in Table 1. There was a substantial
concordance between radiological and pathological staging (к=0.52,
p\textless{}0.001) (Table 2). Sensitivity, specificity, negative and
positive predictive values and accuracy rates of radiologic staging for
pathologic stage are shown in table 3. The sensitivity in stage III was
lower than the other stages (p\textless{}0.05). Sub-analysis of stage
IIIa cases revealed that, for perirenal fat invasion and renal vein
invasion, sensitivity values were 15.4\% and 11.3\%, respectively. Out
of 383 radiological stage III cases, concordant pathology was found in
185 (48.3\%). Of 2658 radiologically localized tumors (stage I or II),
464 (17.5\%) identified as up-staged to stage III after nephrectomy
(Table 2). Positive surgical margins (PSM) were found in 39 (8.4\%) of
464 up-staged patients and 23 (12.4\%) of 185 concordant pathology cases
(p=0.08).

\textbf{Discussion}

More than 50\% of patients with RCC are diagnosed incidentally by
abdominal ultrasound or non-enhanced CT for other medical reasons
(10,11). Radiological T stage of a renal cancer is a major factor in
predicting prognosis and survival in these patients. Some studies have
reported that multi-phasic CT or MRI for the diagnosis of RCC have
accuracy of up to 90\% (12-14). In this study, using a large sample
size, we also showed that there was a substantial concordance between
radiological and pathological staging in Turkey. In addition, the
results showed that CT (75.8\%) is being used three times more commonly
than MRI (24.2\%) for the diagnosis and staging of RCC. The reason why
urologists prefer CT rather than MRI for renal imaging may be due to the
fact that CT is less time consuming and cheaper than MRI, and the
urologists are more familiar with CT images rather than MRI images.

Although the accuracy of CT and MRI in the diagnosis and staging of RCC
is generally high, the sensitivity and specificity values are found to
be lower in T3 cases compared to other stages (15). Renard et al.,
retrospectively, investigated the diagnostic accuracy of CT in
predicting pT3a RCC in 96 cases (15). Renal sinus fat infiltration,
peri-nephric fat infiltration and renal venous wall involvement were
assessed by two radiologists specialized in urological imaging and
compared with the histopathologic staging. The authors found that
assessment of renal tumor extension into perinephric fat remained a
difficult task, leading to reduced accuracy in T3a staging. Similarly,
the results of our study showed that the diagnostic accuracy of CT or
MRI in stage III RCC was lower than other stages. The importance of
these findings is that in all RCC types prognosis worsens with stage
(2), and this is also true for stage III cases compared to those with
stage I and II tumors. Chevinsky et al. reported pathological stage T3a
as a poor~ prognostic factor in RCC regardless of tumor size and also
demonstrated that there was an increased rate of risk of recurrence with
perinephric fat invasion compared to those with pT1/T2 tumors (16).
Therefore, radiologic under-staging in pT3a cases, will underestimate
the risk of cancer recurrence and survival rates, and the patient will
be misinformed regarding prognosis of his/her tumor during patient
counselling before surgery.

Although, both renal vein invasion and perirenal fat invasion are
classified as T3a disease, it was reported in recent studies that
patients with pT3aN0M0 RCC with renal vein invasion have a significantly
poorer prognosis than those with fat invasion (17). In TNM sub-group
analysis of Stage III, we found that the sensitivities of perirenal fat
and renal vein invasions were 15.4\% and 11.3\%, respectively. Although
these values are very low compared to values reported in other studies
(15), other studies also showed that peri-nephric fat and renal vein
invasion in RCC are difficult to evaluate radiologically (5). By using
the Surveillance Epidemiology and End Results registries Srivastava et
al. reported that from the patients undergoing partial nephrectomy, the
estimated proportion up-staged to pT3a was 9.5\%, and 19.5\% for cT1b,
and cT2, respectively (5). In our study, incidence of up-staging from
localized stages to stage III was 17.5\%, which is consistent with the
results reported in literature. Therefore, preoperative imaging in
patients with stage III RCC has to be improved. Advanced MRI techniques
such as diffusion weighted and perfusion-weighted imaging are being
explored for renal mass assessment and staging (18).

Presence of PSM on final pathology creates uncertainty in terms of
further management options. Some have performed an immediate or delayed
nephrectomy whereas others followed patients without complete
nephrectomy (19,20). The incidence of PSM ranges from 0--10.7\% in
literature and the rate of PSM may be influenced by tumour stage, fat
invasion and tumor grade (19,20). Bansal et al, by looking at the
partial nephrectomy patients included in the Canadian Kidney Cancer
information system database, reported that higher stage (\selectlanguage{english}[?]T3) and grade
were associated with a higher risk of PSM (19). In our study, PSM rate
was 8.4\% in patients up-staged from localized tumor to pathologically
stage III and 12.4\% in radiologically stage III cases with concordant
pathology (p=0.08). As there is no statistically significant difference
between these two rates, during surgery one should also be as cautious
as possible in radiologically localized disease in order not to have a
PSM.

The present study is limited by its retrospective nature. In addition,
central pathological and radiological review could not be performed.
Patients were included from different centres and therefore the quality
of radiologic and pathologic evaluation is probably variable. However,
the aim of our study was to evaluate the accuracy of radiological
staging of RCC in daily routine urology practice, rather than assessment
of radiological techniques or surgical procedures. So, we did not
perform any comparison between radiological techniques, surgical
procedures or centers.

There was a substantial concordance between radiological (CT and/or MRI)
and pathological T staging in RCC. However, this is not true for stage
T3 cases. The reason is that, it is difficult to evaluate peri-nephric
fat and renal vein invasion radiologically. Therefore, the sensitivity
of preoperative radiological imaging in patients with pT3a tumors is
insufficient and lower than the other stages. Consequently, preoperative
imaging in patients with T3 RCC has to be improved, in order to better
inform the patients regarding prognosis of their disease.

\textbf{Acknowledgments}

Dr Talha M

uezzino

\selectlanguage{english}?

glu and Dr Cihat

Ozcan made a

substantial contribution to the study by sharing the data of

their patients

Dr Talha M

uezzino

\selectlanguage{english}?

glu and Dr Cihat

Ozcan made a

substantial contribution to the study by sharing the data of

their patients

This study was supported by the Turkish Society of Urooncology. The
authors thank Dr. Levent Turkeri, Dr. Tayyar Alp Ozkan, Dr. Nihat
Karakoyunlu, Dr. \selectlanguage{ngerman}Özdal Dillioglugil, Dr. \selectlanguage{polish}İ\selectlanguage{english}lker Tinay and Dr. Hayrettin
Sahin making a substantial contribution to the study.

\textbf{Ethical standards}

The Local Ethics Committee approved the study protocol.

\textbf{Conflict of interest}

There are no conflicts of interest to be stated for the corresponding
author and all co-authors.

\textbf{Funding Sources}

The authors received no specific funding for this work.

\textbf{REFERENCES}

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\tightlist
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\textbf{TABLES}

\textbf{Table 1. The demographic and surgical data of all the patients.}\selectlanguage{english}
\begin{longtable}[]{@{}llll@{}}
\toprule
\begin{minipage}[b]{0.22\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[b]{0.22\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[b]{0.22\columnwidth}\raggedright\strut
N (\%)\strut
\end{minipage} & \begin{minipage}[b]{0.22\columnwidth}\raggedright\strut
Mean \selectlanguage{ngerman}± SD (min-max)\strut
\end{minipage}\tabularnewline
\midrule
\endhead
\begin{minipage}[t]{0.22\columnwidth}\raggedright\strut
Age (years)\strut
\end{minipage} & \begin{minipage}[t]{0.22\columnwidth}\raggedright\strut
Age (years)\strut
\end{minipage} & \begin{minipage}[t]{0.22\columnwidth}\raggedright\strut
3309 (100)\strut
\end{minipage} & \begin{minipage}[t]{0.22\columnwidth}\raggedright\strut
58.04 \selectlanguage{ngerman}± 12.26 (18-99)\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.22\columnwidth}\raggedright\strut
Tumor size (cm)\strut
\end{minipage} & \begin{minipage}[t]{0.22\columnwidth}\raggedright\strut
Tumor size (cm)\strut
\end{minipage} & \begin{minipage}[t]{0.22\columnwidth}\raggedright\strut
3309 (100)\strut
\end{minipage} & \begin{minipage}[t]{0.22\columnwidth}\raggedright\strut
5.89 \selectlanguage{ngerman}± 3.60 (1-37)\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.24\columnwidth}\raggedright\strut
Sex\strut
\end{minipage} & \begin{minipage}[t]{0.24\columnwidth}\raggedright\strut
Male Female\strut
\end{minipage} & \begin{minipage}[t]{0.24\columnwidth}\raggedright\strut
2176 (65.8) 1133 (34.2)\strut
\end{minipage} & \begin{minipage}[t]{0.24\columnwidth}\raggedright\strut
\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.24\columnwidth}\raggedright\strut
Surgical procedure\strut
\end{minipage} & \begin{minipage}[t]{0.24\columnwidth}\raggedright\strut
Radical nephrectomy Partial nephrectomy\strut
\end{minipage} & \begin{minipage}[t]{0.24\columnwidth}\raggedright\strut
2099 (63.4) 1210 (36.6)\strut
\end{minipage} & \begin{minipage}[t]{0.24\columnwidth}\raggedright\strut
\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.22\columnwidth}\raggedright\strut
Surgic al approach\strut
\end{minipage} & \begin{minipage}[t]{0.22\columnwidth}\raggedright\strut
Open Laparoscopic\strut
\end{minipage} & \begin{minipage}[t]{0.22\columnwidth}\raggedright\strut
2611(78.9) 698 (21.1)\strut
\end{minipage} & \begin{minipage}[t]{0.22\columnwidth}\raggedright\strut
\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.24\columnwidth}\raggedright\strut
Radiological technique\strut
\end{minipage} & \begin{minipage}[t]{0.24\columnwidth}\raggedright\strut
CT MRI\strut
\end{minipage} & \begin{minipage}[t]{0.24\columnwidth}\raggedright\strut
2510 (75.8) 799 (24.2)\strut
\end{minipage} & \begin{minipage}[t]{0.24\columnwidth}\raggedright\strut
\strut
\end{minipage}\tabularnewline
\bottomrule
\end{longtable}

CT: Computer Tomography, MRI: Magnetic Resonance Imaging

\textbf{Table 2.} Concordance of the stages between radiological and
patological staging.\selectlanguage{english}
\begin{longtable}[]{@{}lllllll@{}}
\toprule
\begin{minipage}[b]{0.12\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[b]{0.12\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[b]{0.12\columnwidth}\raggedright\strut
\textbf{Pathological Staging}\strut
\end{minipage} & \begin{minipage}[b]{0.12\columnwidth}\raggedright\strut
\textbf{Pathological Staging}\strut
\end{minipage} & \begin{minipage}[b]{0.12\columnwidth}\raggedright\strut
\textbf{Pathological Staging}\strut
\end{minipage} & \begin{minipage}[b]{0.12\columnwidth}\raggedright\strut
\textbf{Pathological Staging}\strut
\end{minipage} & \begin{minipage}[b]{0.12\columnwidth}\raggedright\strut
\textbf{Pathological Staging}\strut
\end{minipage}\tabularnewline
\midrule
\endhead
\begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
Stage I (n=1904)\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
Stage II (n=401)\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
Stage III (n=669)\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
Stage IV (n=335)\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
\selectlanguage{russian}к=0.52 p\textless{}0.001\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
\textbf{Radiological staging}\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
Stage I (n=2157)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
1726 (80\%)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
81 (3.7\%)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
306 (14.2\%)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
44 (2.1\%)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
Stage II (n=501)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
46 (9.2\%)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
270 (53.9\%)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
158 (31.5\%)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
27 (5.4\%)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
Stage III (n=383)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
110 (28.7\%)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
39 (10.2\%)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
185 (48.3\%)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
49 (12.8\%)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
Stage IV (n=268)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
22 (8.2\%)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
11 (4.1\%)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
20 (7.5\%)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
215 (80.2\%)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
\strut
\end{minipage}\tabularnewline
\bottomrule
\end{longtable}

\textbf{Table 3. Sensitivity, specificity, negative and positive
predictive values and accuracy rates of radiologic staging}\selectlanguage{english}
\begin{longtable}[]{@{}lllllll@{}}
\toprule
\begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
Sensitivity \%\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
\textbf{Specificity \%}\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
Negative predictive value \%\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
Positive predictive value \%\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
Accuracy \%\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
\textbf{Pathological staging}\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
Stage I\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
90.7\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
69.3\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
84.5\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
80.0\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
81.6\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
Stage II\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
67.3\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
92.1\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
95.3\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
53.9\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
89.1\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
Stage III\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
27.7\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
92.5\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
83.5\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
48.3\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
79.4\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
Stage IV\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
64.2\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
98.2\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
96.1\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
80.2\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
94.8\strut
\end{minipage}\tabularnewline
\bottomrule
\end{longtable}

\selectlanguage{english}
\FloatBarrier
\end{document}

