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Bhatla A, Menez S, Feldman L. Things We Do For No Reason™: Routine renal ultrasound testing for patients presenting with or developing acute kidney injury in the hospital. J Hosp Med 2024. [PMID: 38937273 DOI: 10.1002/jhm.13446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2024] [Revised: 05/28/2024] [Accepted: 06/15/2024] [Indexed: 06/29/2024]
Affiliation(s)
- Anjali Bhatla
- Department of Medicine, Division of Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Steven Menez
- Department of Medicine, Division of Nephrology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Leonard Feldman
- Departments of Internal Medicine and Pediatrics, Division of Hospital Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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2
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Chen B, Meng X, Wu W, Zhang Y, Ma L, Chen K, Fang X. A novel CEST-contrast nanoagent for differentiating the malignant degree in breast cancer. RSC Adv 2023; 13:14131-14138. [PMID: 37180024 PMCID: PMC10167945 DOI: 10.1039/d3ra01006f] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 05/03/2023] [Indexed: 05/15/2023] Open
Abstract
Different subtypes of breast cancer (BCC) have variable degrees of malignancy, which is closely related to their extracellular pH (pHe). Therefore, it is increasingly significant to monitor the extracellular pH sensitively to further determine the malignancy of different subtypes of BCC. Here, a l-arginine and Eu3+ assembled nanoparticle Eu3+@l-Arg was prepared to detect the pHe of two breast cancer models (TUBO is non-invasive and 4T1 is malignant) using a clinical chemical exchange saturation shift imaging technique. The experiments in vivo showed that Eu3+@l-Arg nanomaterials could respond sensitively to changes of pHe. In 4T1 models, the CEST signal enhanced about 5.42 times after Eu3+@l-Arg nanomaterials were used to detect the pHe. In contrast, few enhancements of the CEST signal were seen in the TUBO models. This significant difference had led to new ideas for identifying subtypes of BCC with different degrees of malignancy.
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Affiliation(s)
- Bixue Chen
- Department of Radiology, The Affiliated Wuxi People's Hospital of Nanjing Medical University Wuxi China
| | - Xianfu Meng
- Department of Medical Ultrasound, Shanghai Tenth People's Hospital, School of Medicine, Tongji University Shanghai China
- Department of Materials Science, State Key Laboratory of Molecular Engineering of Polymers, Fudan University Shanghai China
| | - Wanlu Wu
- Department of Radiology, The Affiliated Wuxi People's Hospital of Nanjing Medical University Wuxi China
| | - Yuwen Zhang
- Institute of Science and Technology for Brain-Inspired Intelligence, Fudan University Shanghai China
| | - Lin Ma
- Department of Radiology, The Affiliated Wuxi People's Hospital of Nanjing Medical University Wuxi China
| | - Kaidong Chen
- Department of Radiology, The Affiliated Wuxi People's Hospital of Nanjing Medical University Wuxi China
| | - Xiangming Fang
- Department of Radiology, The Affiliated Wuxi People's Hospital of Nanjing Medical University Wuxi China
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3
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Hao Q, Huang Z, Li Q, Liu D, Wang P, Wang K, Li J, Cao W, Deng W, Wu K, Su R, Liu Z, Vadgama J, Wu Y. A Novel Metabolic Reprogramming Strategy for the Treatment of Diabetes-Associated Breast Cancer. ADVANCED SCIENCE (WEINHEIM, BADEN-WURTTEMBERG, GERMANY) 2022; 9:e2102303. [PMID: 35023320 PMCID: PMC8867195 DOI: 10.1002/advs.202102303] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 10/08/2021] [Indexed: 05/11/2023]
Abstract
Diabetes is directly related to the risk of breast cancer (BC) occurrence and worsened BC prognosis. Currently, there are no specific treatments for diabetes-associated BC. This paper aims to understand the fundamental mechanisms of diabetes-induced BC progression and to develop personalized treatments. It reports a metabolic reprogramming strategy (MRS) that pharmaceutical induction of glucose import and glycolysis with metformin and NF-κB inhibitor (NF-κBi) while blocking the export of excessive lactate via inhibiting monocarboxylate transporter 4 (MCT4) leads to a metabolic crisis within the cancer cells. It demonstrates that the MRS shifts the metabolism of BC cells toward higher production of lactate, blocks lactate secretion, prompts intracellular acidification and induces significant cytotoxicity. Moreover, a novel MCT4 inhibitor CB-2 has been identified by structure-based virtual screening. A triple combination of metformin, CB-2, and trabectedin, a drug that impedes NF-κB signaling, strongly inhibits BC cells. Compared to normal glucose condition, MRS elicits more potent cancer cell-killing effects under high glucose condition. Animal model studies show that diabetic conditions promote the proliferation and progression of BC xenografts in nude mice and that MRS treatment significantly inhibits HG-induced BC progression. Therefore, inhibition of MCT4 combined with metformin/NF-κBi is a promising cancer therapy, especially for diabetes-associated BC.
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Affiliation(s)
- Qiongyu Hao
- Division of Cancer Research and TrainingDepartment of Internal MedicineCharles Drew University of Medicine and ScienceDavid Geffen UCLA School of Medicine and UCLA Jonsson Comprehensive Cancer CenterLos AngelesCA90095USA
| | - Zhimin Huang
- Key Laboratory of Cell Differentiation and ApoptosisMinistry of EducationDepartment of PathophysiologyShanghai Jiao‐Tong University School of MedicineShanghai200025China
- Department of BioengineeringRice UniversityHoustonTX77005USA
| | - Qun Li
- Department of OncologyShanghai East HospitalSchool of MedicineTongji UniversityShanghai200123China
| | - Dingxie Liu
- Bluewater Biotech LLCNew ProvidenceNJ07974USA
| | - Piwen Wang
- Division of Cancer Research and TrainingDepartment of Internal MedicineCharles Drew University of Medicine and ScienceDavid Geffen UCLA School of Medicine and UCLA Jonsson Comprehensive Cancer CenterLos AngelesCA90095USA
| | - Kun Wang
- Department of Breast CancerCancer CenterGuangdong Provincial People's Hospital & Guangdong Academy of Medical SciencesGuangzhou510080China
| | - Jieqing Li
- Division of Cancer Research and TrainingDepartment of Internal MedicineCharles Drew University of Medicine and ScienceDavid Geffen UCLA School of Medicine and UCLA Jonsson Comprehensive Cancer CenterLos AngelesCA90095USA
- Department of Breast CancerCancer CenterGuangdong Provincial People's Hospital & Guangdong Academy of Medical SciencesGuangzhou510080China
| | - Wei Cao
- Division of Cancer Research and TrainingDepartment of Internal MedicineCharles Drew University of Medicine and ScienceDavid Geffen UCLA School of Medicine and UCLA Jonsson Comprehensive Cancer CenterLos AngelesCA90095USA
| | - Wenhong Deng
- Division of Cancer Research and TrainingDepartment of Internal MedicineCharles Drew University of Medicine and ScienceDavid Geffen UCLA School of Medicine and UCLA Jonsson Comprehensive Cancer CenterLos AngelesCA90095USA
- Department of General SurgeryRenmin Hospital of Wuhan UniversityWuhan430060China
| | - Ke Wu
- Division of Cancer Research and TrainingDepartment of Internal MedicineCharles Drew University of Medicine and ScienceDavid Geffen UCLA School of Medicine and UCLA Jonsson Comprehensive Cancer CenterLos AngelesCA90095USA
| | - Rui Su
- College of EngineeringUniversity of CaliforniaBerkeleyCA94720USA
| | - Zhongmin Liu
- The Institute for Biomedical Engineering & Nano ScienceShanghai East HospitalTongji University School of MedicineShanghai200120China
| | - Jay Vadgama
- Division of Cancer Research and TrainingDepartment of Internal MedicineCharles Drew University of Medicine and ScienceDavid Geffen UCLA School of Medicine and UCLA Jonsson Comprehensive Cancer CenterLos AngelesCA90095USA
| | - Yong Wu
- Division of Cancer Research and TrainingDepartment of Internal MedicineCharles Drew University of Medicine and ScienceDavid Geffen UCLA School of Medicine and UCLA Jonsson Comprehensive Cancer CenterLos AngelesCA90095USA
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4
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Bradley AJ, Maskell GF, Mannava A, Pollard A, Welsh T. Routes to diagnosis and missed opportunities in the detection of renal cancer. Clin Radiol 2020; 76:129-134. [PMID: 33309335 DOI: 10.1016/j.crad.2020.11.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Accepted: 11/17/2020] [Indexed: 12/21/2022]
Abstract
AIM To determine the proportion of renal cancers for which incidental detection was the route to diagnosis, the characteristics of tumours identified in this way, and the frequency with which opportunities to make this diagnosis were missed. MATERIALS AND METHODS Consecutive patients with renal cancers treated at Royal Cornwall Hospitals NHS Trust (April 2011 and July 2018 inclusive) were identified from the Trust's cancer registry database, and a retrospective review of the imaging and electronic case notes was undertaken. Mann-Whitney U-tests for comparison of patient age and tumour size at diagnosis, and chi-squared tests for comparing cell type distribution and grade were performed. Logistic regression was then used to identify the characteristics of patients in whom a renal tumour was missed initially. RESULTS Of 327 patients, 194 (63%) presented incidentally, and 133 (37%) symptomatically. Incidentally detected cancers were found in younger patients, (median of 65 years versus 69 p=0.01) and were smaller at presentation (median of 5.5 versus 7.2 cm, p<0.00001). Thirty-six different reporters missed opportunities to diagnose renal cancer in 50 (16%) patients on 78 occasions, 28 lesions (35%) being missed more than once. Thirty were imaged incompletely; four were visible only on a single image and three on a scout view at magnetic resonance imaging. CONCLUSION The commonest route to diagnosis of renal cancer is by incidental detection of a mass. In 16% of patients in whom renal cancer is diagnosed, there is at least one prior examination on which the lesion is visible at an earlier date. The clinical impact of these missed diagnostic opportunities remains uncertain.
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Affiliation(s)
- A J Bradley
- Department of Radiology, Royal Cornwall Hospitals NHS Trust, Treliske, Truro, Cornwall TR1 3LQ, UK.
| | - G F Maskell
- Department of Radiology, Royal Cornwall Hospitals NHS Trust, Treliske, Truro, Cornwall TR1 3LQ, UK
| | - A Mannava
- Department of Radiology, Royal Cornwall Hospitals NHS Trust, Treliske, Truro, Cornwall TR1 3LQ, UK
| | - A Pollard
- Research Development and Innovation, Royal Cornwall Hospitals NHS Trust, Treliske, Truro, Cornwall TR1 3LQ, UK
| | - T Welsh
- Department of Radiology, Royal Cornwall Hospitals NHS Trust, Treliske, Truro, Cornwall TR1 3LQ, UK
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5
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Hussain T, Lam V, Farhad M, Lee S, Stephenson JA, Kockelbergh R, Rajesh A. Can subcentimetre ultrasound detected angiomyolipomas be safely disregarded? Clin Radiol 2020; 75:287-292. [PMID: 31916983 DOI: 10.1016/j.crad.2019.12.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Accepted: 12/04/2019] [Indexed: 01/20/2023]
Abstract
AIM To optimise follow-up by dismissing lesions on baseline ultrasound (US) if renal lesions conform to US criteria of an angiomyolipoma (AML). METHOD AND MATERIALS The present study was a 10-year retrospective review of patients who were found to have incidental hyperechoic renal lesions on US to ascertain the outcome from subsequent imaging, clinical encounters, and cancer registrations. Exclusions included renal calculi, tuberous sclerosis, Von-Hippel-Lindau, or a known cancer. RESULTS After excluding 39 patients, 1,493 patients were identified. One hundred and sixty had more than one lesion with 87 patients having bilateral lesions. Regardless of indication, 889 patients had subsequent imaging within 5 years (59.5%). The average size of all AMLs was 13.2 mm. In the group with lesions that were <10 mm (807), 438 had imaging follow-up with an average follow-up time of 1.5 years. Mean lesion size in this group was 7 mm, with an average increase of <0.5 mm on follow-up. No lesions were found to be malignant on subsequent imaging nor did any of these patients have a subsequent renal cancer diagnosis registered at local multidisciplinary team meetings. CONCLUSION No incidental subcentimetre hyperechoic renal lesion with imaging characteristics of an AML demonstrated significant growth or developed into a malignancy on follow-up.
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Affiliation(s)
- T Hussain
- Department of Radiology, University Hospitals of Leicester NHS Trust, Leicester General Hospital, Gwendolen Road, Leicester LE5 4PW, UK
| | - V Lam
- Department of Radiology, University Hospitals of Leicester NHS Trust, Leicester General Hospital, Gwendolen Road, Leicester LE5 4PW, UK
| | - M Farhad
- Department of Radiology, University Hospitals of Leicester NHS Trust, Leicester General Hospital, Gwendolen Road, Leicester LE5 4PW, UK
| | - S Lee
- Department of Radiology, University Hospitals of Leicester NHS Trust, Leicester General Hospital, Gwendolen Road, Leicester LE5 4PW, UK
| | - J A Stephenson
- Department of Radiology, University Hospitals of Leicester NHS Trust, Leicester General Hospital, Gwendolen Road, Leicester LE5 4PW, UK
| | - R Kockelbergh
- Department of Urology, University Hospitals of Leicester NHS Trust, Leicester General Hospital, Gwendolen Road, Leicester LE5 4PW, UK
| | - A Rajesh
- Department of Radiology, University Hospitals of Leicester NHS Trust, Leicester General Hospital, Gwendolen Road, Leicester LE5 4PW, UK.
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6
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Ahmad A, Nettleton J, Hotston M, Bradley A, Maskell G. Incidental urological findings in patients undergoing computed tomography colonography for investigation of suspected colorectal cancer. JOURNAL OF CLINICAL UROLOGY 2019. [DOI: 10.1177/2051415819847070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective: To determine the rate of incidental urological findings in patients undergoing computed tomography (CT) colonography/CT colonoscopy (CTC) for investigation of suspected colorectal cancer. Methods: Retrospective analysis of patients undergoing CTC between January 2011 and December 2013. All patients with new incidental urological findings were included with their type and number of urological findings. These were stratified as per the colonography reporting and data system (C-RADS) criteria, and a note made of any further imaging, intervention and histology where appropriate. Results: Within the time period, n = 1891 CTCs were undertaken. Of these, n = 333 (17.6%) had an incidental urological finding and n = 41 of these patients had dual incidental urological pathologies. In total, n = 49 had significant pathology which required monitoring, further imaging, and medical or surgical intervention; n = 12 required further imaging. In n = 1, the imaging result led to a decision to operate and in n = 9 the results excluded the need for surgical intervention; n = 24 underwent operative intervention. The rates of incidental urological findings were similar to those quoted in literature. Conclusion: Our study demonstrates a 17.6% rate of incidental urological findings. Of all findings, 13.1% were deemed significant to warrant further investigation or intervention, and 7.2% of patients with urological findings required intervention. CTCs can adequately image renal masses and further imaging of renal masses did not change management. Level of evidence: 4
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Affiliation(s)
- Adnan Ahmad
- Department of Urology and Radiology, Royal Cornwall Hospital, UK
| | - Jeremy Nettleton
- Department of Urology and Radiology, Royal Cornwall Hospital, UK
| | - Matthew Hotston
- Department of Urology and Radiology, Royal Cornwall Hospital, UK
| | - Alison Bradley
- Department of Urology and Radiology, Royal Cornwall Hospital, UK
| | - Giles Maskell
- Department of Urology and Radiology, Royal Cornwall Hospital, UK
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7
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Udare A, Abreu-Gomez J, Krishna S, McInnes M, Siegelman E, Schieda N. Imaging Manifestations of Acute and Chronic Renal Infection That Mimics Malignancy: How to Make the Diagnosis Using Computed Tomography and Magnetic Resonance Imaging. Can Assoc Radiol J 2019; 70:424-433. [PMID: 31537315 DOI: 10.1016/j.carj.2019.07.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Revised: 07/11/2019] [Accepted: 07/11/2019] [Indexed: 02/07/2023] Open
Abstract
PURPOSE To review the computed tomography and magnetic resonance imaging manifestations of acute and chronic renal infections that may mimic malignancy and to provide useful tips to establish an imaging diagnosis. CONCLUSION Acute and chronic bacterial pyelonephritis are usually readily diagnosed clinically and on imaging when the diagnosis is suspected based upon clinical presentation. When unsuspected, focal, extensive or mass-like, acute and chronic bacterial pyelonephritis may mimic infiltrative tumours such as urothelial cell carcinoma (UCC), lymphoma, and metastatic disease. Infection may be suspected when patients are young and otherwise healthy when there is marked associated perinephric changes and in the absence of metastatic adenopathy or disease elsewhere in the abdomen and pelvis. Renal abscesses, from bacterial or atypical microbial agents, can appear as complex cystic renal masses mimicking cystic renal cell carcinoma. Associated inflammatory changes in and around the kidney and local invasion favour infection. Emphysematous pyelonephritis can mimic necrotic or fistulizing tumour; however, infection is more likely and should always be considered first. Xanthogranulomatous pyelonephritis can mimic malignancy when focal or multifocal and in cases without associated renal calculi. Malacoplakia is an inflammatory process that may mimic malignancy and should be considered in patients with chronic infection. Bacillus Calmette-Guerin (BCG)-induced pyelonephritis is rare but can mimic renal malignancy and should be considered in patients presenting with a renal mass when being treated with BCG for urinary bladder UCC.
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Affiliation(s)
- Amar Udare
- Department of Medical Imaging, The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada
| | - Jorge Abreu-Gomez
- Department of Medical Imaging, The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada
| | - Satheesh Krishna
- Joint Department of Medical Imaging, Toronto General Hospital, The University of Toronto, Toronto, Ontario, Canada
| | - Matthew McInnes
- Department of Medical Imaging, The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada
| | - Evan Siegelman
- Department of Radiology, The Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Nicola Schieda
- Department of Medical Imaging, The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada.
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8
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Leão LRDS, Mussi TC, Yamauchi FI, Baroni RH. Common pitfalls in renal mass evaluation: a practical guide. Radiol Bras 2019; 52:254-261. [PMID: 31435088 PMCID: PMC6696749 DOI: 10.1590/0100-3984.2018.0007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
More than half of patients over 50 years of age have had at least one focal renal lesion detected as an incidental finding during an ultrasound, computed tomography, or magnetic resonance imaging examination. Although the majority of such lesions can be easily detected and correctly characterized, misdiagnoses may occur and are often related to methodological limitations, inappropriate imaging protocols, or misinterpretation. This pictorial essay provides recommendations on how to recognize benign and malignant renal processes that can be potentially missed or mischaracterized in imaging studies.
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Affiliation(s)
| | - Thais Caldara Mussi
- Department of Radiology and Diagnostic Imaging, Hospital Israelita Albert Einstein, São Paulo, SP, Brazil
| | - Fernando Ide Yamauchi
- Department of Radiology and Diagnostic Imaging, Hospital Israelita Albert Einstein, São Paulo, SP, Brazil
| | - Ronaldo Hueb Baroni
- Department of Radiology and Diagnostic Imaging, Hospital Israelita Albert Einstein, São Paulo, SP, Brazil
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9
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McEwan L, McBean R, Yaxley J, Wong D. Unexpected significant findings non‐related to prostate cancer identified using combined prostate‐specific membrane antigen positron emission tomography/
CT
and diagnostic
CT
scan in primary staging for prostate cancer. J Med Imaging Radiat Oncol 2019; 63:318-323. [DOI: 10.1111/1754-9485.12864] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Accepted: 02/05/2019] [Indexed: 12/01/2022]
Affiliation(s)
- Louise McEwan
- Wesley Medical Imaging The Wesley Hospital Brisbane Queensland Australia
| | - Rhiannon McBean
- Wesley Medical Imaging The Wesley Hospital Brisbane Queensland Australia
| | - John Yaxley
- Wesley Urology Clinic The Wesley Hospital Brisbane Queensland Australia
| | - David Wong
- Wesley Medical Imaging The Wesley Hospital Brisbane Queensland Australia
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Abstract
Renal cell carcinoma (RCC) is the most common kidney cancer and includes several molecular and histological subtypes with different clinical characteristics. While survival rates are high if RCC is diagnosed when still confined to the kidney and treated definitively, there are no specific diagnostic screening tests available and symptoms are rare in early stages of the disease. Management of advanced RCC has changed significantly with the advent of targeted therapies, yet survival is usually increased by months due to acquired resistance to these therapies. DNA methylation, the covalent addition of a methyl group to a cytosine, is essential for normal development and transcriptional regulation, but becomes altered commonly in cancer. These alterations result in broad transcriptional changes, including in tumor suppressor genes. Because DNA methylation is one of the earliest molecular changes in cancer and is both widespread and stable, its role in cancer biology, including RCC, has been extensively studied. In this review, we examine the role of DNA methylation in RCC disease etiology and progression, the preclinical use of DNA methylation alterations as diagnostic, prognostic and predictive biomarkers, and the potential for DNA methylation-directed therapies.
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Affiliation(s)
- Brittany N Lasseigne
- HudsonAlpha Institute for Biotechnology, 601 Genome Way, Huntsville, AL, 35806-2908, USA.
| | - James D Brooks
- Department of Urology, Stanford University Medical Center, 300 Pasteur Drive, Stanford, CA, 94305-5118, USA
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Abstract
Increasingly, renal cell cancer is diagnosed because of an incidental finding of a renal mass on an imaging study. Incidentally discovered masses are more likely to be small and, if malignant, represent localized renal cell cancer. The imaging features of the tumor and patient characteristics inform the management options, which favor a nephron-sparing approach over radical nephrectomy. Clinical stage at the time of diagnosis has important prognostic implications for the patient. This article reviews the presentation, diagnostic evaluation, and management of an incidentally discovered renal mass.
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12
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Meyer HJ, Pfeil A, Schramm D, Bach AG, Surov A. Renal incidental findings on computed tomography: Frequency and distribution in a large non selected cohort. Medicine (Baltimore) 2017; 96:e7039. [PMID: 28658098 PMCID: PMC5500020 DOI: 10.1097/md.0000000000007039] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Renal incidental findings (IFs) are common. However, previous reports investigated renal IFs were limited to patient selection. The purpose of this study was to estimate the prevalence and distribution of all renal IFs on computed tomography (CT) in a large patient collective.All patients, who underwent CT investigations of the abdominal region at our institution in the time period between January 2006 and February 2014 were included in this study. Inclusion criteria were as follows: no previous history of renal diseases and well image quality. Patients with known kidney disorders were excluded from the study. Overall, 7365 patients meet the inclusion criteria were identified. There were 2924 (39.7%) women and 4441 men (60.3%) with a mean age of 59.8 ± 16.7 years. All CTs were retrospectively analyzed in consensus by 2 radiologists. Collected data were evaluated by means of descriptive statistics.Overall, 2756 patients (37.42% of all included patients) showed 3425 different renal IFs (1.24 findings per patient). Of all renal IFs, 123 (3.6%) findings were clinically relevant, 259 (7.6%) were categorized as possibly clinically relevant, and 3043 (88.8%) were clinically non relevant.Different renal IFs can be detected on CT. The present study provides a real prevalence and proportion of them in daily clinical routine. Kidneys should be thoroughly evaluated because of the fact that incidental renal findings occur frequently.
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Affiliation(s)
- Hans Jonas Meyer
- Department of Radiology, Martin-Luther-University Halle-Wittenberg, Halle
- Department of Diagnostic and Interventional Radiology, University of Leipzig, Leipzig, Germany
| | - Alina Pfeil
- Department of Radiology, Martin-Luther-University Halle-Wittenberg, Halle
| | - Dominik Schramm
- Department of Radiology, Martin-Luther-University Halle-Wittenberg, Halle
| | | | - Alexey Surov
- Department of Diagnostic and Interventional Radiology, University of Leipzig, Leipzig, Germany
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13
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Magnetic Resonance Imaging and the Use in Small Renal Masses. Indian J Surg Oncol 2017; 8:19-23. [PMID: 28127178 DOI: 10.1007/s13193-016-0575-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2016] [Accepted: 07/21/2016] [Indexed: 01/06/2023] Open
Abstract
The incidence of small renal masses (SRM) has been increasing, and this is mainly attributed to the incidental finding of such masses on imaging performed in asymptomatic patients. Consequently, this calls for careful evaluation and management of these masses to determine their nature and need for treatment. This article reviews current literature regarding the evaluation and management of SRM. It focuses on the specific use of MRI in the diagnosis and management of SRM. A Medline review of the literature was performed from 1996 to the present time. Computed tomography (CT) imaging has been the investigation of choice for evaluating SRM. However, some remain difficult to determine their malignant or benign nature and remain indeterminate. In such cases, further imaging with magnetic resonance imaging (MRI) can be performed to evaluate the mass in more detail. It can also be used where CT is contraindicated and where active surveillance is the treatment of choice and radiation exposure is a concern. MRI is a useful tool in evaluating an indeterminate small renal mass. Accurate diagnosis and management of SRM require close collaboration between a urologist and radiologist to identify potentially malignant tumours to subsequently reduce mortality from renal cell cancer.
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14
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Skakić A, Stojanov D, Bašić D, Dinić L, Potić M, Tasić A. DIAGNOSTIC IMAGING OF SMALL RENAL MASSES. ACTA MEDICA MEDIANAE 2016. [DOI: 10.5633/amm.2016.0309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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15
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Itani M, Pandya A, Bude RO. Sonographically Identified Echogenic Renal Masses Up to 1 cm in Size Are So Rarely Malignant They Can Be Safely Ignored. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2016; 35:323-328. [PMID: 26740491 DOI: 10.7863/ultra.15.05080] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/27/2015] [Accepted: 07/20/2015] [Indexed: 06/05/2023]
Abstract
OBJECTIVES The purpose of this study was to determine whether small echogenic renal masses up to 1 cm in size incidentally detected by sonography are rarely malignant and thus do not need further workup. METHODS We reviewed approximately 13,600 reports of all abdominal sonographic examinations performed between November 2001 and October 2007 that identified a small echogenic mass in a kidney. Patients with known malignancy of any kind, tuberous sclerosis, lesions larger than 1.0 cm, lesions with heterogeneous echogenicity, and lesions with posterior ring-down artifacts or posterior acoustic shadowing were excluded. All patients without magnetic resonance imaging or computed tomographic scans that completely characterized the lesions were excluded unless a follow-up study (sonography, magnetic resonance imaging, or contrast-enhanced computed tomography) at least 5 years later was available for comparison to prove that the lesion was benign. RESULTS A total of 120 lesions in 111 patients satisfied the inclusion criteria. Lesion sizes were 0 to 5 mm (n = 16) and 6 to 10 mm (n = 104). Of these, 54 lesions were characterized as definitely benign (47 angiomyolipomas and 7 other benign entities: calcifications in stones or within a cyst or calyx and cysts that were either simple on follow-up studies or complicated with hemorrhagic or proteinaceous content). For the remaining 66 lesions, follow-up results after at least 5 years were normal in 24 cases (which meant that the lesion was no longer visible), and the remaining 42 lesions were stable in size. The mean duration of follow-up for these 66 lesions was 7.4 years. CONCLUSIONS Small echogenic renal masses up to 1 cm in size that fulfill our study criteria are so likely to be benign that they can be safely ignored.
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Affiliation(s)
- Malak Itani
- Department of Radiology, University of Washington Medical Center, Seattle, Washington USA (M.I.); and Department of Radiology, University of Michigan Health System, Ann Arbor, Michigan USA (A.P., R.O.B.)
| | - Amit Pandya
- Department of Radiology, University of Washington Medical Center, Seattle, Washington USA (M.I.); and Department of Radiology, University of Michigan Health System, Ann Arbor, Michigan USA (A.P., R.O.B.)
| | - Ronald O Bude
- Department of Radiology, University of Washington Medical Center, Seattle, Washington USA (M.I.); and Department of Radiology, University of Michigan Health System, Ann Arbor, Michigan USA (A.P., R.O.B.)
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Renal Masses With Equivocal Enhancement at CT: Characterization With Contrast-Enhanced Ultrasound. AJR Am J Roentgenol 2015; 204:W557-65. [PMID: 25905962 DOI: 10.2214/ajr.14.13375] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVE The purpose of this article is to retrospectively investigate in two radiology centers the role of contrast-enhanced ultrasound in the characterization of renal masses with equivocal enhancement at CT (i.e., with a density increase of 10-20 HU between unenhanced and contrast-enhanced scans) not characterized with conventional ultrasound modes. MATERIALS AND METHODS Forty-seven renal lesions (range, 0.8-7.7 cm; average, 2.6 cm) with equivocal enhancement at CT underwent contrast-enhanced ultrasound using sulfur hexafluoride-filled microbubbles. Examinations were digitally recorded for retrospective blinded evaluation by two radiologists with 20 and 10 years' experience in urologic imaging. Histologic results were available for 30 of 47 (64%) lesions (25 primary malignant tumors, two metastases, and three primary benign lesions). Two lesions increased in size and complexity during the follow-up and were considered malignant. One Bosniak category III and 14 category IIF cysts were stable after a follow-up of at least 3 years and were considered benign. ROC curve analysis was used to assess the capability of contrast-enhanced ultrasound to differentiate benign from malignant lesions. RESULTS Twelve likely complex cystic lesions at gray-scale ultrasound were cystic also on contrast-enhanced ultrasound and reference procedures. Eleven of 34 lesions that appeared solid at gray-scale ultrasound were cystic on contrast-enhanced ultrasound and reference procedures. One lesion considered likely solid by one radiologist and possibly cystic by the other was a solid tumor at contrast-enhanced ultrasound and histologic analysis. The diagnostic performance of contrast-enhanced ultrasound to characterize the lesions as benign or malignant was high for both readers (AUC, 0.958 and 0.966, respectively). CONCLUSION Contrast-enhanced ultrasound is effective for characterizing renal lesions presenting with equivocal enhancement at CT.
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Segura-Grau A, Herzog R, Díaz-Rodriguez N, Segura-Cabral JM. [Ultrasound of the urinary system]. Semergen 2015; 42:388-94. [PMID: 25982474 DOI: 10.1016/j.semerg.2015.03.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2014] [Revised: 03/18/2015] [Accepted: 03/20/2015] [Indexed: 01/29/2023]
Abstract
Ultrasound techniques are able to provide a fairly complete examination of the urinary system, achieving a high sensitivity in relevant-pathology detection, especially in the kidney, bladder and prostate. Early detection of pathologies such as tumors or urinary tract obstructions, sometimes even before their clinical manifestation, has improved their management and prognosis in many cases. This, added to its low cost and harmlessness, makes ultrasound ideal for early approaches and follow-up of a wide number of urinary system pathologies. In this article, the ultrasound characteristics of the main urinary system pathologies that can be diagnosed by this technique, are reviewed.
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Affiliation(s)
- A Segura-Grau
- Unidad de Ecografía San Francisco de Asís, Madrid, España; Centro de Diagnóstico Ecográfico, Madrid, España; Grupo de Trabajo de Ecografía de SEMERGEN, Madrid, España
| | - R Herzog
- Unidad de Ecografía San Francisco de Asís, Madrid, España; Centro de Diagnóstico Ecográfico, Madrid, España; Grupo de Trabajo de Ecografía de SEMERGEN, Madrid, España; Servicio de Atención Rural, Mejorada del Campo, Madrid, España.
| | - N Díaz-Rodriguez
- Centro de Salud A Valenza, Ourense, España; Grupo de Trabajo de Ecografía de SEMERGEN, Ourense, España
| | - J M Segura-Cabral
- Unidad de Ecografía San Francisco de Asís, Madrid, España; Centro de Diagnóstico Ecográfico, Madrid, España
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Silverman SG, Israel GM, Trinh QD. Incompletely Characterized Incidental Renal Masses: Emerging Data Support Conservative Management. Radiology 2015; 275:28-42. [DOI: 10.1148/radiol.14141144] [Citation(s) in RCA: 88] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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Role of MRI in indeterminate renal mass: diagnostic accuracy and impact on clinical decision making. Int Urol Nephrol 2015; 47:585-93. [DOI: 10.1007/s11255-015-0928-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2014] [Accepted: 01/30/2015] [Indexed: 01/28/2023]
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Collins CE, Cherng N, McDade T, Movahedi B, Emhoff TA, Whalen GF, LaFemina J, Dorfman JD. Improving patient notification of solid abdominal viscera incidental findings with a standardized protocol. J Trauma Manag Outcomes 2015; 9:1. [PMID: 25670964 PMCID: PMC4322550 DOI: 10.1186/s13032-014-0022-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2014] [Accepted: 12/16/2014] [Indexed: 12/21/2022]
Abstract
Background The increasing use of computed tomography (CT) scans in the evaluation of trauma patients has led to increased detection of incidental radiologic findings. Incidental findings (IFs) of the abdominal viscera are among the most commonly discovered lesions and can carry a risk of malignancy. Despite this, patient notification regarding these findings is often inadequate. Methods We identified patients who underwent abdominopelvic CTs as part of their trauma evaluation during a recent 1-year period (9/2011-8/2012). Patients with IFs of the kidneys, liver, adrenal glands, pancreas and/or ovaries had their charts reviewed for documentation of the lesion in their discharge paperwork or follow-up. A quality improvement project was initiated where patients with abdominal IFs were verbally informed of the finding, it was noted on their discharge summary and/or were referred to specialists for evaluation. Nine months after the implementation of the IF protocol, a second chart review was performed to determine if the rate of patient notification improved. Results Of 1,117 trauma patients undergoing abdominopelvic CT scans during the 21 month study period, 239 patients (21.4%) had 292 incidental abdominal findings. Renal lesions were the most common (146 patients, 13% of all patients) followed by hepatic (95/8.4%) and adrenal (38/3.4%) lesions. Pancreatic (10/0.9%) and ovarian lesions (3/0.3%) were uncommon. Post-IF protocol implementation patient notification regarding IFs improved by over 80% (32.4% vs. 17.7% pre-protocol, p = 0.02). Conclusion IFs of the solid abdominal organs are common in trauma patients undergoing abdominopelvic CT scan. Patient notification regarding these lesions is often inadequate. A systematic approach to the documentation and evaluation of incidental radiologic findings can significantly improve the rate of patient notification. Electronic supplementary material The online version of this article (doi:10.1186/s13032-014-0022-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Courtney E Collins
- University of Massachusetts Medical School and UMass Memorial, Worcester, MA USA
| | - Nicole Cherng
- University of Massachusetts Medical School and UMass Memorial, Worcester, MA USA
| | - Theodore McDade
- University of Massachusetts Medical School and UMass Memorial, Worcester, MA USA
| | - Babak Movahedi
- University of Massachusetts Medical School and UMass Memorial, Worcester, MA USA
| | - Timothy A Emhoff
- University of Massachusetts Medical School and UMass Memorial, Worcester, MA USA
| | - Giles F Whalen
- University of Massachusetts Medical School and UMass Memorial, Worcester, MA USA
| | - Jennifer LaFemina
- University of Massachusetts Medical School and UMass Memorial, Worcester, MA USA
| | - Jon D Dorfman
- University of Massachusetts Medical School and UMass Memorial, Worcester, MA USA
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Lasseigne BN, Burwell TC, Patil MA, Absher DM, Brooks JD, Myers RM. DNA methylation profiling reveals novel diagnostic biomarkers in renal cell carcinoma. BMC Med 2014; 12:235. [PMID: 25472429 PMCID: PMC4265327 DOI: 10.1186/s12916-014-0235-x] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2014] [Accepted: 11/12/2014] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Renal cell carcinoma (RCC) is the tenth most commonly diagnosed cancer in the United States. While it is usually lethal when metastatic, RCC is successfully treated with surgery when tumors are confined to the kidney and have low tumor volume. Because most early stage renal tumors do not result in symptoms, there is a strong need for biomarkers that can be used to detect the presence of the cancer as well as to monitor patients during and after therapy. METHODS We examined genome-wide DNA methylation alterations in renal cell carcinomas of diverse histologies and benign adjacent kidney tissues from 96 patients. RESULTS We observed widespread methylation differences between tumors and benign adjacent tissues, particularly in immune-, G-protein coupled receptor-, and metabolism-related genes. Additionally, we identified a single panel of DNA methylation biomarkers that reliably distinguishes tumor from benign adjacent tissue in all of the most common kidney cancer histologic subtypes, and a second panel does the same specifically for clear cell renal cell carcinoma tumors. This set of biomarkers were validated independently with excellent performance characteristics in more than 1,000 tissues in The Cancer Genome Atlas clear cell, papillary, and chromophobe renal cell carcinoma datasets. CONCLUSIONS These DNA methylation profiles provide insights into the etiology of renal cell carcinoma and, most importantly, demonstrate clinically applicable biomarkers for use in early detection of kidney cancer.
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Affiliation(s)
- Brittany N Lasseigne
- HudsonAlpha Institute for Biotechnology, 601 Genome Way, Huntsville, AL, 35806, USA.
- Department of Biological Sciences, University of Alabama in Huntsville, Shelby Center for Science and Technology, Room 369, 301 Sparkman Drive, Huntsville, Alabama, 35899, USA.
| | - Todd C Burwell
- HudsonAlpha Institute for Biotechnology, 601 Genome Way, Huntsville, AL, 35806, USA.
| | - Mohini A Patil
- Department of Urology, Stanford University, 875 Blake Wilbur Dr. Clinic E, Stanford, California, 94305-5118, USA.
| | - Devin M Absher
- HudsonAlpha Institute for Biotechnology, 601 Genome Way, Huntsville, AL, 35806, USA.
| | - James D Brooks
- Department of Urology, Stanford University, 875 Blake Wilbur Dr. Clinic E, Stanford, California, 94305-5118, USA.
| | - Richard M Myers
- HudsonAlpha Institute for Biotechnology, 601 Genome Way, Huntsville, AL, 35806, USA.
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Wagstaff PGK, Zondervan PJ, de la Rosette JJMCH, Laguna MP. The Role of Imaging in the Active Surveillance of Small Renal Masses. Curr Urol Rep 2014; 15:386. [DOI: 10.1007/s11934-013-0386-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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Damaghi M, Wojtkowiak JW, Gillies RJ. pH sensing and regulation in cancer. Front Physiol 2013; 4:370. [PMID: 24381558 PMCID: PMC3865727 DOI: 10.3389/fphys.2013.00370] [Citation(s) in RCA: 361] [Impact Index Per Article: 32.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2013] [Accepted: 11/26/2013] [Indexed: 12/13/2022] Open
Abstract
Cells maintain intracellular pH (pHi) within a narrow range (7.1–7.2) by controlling membrane proton pumps and transporters whose activity is set by intra-cytoplasmic pH sensors. These sensors have the ability to recognize and induce cellular responses to maintain the pHi, often at the expense of acidifying the extracellular pH. In turn, extracellular acidification impacts cells via specific acid-sensing ion channels (ASICs) and proton-sensing G-protein coupled receptors (GPCRs). In this review, we will discuss some of the major players in proton sensing at the plasma membrane and their downstream consequences in cancer cells and how these pH-mediated changes affect processes such as migration and metastasis. The complex mechanisms by which they transduce acid pH signals to the cytoplasm and nucleus are not well understood. However, there is evidence that expression of proton-sensing GPCRs such as GPR4, TDAG8, and OGR1 can regulate aspects of tumorigenesis and invasion, including cofilin and talin regulated actin (de-)polymerization. Major mechanisms for maintenance of pHi homeostasis include monocarboxylate, bicarbonate, and proton transporters. Notably, there is little evidence suggesting a link between their activities and those of the extracellular H+-sensors, suggesting a mechanistic disconnect between intra- and extracellular pH. Understanding the mechanisms of pH sensing and regulation may lead to novel and informed therapeutic strategies that can target acidosis, a common physical hallmark of solid tumors.
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Affiliation(s)
- Mehdi Damaghi
- Department of Cancer Imaging and Metabolism, Moffitt Cancer Center and Research Institute Tampa, FL, USA
| | - Jonathan W Wojtkowiak
- Department of Cancer Imaging and Metabolism, Moffitt Cancer Center and Research Institute Tampa, FL, USA
| | - Robert J Gillies
- Department of Cancer Imaging and Metabolism, Moffitt Cancer Center and Research Institute Tampa, FL, USA
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Podoll A, Walther C, Finkel K. Clinical utility of gray scale renal ultrasound in acute kidney injury. BMC Nephrol 2013; 14:188. [PMID: 24011084 PMCID: PMC3844534 DOI: 10.1186/1471-2369-14-188] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2013] [Accepted: 09/04/2013] [Indexed: 12/04/2022] Open
Abstract
Background Acute kidney injury occurs commonly in hospitalized patients and is associated with significant morbidity and mortality. Although renal ultrasound is often performed, its clinical utility in determining of the cause of acute kidney injury, particularly the detection of urinary tract obstruction, is not established. Methods Retrospective cohort study of all adult inpatients that underwent renal ultrasound for acute kidney injury over a 3-year period at a large university teaching hospital. The frequency of renal ultrasound abnormalities and clinical characteristics that predicted the finding of urinary tract obstruction was determined. Results Over the 3-year period, 1471 renal ultrasounds were performed of which 55% (810) were for evaluation of acute kidney injury. Renal ultrasound was normal in 62% (500 of 810) of patients. Hydronephrosis was detected in only 5% (42 of 810) of studies and in only 2.3% (19 of 810) of the cases was obstructive uropathy considered the cause of acute kidney injury. The majority of these patients (14 of 19) had a medical history suggestive of urinary tract obstruction. Less than 1% of patients (5 of 810) had urinary tract obstruction on ultrasound without a suggestive medical history. Most other ultrasound findings were incidental and did not establish an etiology for the acute kidney injury. Conclusions Renal ultrasound for evaluation of acute kidney injury is indicated if there is medical history suggestive of urinary tract obstruction. Otherwise, renal ultrasound is unlikely to yield useful results and should be used more selectively based on patients’ medical history.
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Affiliation(s)
- Amber Podoll
- UTHealth Science Center at Houston, Department of Internal Medicine, Division of Renal Diseases & Hypertension, 6431 Fannin MSB 5,134, Houston, TX 77030, USA.
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Jones KL, Tripathi PB, Srivastava SA, Beavis AL, Matsuo K, Moffitt MN, Maliglig A, Lin YG. Leiomyomatoid angiomatous neuroendocrine tumor of the uterine myometrium with synchronous renal leiomyosarcoma: case report and review of the literature. Int Cancer Conf J 2012. [DOI: 10.1007/s13691-012-0050-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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Current world literature. Curr Opin Urol 2012; 22:432-43. [PMID: 22854603 DOI: 10.1097/mou.0b013e3283572fe1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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