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Warren H, Fanshawe JB, Mok V, Iyer P, Chan VW, Hesketh R, Zimmermann E, Kasivisvanathan V, Emberton M, Tran MGB, Gurusamy K. Imaging modalities for characterising T1 renal tumours: A systematic review and meta-analysis of diagnostic accuracy. BJUI COMPASS 2024; 5:636-650. [PMID: 39022655 PMCID: PMC11249832 DOI: 10.1002/bco2.355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Accepted: 02/28/2024] [Indexed: 07/20/2024] Open
Abstract
Objectives International guidelines recommend resection of suspected localised renal cell carcinoma (RCC), with surgical series showing benign pathology in 30%. Non-invasive diagnostic tests to differentiate benign from malignant tumours are an unmet need. Our objective was to determine diagnostic accuracy of imaging modalities for detecting cancer in T1 renal tumours. Methods A systematic review was performed for reports of diagnostic accuracy of any imaging test compared to a reference standard of histopathology for T1 renal masses, from inception until January 2023. Twenty-seven publications (including 2277 tumours in 2044 participants) were included in the systematic review, and nine in the meta-analysis. Results Forest plots of sensitivity and specificity were produced for CT (seven records, 1118 participants), contrast-enhanced ultrasound (seven records, 197 participants), [99mTc]Tc-sestamibi SPECT/CT (five records, 263 participants), MRI (three records, 220 participants), [18F]FDG PET (four records, 43 participants), [68Ga]Ga-PSMA-11 PET (one record, 27 participants) and [111In]In-girentuximab SPECT/CT (one record, eight participants). Meta-analysis returned summary estimates of sensitivity and specificity for [99mTc]Tc-sestamibi SPECT/CT of 88.6% (95% CI 82.7%-92.6%) and 77.0% (95% CI 63.0%-86.9%) and for [18F]FDG PET 53.5% (95% CI 1.6%-98.8%) and 62.5% (95% CI 14.0%-94.5%), respectively. A comparison hierarchical summary receiver operating characteristic (HSROC) model did not converge. Meta-analysis was not performed for other imaging due to different thresholds for test positivity. Conclusion The optimal imaging strategy for T1 renal masses is not clear. [99mTc]Tc-sestamibi SPECT/CT is an emerging tool, but further studies are required to inform its role in clinical practice. The field would benefit from standardisation of diagnostic thresholds for CT, MRI and contrast-enhanced ultrasound to facilitate future meta-analyses.
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Affiliation(s)
- Hannah Warren
- Division of Surgery and Interventional ScienceUniversity College LondonLondonUK
- Royal Free Hospital Specialist Centre for Kidney CancerLondonUK
| | | | - Valerie Mok
- Faculty of MedicineUniversity of British ColumbiaVancouverCanada
| | - Priyanka Iyer
- Guy's, King's and St Thomas' School of Medical EducationKing's College LondonLondonUK
| | | | - Richard Hesketh
- Centre of Medical Imaging AUniversity College LondonLondonUK
| | | | | | - Mark Emberton
- Division of Surgery and Interventional ScienceUniversity College LondonLondonUK
| | - Maxine G. B. Tran
- Division of Surgery and Interventional ScienceUniversity College LondonLondonUK
- Royal Free Hospital Specialist Centre for Kidney CancerLondonUK
| | - Kurinchi Gurusamy
- Division of Surgery and Interventional ScienceUniversity College LondonLondonUK
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Luo S, Lin W, Wu J, Zhang W, Kui X, Lai S, Wei R, Pang X, Wang Y, He C, Liu J, Yang R. Quantitative Measurement on Contrast-Enhanced CT Distinguishes Small Clear Cell Renal Cell Carcinoma From Benign Renal Tumors: A Multicenter Study. Acad Radiol 2024; 31:1460-1471. [PMID: 37945492 DOI: 10.1016/j.acra.2023.10.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 09/14/2023] [Accepted: 10/05/2023] [Indexed: 11/12/2023]
Abstract
RATIONALE AND OBJECTIVES To evaluate the potential of quantitative measurements on contrast-enhanced CT (CECT) in differentiating small (≤4 cm) clear cell renal cell carcinoma (ccRCC) from benign renal tumors, including fat-poor angiomyolipoma (fpAML) and renal oncocytoma (RO). MATERIALS AND METHODS 244 patients with pathologically confirmed ccRCC (n = 184) and benign renal tumors (fpAML, n = 50; RO, n = 10) were randomly assigned into training cohort (n = 193) and test cohort 1 (n = 51), while external test cohort 2 (n = 50) was from another hospital. Quantitative parameters were obtained from CECT (unenhanced phase, UP; corticomedullary phase, CMP; nephrographic phase, NP; excretory phase, EP) by measuring attenuation of renal mass and cortex and subsequently calculated. Univariable and multivariable logistic regression analyses were performed to evaluate the association between these parameters and ccRCC. Finally, the constructed models were compared with radiologists' diagnoses. RESULTS In univariable analysis, UP-related parameters, particularly UPC-T (cortex minus tumor attenuation on UP), demonstrated AUC of 0.766 in training cohort, 0.901 in test cohort 1, 0.805 in test cohort 2. The heterogeneity-related parameter SD (standard deviation) showed AUC of 0.781, 0.834, and 0.875 respectively. In multivariable analysis, model 1 incorporating UPC-T, NPC-T (cortex minus tumor attenuation on NP), CMPT-UPT (tumor attenuation on CMP minus UP), and SD yielded AUC of 0.866, 0.923, and 0.949 respectively. When compared with radiologists, multivariate models demonstrated higher accuracy (0.800-0.860) and sensitivity (0.794-0.971) than radiologists' assessments (accuracy: 0.700-0.720, sensitivity: 0.588-0.706). CONCLUSION Quantitative measurements on CECT, particularly UP- and heterogeneity-related parameters, have potential to discriminate ccRCC and benign renal tumors (fpAML, RO).
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Affiliation(s)
- Shiwei Luo
- Department of Radiology, the Second Affiliated Hospital, School of Medicine, South China University of Technology, Guangzhou 510180, Guangdong, China (S.L., W.L., W.Z., R.W., X.P., Y.W., C.H., R.Y.); Department of Radiology, the Second Xiangya Hospital of Central South University, Changsha 410011, Hunan, China (S.L., J.L.).
| | - Wanxian Lin
- Department of Radiology, the Second Affiliated Hospital, School of Medicine, South China University of Technology, Guangzhou 510180, Guangdong, China (S.L., W.L., W.Z., R.W., X.P., Y.W., C.H., R.Y.).
| | - Jialiang Wu
- Department of Radiology, University of Hong Kong-Shenzhen Hospital, Shenzhen, Guangdong 518000, China (J.W.).
| | - Wanli Zhang
- Department of Radiology, the Second Affiliated Hospital, School of Medicine, South China University of Technology, Guangzhou 510180, Guangdong, China (S.L., W.L., W.Z., R.W., X.P., Y.W., C.H., R.Y.).
| | - Xiaoyan Kui
- School of Computer Science and Engineering, Central South University, Changsha 410083, Hunan, China (X.K.).
| | - Shengsheng Lai
- School of Medical Equipment, Guangdong Food and Drug Vocational College, Guangzhou 510520, Guangdong, China (S.L.).
| | - Ruili Wei
- Department of Radiology, the Second Affiliated Hospital, School of Medicine, South China University of Technology, Guangzhou 510180, Guangdong, China (S.L., W.L., W.Z., R.W., X.P., Y.W., C.H., R.Y.).
| | - Xinrui Pang
- Department of Radiology, the Second Affiliated Hospital, School of Medicine, South China University of Technology, Guangzhou 510180, Guangdong, China (S.L., W.L., W.Z., R.W., X.P., Y.W., C.H., R.Y.).
| | - Ye Wang
- Department of Radiology, the Second Affiliated Hospital, School of Medicine, South China University of Technology, Guangzhou 510180, Guangdong, China (S.L., W.L., W.Z., R.W., X.P., Y.W., C.H., R.Y.).
| | - Chutong He
- Department of Radiology, the Second Affiliated Hospital, School of Medicine, South China University of Technology, Guangzhou 510180, Guangdong, China (S.L., W.L., W.Z., R.W., X.P., Y.W., C.H., R.Y.).
| | - Jun Liu
- Department of Radiology, the Second Xiangya Hospital of Central South University, Changsha 410011, Hunan, China (S.L., J.L.).
| | - Ruimeng Yang
- Department of Radiology, the Second Affiliated Hospital, School of Medicine, South China University of Technology, Guangzhou 510180, Guangdong, China (S.L., W.L., W.Z., R.W., X.P., Y.W., C.H., R.Y.).
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Baio R, Molisso G, Caruana C, Di Mauro U, Intilla O, Pane U, D’Angelo C, Campitelli A, Pentimalli F, Sanseverino R. "To Be or Not to Be Benign" at Partial Nephrectomy for Presumed RCC Renal Masses: Single-Center Experience with 195 Consecutive Patients. Diseases 2023; 11:diseases11010027. [PMID: 36810541 PMCID: PMC9945135 DOI: 10.3390/diseases11010027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 01/21/2023] [Accepted: 01/31/2023] [Indexed: 02/11/2023] Open
Abstract
In daily medical practice, an increasing number of kidney masses are being incidentally detected using common imaging techniques, owing to the improved diagnostic accuracy and increasingly frequent use of these techniques. As a consequence, the rate of detection of smaller lesions is increasing considerably. According to certain studies, following surgical treatment, up to 27% of small enhancing renal masses are identified as benign tumors at the final pathological examination. This high rate of benign tumors challenges the appropriateness of surgery for all suspicious lesions, given the morbidity associated with such an intervention. The objective of the present study was, therefore, to determine the incidence of benign tumors at partial nephrectomy (PN) for a solitary renal mass. To meet this end, a total of 195 patients who each underwent one PN for a solitary renal lesion with the intent to cure RCC were included in the final retrospective analysis. A benign neoplasm was identified in 30 of these patients. The age of the patients ranged from 29.9-79 years (average: 60.9 years). The tumor size range was 1.5-7 cm (average: 3 cm). All the operations were successful using the laparoscopic approach. The pathological results were renal oncocytoma in 26 cases, angiomyolipomas in two cases, and cysts in the remaining two cases. In conclusion, we have shown in our present series the incidence rate of benign tumors in patients who have been subjected to laparoscopic PN due to a suspected solitary renal mass. Based on these results, we advise that the patient should be counseled not only about the intra- and post-operative risks of nephron-sparing surgery but also about its dual therapeutic and diagnostic role. Therefore, the patients should be informed of the considerably high probability of a benign histological result.
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Affiliation(s)
- Raffaele Baio
- Department of Medicine and Surgery “Scuola Medica Salernitana”, University of Salerno, 84081 Baronissi, Italy
- Correspondence:
| | - Giovanni Molisso
- Department of Urology, Umberto I, Nocera Inferiore, 84014 Salerno, Italy
| | | | - Umberto Di Mauro
- Department of Urology, Umberto I, Nocera Inferiore, 84014 Salerno, Italy
| | - Olivier Intilla
- Department of Urology, Umberto I, Nocera Inferiore, 84014 Salerno, Italy
| | - Umberto Pane
- Department of Urology, Umberto I, Nocera Inferiore, 84014 Salerno, Italy
| | - Costantino D’Angelo
- Department of Medical Biotechnologies, University of Siena, 53100 Siena, Italy
| | - Antonio Campitelli
- Department of Urology, Umberto I, Nocera Inferiore, 84014 Salerno, Italy
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Qu J, Zhang Q, Song X, Jiang H, Ma H, Li W, Wang X. CT differentiation of the oncocytoma and renal cell carcinoma based on peripheral tumor parenchyma and central hypodense area characterisation. BMC Med Imaging 2023; 23:16. [PMID: 36707788 PMCID: PMC9881251 DOI: 10.1186/s12880-023-00972-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Accepted: 01/18/2023] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Although the central scar is an essential imaging characteristic of renal oncocytoma (RO), its utility in distinguishing RO from renal cell carcinoma (RCC) has not been well explored. The study aimed to evaluate whether the combination of CT characteristics of the peripheral tumor parenchyma (PTP) and central hypodense area (CHA) can differentiate typical RO with CHA from RCC. METHODS A total of 132 tumors on the initial dataset were retrospectively evaluated using four-phase CT. The excretory phases were performed more than 20 min after the contrast injection. In corticomedullary phase (CMP) images, all tumors had CHAs. These tumors were categorized into RO (n = 23), clear cell RCC (ccRCC) (n = 85), and non-ccRCC (n = 24) groups. The differences in these qualitative and quantitative CT features of CHA and PTP between ROs and ccRCCs/non-ccRCCs were statistically examined. Logistic regression filters the main factors for separating ROs from ccRCCs/non-ccRCCs. The prediction models omitting and incorporating CHA features were constructed and evaluated, respectively. The effectiveness of the prediction models including CHA characteristics was then confirmed through a validation dataset (8 ROs, 35 ccRCCs, and 10 non-ccRCCs). RESULTS The findings indicate that for differentiating ROs from ccRCCs and non-ccRCCs, prediction models with CHA characteristics surpassed models without CHA, with the corresponding areas under the curve (AUC) being 0.962 and 0.914 versus 0.952 and 0.839 respectively. In the prediction models that included CHA parameters, the relative enhancement ratio (RER) in CMP and enhancement inversion, as well as RER in nephrographic phase and enhancement inversion were the primary drivers for differentiating ROs from ccRCCs and non-ccRCCs, respectively. The prediction models with CHA characteristics had the comparable diagnostic ability on the validation dataset, with respective AUC values of 0.936 and 0.938 for differentiating ROs from ccRCCs and non-ccRCCs. CONCLUSION The prediction models with CHA characteristics can help better differentiate typical ROs from RCCs. When a mass with CHA is discovered, particularly if RO is suspected, EP images with longer delay scanning periods should be acquired to evaluate the enhancement inversion characteristics of CHA.
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Affiliation(s)
- Jianyi Qu
- Yuhuangding Hospital, Qingdao University School of Medicine, Shandong, Yantai, China
| | - Qianqian Zhang
- Yuhuangding Hospital, Qingdao University School of Medicine, Shandong, Yantai, China
| | - Xinhong Song
- Yuhuangding Hospital, Qingdao University School of Medicine, Shandong, Yantai, China
| | - Hong Jiang
- Yuhuangding Hospital, Qingdao University School of Medicine, Shandong, Yantai, China
| | - Heng Ma
- Yuhuangding Hospital, Qingdao University School of Medicine, Shandong, Yantai, China
| | - Wenhua Li
- Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.
| | - Xiaofei Wang
- Yantaishan Hospital, Binzhou Medical University, Shandong, Yantai, China.
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Grajo JR, Batra NV, Bozorgmehri S, Magnelli LL, O'Malley P, Terry R, Su LM, Crispen PL. Association between nuclear grade of renal cell carcinoma and the aorta-lesion-attenuation-difference. Abdom Radiol (NY) 2021; 46:5629-5638. [PMID: 34463815 DOI: 10.1007/s00261-021-03260-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2021] [Revised: 08/19/2021] [Accepted: 08/20/2021] [Indexed: 11/27/2022]
Abstract
INTRODUCTION AND BACKGROUND Several features noted on renal mass biopsy (RMB) can influence treatment selection including tumor histology and nuclear grade. However, there is poor concordance between renal cell carcinoma (RCC) nuclear grade on RMB compared to nephrectomy specimens. Here, we evaluate the association of nuclear grade with aorta-lesion-attenuation-difference (ALAD) values determined on preoperative CT scan. METHODS AND MATERIALS A retrospective review of preoperative CT scans and surgical pathology was performed on patients undergoing nephrectomy for solid renal masses. ALAD was calculated by measuring the difference in Hounsfield units (HU) between the aorta and the lesion of interest on the same image slice on preoperative CT scan. The discriminative ability of ALAD to differentiate low-grade (nuclear grade 1 and 2) and high-grade (nuclear grade 3 and 4) tumors was evaluated by sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and area under curve (AUC) using ROC analysis. Sub-group analysis by histologic sub-type was also performed. RESULTS A total of 368 preoperative CT scans in patients with RCC on nephrectomy specimen were reviewed. Median patient age was 61 years (IQR 52-68). The majority of patients were male, 66% (243/368). Tumor histology was chromophobe RCC in 7.6%, papillary RCC in 15.5%, and clear cell RCC in 76.9%. The majority, 69.3% (253/365) of tumors, were stage T1a. Nuclear grade was grade 1 in 5.46% (19/348), grade 2 in 64.7% (225/348), grade 3 in 26.2% (91/348), and grade 4 in 3.2% (11/348). Nephrographic ALAD values for grade 1, 2, 3, and 4 were 73.7, 46.5, 36.4, and 43.1, respectively (p = 0.0043). Nephrographic ALAD was able to differentiate low-grade from high-grade RCC with a sensitivity of 32%, specificity of 89%, PPV of 86%, and NPV of 36%. ROC analysis demonstrated the predictive utility of nephrographic ALAD to predict high- versus low-grade RCC with an AUC of 0.60 (95% CI 0.51-0.69). CONCLUSION ALAD was significantly associated with nuclear grade in our nephrectomy series. Strong specificity and PPV for the nephrographic phrase demonstrate a potential role for ALAD in the pre-operative setting that may augment RMB findings in assessing nuclear grade of RCC. Although this association was statistically significant, the clinical utility is limited at this time given the results of the statistical analysis (relatively poor ROC analysis). Sub-group analysis by histologic subtype yielded very similar diagnostic performance and limitations of ALAD. Further studies are necessary to evaluate this relationship further.
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Affiliation(s)
- Joseph R Grajo
- Department of Radiology, University of Florida College of Medicine, Gainesville, FL, 32610, USA.
| | - Nikhil V Batra
- Department of Urology, University of Florida College of Medicine, Gainesville, FL, 32610, USA
| | - Shahab Bozorgmehri
- Department of Epidemiology, University of Florida College of Medicine, Gainesville, FL, 32610, USA
| | - Laura L Magnelli
- Department of Radiology, University of Florida College of Medicine, Gainesville, FL, 32610, USA
| | - Padraic O'Malley
- Department of Urology, University of Florida College of Medicine, Gainesville, FL, 32610, USA
| | - Russell Terry
- Department of Urology, University of Florida College of Medicine, Gainesville, FL, 32610, USA
| | - Li-Ming Su
- Department of Urology, University of Florida College of Medicine, Gainesville, FL, 32610, USA
| | - Paul L Crispen
- Department of Urology, University of Florida College of Medicine, Gainesville, FL, 32610, USA
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