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Lounová V, Študent V, Purová D, Hartmann I, Vidlář A, Študent V. Frequency of benign tumors after partial nephrectomy and the association between malignant tumor findings and preoperative clinical parameters. BMC Urol 2024; 24:175. [PMID: 39174947 PMCID: PMC11342569 DOI: 10.1186/s12894-024-01543-3] [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: 04/29/2023] [Accepted: 07/15/2024] [Indexed: 08/24/2024] Open
Abstract
BACKGROUND Partial nephrectomy (PN) has become the dominant treatment modality for cT1 renal tumor lesions. Tumors suspected of malignant potential are indicated for surgery, but some are histologically classified as benign lesions after surgery. This study aims to analyze the number of benign findings after PN according to definitive histology and to evaluate whether there is an association between malignant tumor findings and individual factors. METHODS The retrospective study included 555 patients who underwent open or robotic-assisted PN for a tumor in our clinic from January 2013 to December 2020. The cohort was divided into groups according to definitive tumor histology (malignant tumors vs. benign lesions). The association of factors (age, sex, tumor size, R.E.N.A.L.) with the malignant potential of the tumor was further evaluated. RESULTS In total, 462 tumors were malignant (83%) and 93 benign (17%). Of the malignant tumors, 66% were clear-cell RCC (renal cell carcinoma), 12% papillary RCC, and 6% chromophobe RCC. The most common benign tumor was oncocytoma in 10% of patients, angiomyolipoma in 2%, and papillary adenoma in 1%. In univariate analysis, there was a higher risk of malignant tumor in males (OR 2.13, 95% CI 1.36-3.36, p = 0.001), a higher risk of malignancy in tumors larger than 20 mm (OR 2.32, 95% CI 1.43-3.74, p < 0.001), and a higher risk of malignancy in tumors evaluated by R.E.N.A.L. as tumors of intermediate or high complexity (OR 2.8, 95% CI 1.76-4.47, p < 0.001). In contrast, there was no association between older age and the risk of malignant renal tumor (p = 0.878). CONCLUSIONS In this group, 17% of tumors had benign histology. Male sex, tumor size greater than 20 mm, and intermediate or high R.E.N.A.L. complexity were statistically significant predictors of malignant tumor findings.
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Affiliation(s)
- Veronika Lounová
- Department of Urology, University Hospital Olomouc Palacký University Olomouc, Olomouc, Czech Republic
| | - Vladimír Študent
- Department of Urology, University Hospital Olomouc Palacký University Olomouc, Olomouc, Czech Republic.
| | - Dana Purová
- Olomouc University Social Health Institute, Palacky University Olomouc, Olomouc, Czech Republic
| | - Igor Hartmann
- Department of Urology, University Hospital Olomouc Palacký University Olomouc, Olomouc, Czech Republic
| | - Aleš Vidlář
- Department of Urology, University Hospital Olomouc Palacký University Olomouc, Olomouc, Czech Republic
| | - Vladimír Študent
- Department of Urology, University Hospital Olomouc Palacký University Olomouc, Olomouc, Czech Republic
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2
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Potterveld SK, Mubeen A, Anderson WJ, Clay MR, Bourgeau M, Charville GW, Sangoi AR. Diagnosing liposarcoma on (peri)-renal mass biopsy: A clinicopathological study of 30 cases. Histopathology 2024; 85:254-262. [PMID: 38646791 DOI: 10.1111/his.15197] [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: 02/14/2024] [Revised: 03/25/2024] [Accepted: 04/06/2024] [Indexed: 04/23/2024]
Abstract
AIMS Classification of renal neoplasms on small tissue biopsies is in increasing demand, and maintaining broad differential diagnostic considerations in this setting is necessary. When evaluating a renal or perirenal tumour biopsy with sarcomatoid morphology, together with sarcomatoid renal cell carcinoma and sarcomatoid urothelial carcinoma as top diagnostic considerations, it is vital to additionally consider the possibility of well-differentiated and de-differentiated liposarcoma. METHODS AND RESULTS This study reports a series of 30 biopsy samples from sites in or around the kidney collected from four institutions in which the correct diagnosis was either well-differentiated or de-differentiated liposarcoma. The majority (26 of 30, 87%) of lesions were accurately diagnosed on biopsy sampling, all of which incorporated testing for MDM2 by immunohistochemistry (IHC), fluorescence in-situ hybridisation (FISH) or a combination of the two as part of the diagnostic work-up. Tumour expression of MDM2 by IHC without confirmatory FISH analysis was sometimes (30%) sufficient to reach a diagnosis, but demonstration of MDM2 amplification by FISH was ascertained in the majority (57%) of biopsy samples. A diagnosis of de-differentiated liposarcoma was not definitively established until resection in four (13%) patients, as no MDM2 testing was performed on the corresponding pre-operative biopsies. CONCLUSIONS When a retroperitoneal tumour is not clinically suspected, histological consideration of a liposarcoma diagnosis may be overlooked. Implementation of ancillary immunohistochemical and cytogenetic testing can ultimately lead to a definitive diagnosis in this potentially misleading anatomical location.
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Affiliation(s)
| | | | | | | | | | | | - Ankur R Sangoi
- Department of Pathology, Stanford Medical Center, Stanford, CA, USA
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3
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Liang M, Qiu H, Ou B, Wu J, Zhao X, Luo B. Evaluation of contrast-enhanced ultrasound for predicting tumor grade in small (≤4 cm) clear cell renal cell carcinoma: Qualitative and quantitative analysis. Clin Hemorheol Microcirc 2024:CH231990. [PMID: 39031342 DOI: 10.3233/ch-231990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/22/2024]
Abstract
OBJECTIVE The study aimed to evaluate the utility of qualitative and quantitative analysis employing contrast-enhanced ultrasound (CEUS) in predicting the WHO/ISUP grade of small (≤4 cm) clear cell renal cell carcinoma (ccRCCs). METHODS Patients with small ccRCCs, confirmed by histological examination, underwent preoperative CEUS and were classified into low- (grade I/II) and high-grade (grade III/IV) groups. Qualitative and quantitative assessments of CEUS were conducted and compared between the two groups. Diagnostic performance was assessed using receiver operating characteristic curves. RESULTS A total of 72 patients were diagnosed with small ccRCCs, comprising 23 individuals in the high-grade group and 49 in the low-grade group. The low-grade group exhibited a significantly greater percentage of hyper-enhancement compared to the high-grade group (79.6% VS 39.1%, P < 0.05). The low-grade group showed significantly higher relative index values for peak enhancement, wash-in area under the curve, wash-in rate, wash-in perfusion index, and wash-out rate compared to the high-grade group (all P < 0.05). The AUC values for qualitative and quantitative parameters in predicting the WHO/ISUP grade of small ccRCCs ranged from 0.676 to 0.756. CONCLUSIONS Both qualitative and quantitative CEUS analysis could help to distinguish the high- from low-grade small ccRCCs.
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Affiliation(s)
- Ming Liang
- Department of Ultrasound, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, Guangdong, China
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Medical Research Center, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Haolin Qiu
- Department of Ultrasound, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, Guangdong, China
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Medical Research Center, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Bing Ou
- Department of Ultrasound, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, Guangdong, China
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Medical Research Center, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Jiayi Wu
- Department of Ultrasound, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, Guangdong, China
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Medical Research Center, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Xinbao Zhao
- Department of Ultrasound, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, Guangdong, China
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Medical Research Center, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Baoming Luo
- Department of Ultrasound, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, Guangdong, China
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Medical Research Center, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
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Lerma LA, Pease G, Malleis J, Antic T, Hes O, Tretiakova M. Actual encounters of the kidney kind: Exploring 48 cases of renal collision tumors through the lens of literature. Hum Pathol 2024; 145:26-33. [PMID: 38340966 DOI: 10.1016/j.humpath.2024.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 02/02/2024] [Accepted: 02/06/2024] [Indexed: 02/12/2024]
Abstract
Multiple tumors of different lineages merging into a single mass, termed collision tumors, are considered a rare phenomenon in the kidney. Tumor components, or partners, may be malignant (including metastatic disease), borderline, or benign. We report the largest cohort to date of 48 cases. The cases were identified from the archives of three institutions in the last 16 years, including 43 (90%) with 2 tumor partners (dyad) and 5 (10%) with 3 partners (triad), totaling 101 individual neoplasms. The majority of cases involved immunohistochemical workup, and 5 underwent FISH or molecular studies. Forty (83%) cases featured a malignant entity, including all triads. Twenty dyads and two triads were composed entirely of malignant tumors. The most common malignant partner was clear cell renal cell carcinoma (RCC) (N = 19) followed by papillary RCC (N = 17). Nine (19%) cases featured borderline entities, including 5 multilocular cystic neoplasms of low malignant potential and 6 clear cell papillary renal cell tumors. Twenty one (44%) cases contained a benign partner, including 6 benign dyads. Papillary adenoma (N = 13) and oncocytoma (N = 8) were most common. Epithelial tumors were present in all 48 cases, and non-epithelial neoplasms in 9 cases (19%). Our cohort includes many novel combinations and collision partners with rare entities such as SDH-deficient RCC, TFE3-rearranged RCC, eosinophilic solid and cystic RCC, and acquired cystic disease associated RCC. A comprehensive literature review and analysis of collision tumor phenomenon in kidney placed these cases in context suggesting that collision tumors of the kidney are more common than previously recognized.
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Affiliation(s)
- L Angelica Lerma
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, WA, USA
| | - Garrison Pease
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, WA, USA
| | - James Malleis
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, WA, USA
| | - Tatjana Antic
- Department of Pathology, University of Chicago, Chicago, IL, USA
| | - Ondrej Hes
- Department of Pathology, Faculty of Medicine in Pilsen, Charles University, Pilsen, Czech Republic
| | - Maria Tretiakova
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, WA, USA.
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Wang S, Zhu C, Jin Y, Yu H, Wu L, Zhang A, Wang B, Zhai J. A multi-model based on radiogenomics and deep learning techniques associated with histological grade and survival in clear cell renal cell carcinoma. Insights Imaging 2023; 14:207. [PMID: 38010567 PMCID: PMC10682311 DOI: 10.1186/s13244-023-01557-9] [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: 08/29/2023] [Accepted: 11/01/2023] [Indexed: 11/29/2023] Open
Abstract
OBJECTIVES This study aims to evaluate the efficacy of multi-model incorporated by radiomics, deep learning, and transcriptomics features for predicting pathological grade and survival in patients with clear cell renal cell carcinoma (ccRCC). METHODS In this study, data were collected from 177 ccRCC patients, including radiomics features, deep learning (DL) features, and RNA sequencing data. Diagnostic models were then created using these data through least absolute shrinkage and selection operator (LASSO) analysis. Additionally, a multi-model was developed by combining radiomics, DL, and transcriptomics features. The prognostic performance of the multi-model was evaluated based on progression-free survival (PFS) and overall survival (OS) outcomes, assessed using Harrell's concordance index (C-index). Furthermore, we conducted an analysis to investigate the relationship between the multi-model and immune cell infiltration. RESULTS The multi-model demonstrated favorable performance in discriminating pathological grade, with area under the ROC curve (AUC) values of 0.946 (95% CI: 0.912-0.980) and 0.864 (95% CI: 0.734-0.994) in the training and testing cohorts, respectively. Additionally, it exhibited statistically significant prognostic performance for predicting PFS and OS. Furthermore, the high-grade group displayed a higher abundance of immune cells compared to the low-grade group. CONCLUSIONS The multi-model incorporated radiomics, DL, and transcriptomics features demonstrated promising performance in predicting pathological grade and prognosis in patients with ccRCC. CRITICAL RELEVANCE STATEMENT We developed a multi-model to predict the grade and survival in clear cell renal cell carcinoma and explored the molecular biological significance of the multi-model of different histological grades. KEY POINTS 1. The multi-model achieved an AUC of 0.864 for assessing pathological grade. 2. The multi-model exhibited an association with survival in ccRCC patients. 3. The high-grade group demonstrated a greater abundance of immune cells.
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Affiliation(s)
- Shihui Wang
- Department of Radiology, The First Affiliated Hospital of Wannan Medical College, Wuhu, People's Republic of China
| | - Chao Zhu
- Department of Radiology, The First Affiliated Hospital of Wannan Medical College, Wuhu, People's Republic of China
| | - Yidong Jin
- School of Health Science and Engineering, University of Shanghai for Science and Technology, Shanghai, People's Republic of China
| | - Hongqing Yu
- Department of Radiology, The First Affiliated Hospital of Wannan Medical College, Wuhu, People's Republic of China
| | - Lili Wu
- Department of Radiology, The First Affiliated Hospital of Wannan Medical College, Wuhu, People's Republic of China
| | - Aijuan Zhang
- Department of Radiology, The First Affiliated Hospital of Wannan Medical College, Wuhu, People's Republic of China
| | - Beibei Wang
- Department of Radiology, The First Affiliated Hospital of Wannan Medical College, Wuhu, People's Republic of China
| | - Jian Zhai
- Department of Radiology, The First Affiliated Hospital of Wannan Medical College, Wuhu, People's Republic of China.
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Gao H, Nowroozizadeh B, Zepeda JP, Landman J, Farzaneh T, Johnson C, Hosseini H, Han M. The success rate of small renal mass core needle biopsy and its impact on lowering benign resection rate. BMC Urol 2023; 23:189. [PMID: 37980518 PMCID: PMC10657570 DOI: 10.1186/s12894-023-01363-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 11/09/2023] [Indexed: 11/20/2023] Open
Abstract
BACKGROUND Small renal mass (SRM) biopsy remains under-utilized due to stigma. Meanwhile, the alarmingly high benign findings in resected kidney masses highlight the need for improved preoperative diagnosis and patient selection. METHODS The purpose of this study is to review the success rate of SRM biopsy and to evaluate its impact on patient management. A total of 168 percutaneous image-guided core needle biopsies (CNBs) of SRMs were retrieved at a tertiary academic center between 2015 and 2019. Subsequent treatment choices, side effects and outcomes were retrospectively reviewed. RESULTS The diagnostic rate of CNB was 86.9%. Benign neoplasms accounted for a significant portion (14.3%) of SRM. Renal cell carcinomas (RCCs) were the most common diagnoses (69.6%) as expected. In biopsy-resection correlation, the positive predictive value of CNB was 100%. Tumor typing and subtyping by CNB were highly accurate, 100% and 98.3% respectively. Nuclear grading for clear cell RCC was accurate in 83.8% cases. The CNB results had significant impact on treatment. Most patients with RCCs underwent either resection (54.1%) or ablation (33.9%), in contrast to observation in benign neoplasms (90.5%). Most importantly, the benign resection rate (3.2%) in this series was much lower than the national average. CONCLUSION CNB provided accurate diagnoses for the majority of SRMs and revealed benign diagnoses in a subset of clinically suspicious lesions. Employment of CNB in suspicious SRM may help avoid overtreatment for benign lesions.
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Affiliation(s)
- Haijuan Gao
- Department of Pathology and Laboratory Medicine, University of California, Irvine, Orange, CA, USA
| | - Behdokht Nowroozizadeh
- Department of Pathology and Laboratory Medicine, University of California, Irvine, Orange, CA, USA
| | - Joaquin Ponce Zepeda
- Department of Pathology and Laboratory Medicine, University of California, Irvine, Orange, CA, USA
| | - Jaime Landman
- Department of Urology, University of California, Irvine, Orange, CA, USA
| | - Ted Farzaneh
- Department of Pathology and Laboratory Medicine, University of California, Irvine, Orange, CA, USA
| | - Cary Johnson
- Department of Pathology and Laboratory Medicine, University of California, Irvine, Orange, CA, USA
| | | | - Min Han
- Department of Pathology, City of Hope Medical Center, 1500 E. Duarte Road, Duarte, CA, 91010, USA.
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7
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Chung R, Kurtzman JT, Gillespie A, Martina LP, Wang C, McKiernan JM, Anderson CB. The Utility of Renal Mass Biopsy in Shared Decision-Making for Renal Mass Treatment. Urology 2023; 178:98-104. [PMID: 37149060 DOI: 10.1016/j.urology.2023.04.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 04/24/2023] [Accepted: 04/27/2023] [Indexed: 05/08/2023]
Abstract
OBJECTIVE To evaluate the utility of renal mass biopsy (RMB) in shared decision-making for renal mass treatment. Underutilization of RMB for patients with renal masses is due in part to physicians believing that results have limited clinical utility. MATERIALS AND METHODS This was a prospective study of all patients referred for RMB from October 2019 to October 2021. Patients and physicians completed pre- and post-RMB questionnaires. Questionnaires assessed both parties' perceived utility of RMB and the impact of biopsy results on treatment preference using Likert scales. RESULTS We enrolled 22 patients with a mean age of 66years (SD 14.5) and mean renal tumor size 3.1 cm (SD 1.4). Five were lost to follow-up (three pre-RMB, two post-RMB). Pre-RMB, 100% of patients believed that a biopsy would help them choose a treatment and 45% were unsure of their treatment preferences. After RMB, 92% perceived their biopsy results as useful and only 9% were unsure of treatment preference. Overall, 100% of patients were glad they had a biopsy. Results led patients and physicians to change their treatment preference in 57% and 40% of cases, respectively. Patients and physicians disagreed about treatment in 81% of cases prior to biopsy, but in only 25% of cases after biopsy. CONCLUSION Discordance between patient and physician treatment preference for renal masses is higher in the absence of RMB data. Select patients are willing to undergo RMB and RMB data can increase patient confidence and comfort in a shared decision-making approach for renal mass treatment.
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Affiliation(s)
- Rainjade Chung
- Department of Urology, Columbia University Medical Center, New York, NY
| | - Jane T Kurtzman
- Department of Urology, Columbia University Medical Center, New York, NY
| | - Anton Gillespie
- Department of Urology, Columbia University Medical Center, New York, NY
| | - Luis P Martina
- Department of Medicine, Montefiore Medical Center, New York, NY
| | - Connie Wang
- Department of Urology, Columbia University Medical Center, New York, NY
| | - James M McKiernan
- Department of Urology, Columbia University Medical Center, New York, NY
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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. "Could Patient Age and Gender, along with Mass Size, Be Predictive Factors for Benign Kidney Tumors?": A Retrospective Analysis of 307 Consecutive Single Renal Masses Treated with Partial or Radical Nephrectomy. Bioengineering (Basel) 2023; 10:794. [PMID: 37508821 PMCID: PMC10376757 DOI: 10.3390/bioengineering10070794] [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: 03/24/2023] [Revised: 05/29/2023] [Accepted: 06/25/2023] [Indexed: 07/30/2023] Open
Abstract
Due to the increased use of common and non-invasive abdominal imaging techniques over the last few decades, the diagnosis of about 60% of renal tumors is incidental. Contrast-enhancing renal nodules on computed tomography are diagnosed as malignant tumors, which are often removed surgically without first performing a biopsy. Most kidney nodules are renal cell carcinoma (RCC) after surgical treatment, but a non-negligible rate of these nodules may be benign on final pathology; as a result, patients undergo unnecessary surgery with an associated significant morbidity. Our study aimed to identify a subgroup of patients with higher odds of harboring benign tumors, who would hence benefit from further diagnostic examinations (such as renal biopsy) or active surveillance. We performed a retrospective review of the medical data, including pathology results, of patients undergoing surgery for solid renal masses that were suspected to be RCCs (for a total sample of 307 patients). Owing to the widespread use of common and non-invasive imaging techniques, the incidental diagnosis of kidney tumors has become increasingly common. Considering that a non-negligible rate of these tumors is found to be benign after surgery at pathological examination, it is crucial to identify features that can correctly diagnose a mass as benign or not. According to our study results, female sex and tumor size ≤ 3 cm were independent predictors of benign disease. Contrary to that demonstrated by other authors, increasing patient age was also positively linked to a greater risk of malign pathology.
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Affiliation(s)
- Raffaele Baio
- Department of Medicine and Surgery "Scuola Medica Salernitana", University of Salerno, 84081 Salerno, Italy
| | - 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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Rasmussen R, Sanford T, Parwani AV, Pedrosa I. Artificial Intelligence in Kidney Cancer. Am Soc Clin Oncol Educ Book 2022; 42:1-11. [PMID: 35580292 DOI: 10.1200/edbk_350862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Artificial intelligence is rapidly expanding into nearly all facets of life, particularly within the field of medicine. The diagnosis, characterization, management, and treatment of kidney cancer is ripe with areas for improvement that may be met with the promises of artificial intelligence. Here, we explore the impact of current research work in artificial intelligence for clinicians caring for patients with renal cancer, with a focus on the perspectives of radiologists, pathologists, and urologists. Promising preliminary results indicate that artificial intelligence may assist in the diagnosis and risk stratification of newly discovered renal masses and help guide the clinical treatment of patients with kidney cancer. However, much of the work in this field is still in its early stages, limited in its broader applicability, and hampered by small datasets, the varied appearance and presentation of kidney cancers, and the intrinsic limitations of the rigidly structured tasks artificial intelligence algorithms are trained to complete. Nonetheless, the continued exploration of artificial intelligence holds promise toward improving the clinical care of patients with kidney cancer.
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Affiliation(s)
- Robert Rasmussen
- Department of Radiology, The University of Texas Southwestern Medical Center, Dallas, TX
| | - Thomas Sanford
- Department of Urology, Upstate Medical University, Syracuse, NY
| | - Anil V Parwani
- Department of Pathology, The Ohio State University, Columbus, OH
| | - Ivan Pedrosa
- Department of Radiology, The University of Texas Southwestern Medical Center, Dallas, TX.,Department of Urology, The University of Texas Southwestern Medical Center, Dallas, TX.,Advanced Imaging Research Center, The University of Texas Southwestern Medical Center, Dallas, TX
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10
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Wilson MP, Katlariwala P, Abele J, Low G. A review of 99mTc-sestamibi SPECT/CT for renal oncocytomas: A modified diagnostic algorithm. Intractable Rare Dis Res 2022; 11:46-51. [PMID: 35702579 PMCID: PMC9161129 DOI: 10.5582/irdr.2022.01027] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 04/25/2022] [Accepted: 04/28/2022] [Indexed: 12/11/2022] Open
Abstract
99mTc-sestamibi SPECT/CT is a promising nuclear medicine imaging investigation for benign renal lesions such as renal oncocytomas. The purpose of this article is to i) review the current literature on 99mTc-sestamibi SPECT/CT, ii) to review to current application of 99mTc-sestamibi SPECT/CT for indeterminate renal lesion imaging, and iii) to discuss present limitations and areas for future research. The literature has been reviewed up to April 2022 for articles relating to the application of 99mTc-sestamibi SPECT/CT for benign renal lesions including a recently published systematic review and meta-analysis performed by the authors. One study evaluating 99mTc-sestamibi SPECT alone and five studies evaluating 99mTc-sestamibi SPECT/CT have been performed to date. 99mTc-sestamibi SPECT/CT demonstrates high sensitivity and specificity for detecting benign renal lesions, particularly renal oncocytomas. 99mTc-sestamibi SPECT/CT demonstrates near-perfect specificity for benign and low-grade renal lesions. The optimal quantified threshold ratio for tumor-to-background renal parenchyma radiotracer uptake for a positive result is > 0.6. In this article, we propose a modified diagnostic algorithm for small enhancing renal masses measuring 1-4 cm in which suspected benign lesions after conventional imaging are considered for 99mTc-sestamibi SPECT-CT. In this algorithm, positive studies can be monitored with active surveillance rather than requiring invasive biopsy and/or targeted therapy.
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Affiliation(s)
- Mitchell P Wilson
- Address correspondence to:Mitchell P Wilson, Department of Radiology and Diagnostic Imaging, University of Alberta, 2B2.41 WMC, 8440-112 Street NW, T6G 2B7, Edmonton, Alberta, Canada.
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11
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The value of sestamibi single-photon emission computed tomography/computed tomography in differentiating and staging renal cell carcinomas. Curr Urol 2022; 16:32-37. [PMID: 35633856 PMCID: PMC9132183 DOI: 10.1097/cu9.0000000000000089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Accepted: 03/02/2021] [Indexed: 11/26/2022] Open
Abstract
Misdiagnosis of benign renal neoplasms can lead to unnecessary surgical resections, which increases the risk of other morbidities and mortality. Therefore, it is crucial to find a diagnostic modality for differentiation between benign and malignant renal masses. In the current study, we summarized published pieces of evidence concerning the use of technetium-99m (99mTc)-sestamibi single-photon emission computed tomography/computed tomography (SPECT/CT) as a promising diagnostic nuclear imaging modality for the differentiation of renal neoplasms. The study was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement for Systematic Reviews and Meta-Analyses. We conducted a systematic electronic database search for suitable studies from inception till February 20, 2020 in 9 databases. The risk of bias was assessed for the included studies using the Quality Assessment of Diagnostic Accuracy Studies-2 tool. We identified 9373 records after exclusion of 8978 duplicates using EndNote software. Title and abstract screening resulted in 761 records for further full-text screening. Finally, four studies were included with total sample size of 80 patients. The overall risk of bias was low to moderate. The results of all the included studies supported using 99mTc-sestamibi SPECT/CT for the differentiation between benign and malignant renal neoplasms. The use of 99mTc-sestamibi SPECT/CT could be a rapid, less invasive, promising diagnostic modality for histological diagnosis and staging of renal neoplasm, as well as monitoring post-therapy tumor's response. However, more studies with large sample sizes are essential to confirm the reliability and accuracy of this modality for usage.
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Kapur P, Setoodeh S, Araj E, Yan J, Malladi V, Cadeddu JA, Christie A, Brugarolas J. Improving Renal Tumor Biopsy Prognostication With BAP1 Analyses. Arch Pathol Lab Med 2022; 146:154-165. [PMID: 34019633 PMCID: PMC9812366 DOI: 10.5858/arpa.2020-0413-oa] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/08/2021] [Indexed: 01/07/2023]
Abstract
CONTEXT.— Active surveillance of small renal masses highlights the need for accurate prognostication of biopsies. OBJECTIVE.— To comprehensively evaluate the accuracy of biopsies in assessing known prognostic parameters including histologic subtype by comparison with subsequent nephrectomy samples. DESIGN.— We retrospectively identified patients at University of Texas Southwestern Medical Center, Dallas, Texas, who had a biopsy for a renal mass between 2004-2018. Biopsy samples were evaluated for known prognostic factors such as tumor grade, necrosis, sarcomatoid/rhabdoid change, and BRCA1-associated protein-1 (BAP1) status, which we previously showed is an independent prognostic factor for clear cell renal cell carcinoma. Accuracy was determined by comparison with subsequent analyses of nephrectomy specimens. Statistical analyses were performed to assess biopsy accuracy and correlation with tumor size and pathologic stage. RESULTS.— From 805 biopsies with a diagnosis of renal neoplasm, 178 had subsequent resection of the biopsied tumor. Concordance rate for histologic subtype was 96.9% (κ [w], 0.90; 95% CI, 0.82-0.99) and excellent for small renal masses (98.8%; κ [w], 0.97; 95% CI, 0.90-1). Amongst the prognostic variables evaluated, BAP1 immunohistochemistry in clear cell renal cell carcinoma had the highest agreement (94.8%; κ [w], 0.83; 95% CI, 0.66-0.99). The presence of 1 or more aggressive features (grade 3-4, tumor necrosis, BAP1 loss, sarcomatoid/rhabdoid change) in a biopsy significantly correlated with pT stage (P = .004). CONCLUSIONS.— Biopsy analyses showed high accuracy for subtyping renal tumors, but it underestimated several poor prognostic features. Addition of BAP1 for clear cell renal cell carcinoma may increase prognostic accuracy. If validated, routine incorporation of BAP1 immunohistochemistry in clear cell renal cell carcinoma biopsies may refine prognosis and aid in the selection of patients for active surveillance.
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Affiliation(s)
- Payal Kapur
- Department of Pathology, Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, TX, 75390,Department of Urology, Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, TX, 75390,Kidney Cancer Program, Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, TX, 75390
| | - Sasan Setoodeh
- Department of Pathology, Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, TX, 75390
| | - Ellen Araj
- Department of Pathology, Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, TX, 75390
| | - Jingsheng Yan
- Department of Population and Data Sciences, Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, TX, 75390
| | - Venkat Malladi
- Kidney Cancer Program, Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, TX, 75390,Lyda Hill Department of Bioinformatics, Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, TX, 75390
| | - Jeffrey A Cadeddu
- Department of Urology, Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, TX, 75390,Kidney Cancer Program, Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, TX, 75390
| | - Alana Christie
- Kidney Cancer Program, Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, TX, 75390
| | - James Brugarolas
- Internal Medicine, Hematology-Oncology Division, Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, TX, 75390,Kidney Cancer Program, Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, TX, 75390
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Schieda N, Krishna S, Pedrosa I, Kaffenberger SD, Davenport MS, Silverman SG. Active Surveillance of Renal Masses: The Role of Radiology. Radiology 2021; 302:11-24. [PMID: 34812670 DOI: 10.1148/radiol.2021204227] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Active surveillance of renal masses, which includes serial imaging with the possibility of delayed treatment, has emerged as a viable alternative to immediate therapeutic intervention in selected patients. Active surveillance is supported by evidence that many benign masses are resected unnecessarily, and treatment of small cancers has not substantially reduced cancer-specific mortality. These data are a call to radiologists to improve the diagnosis of benign renal masses and differentiate cancers that are biologically aggressive (prompting treatment) from those that are indolent (allowing treatment deferral). Current evidence suggests that active surveillance results in comparable cancer-specific survival with a low risk of developing metastasis. Radiology is central in this. Imaging is used at the outset to estimate the probability of malignancy and degree of aggressiveness in malignant masses and to follow up masses for growth and morphologic change. Percutaneous biopsy is used to provide a more definitive histologic diagnosis and to guide treatment decisions, including whether active surveillance is appropriate. Emerging applications that may improve imaging assessment of renal masses include standardized assessment of cystic and solid masses and radiomic analysis. This article reviews the current and future role of radiology in the care of patients with renal masses undergoing active surveillance.
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Affiliation(s)
- Nicola Schieda
- From the Department of Medical Imaging, The Ottawa Hospital, University of Ottawa, 1053 Carling Ave, Ottawa, ON, Canada K1H 1H6 (N.S.); Joint Department of Medical Imaging, University Health Network, Mount Sinai Hospital and Women's College Hospital, University of Toronto, Toronto, Canada (S.K.); Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (I.P.); Departments of Urology (S.D.K., M.S.D.) and Radiology (M.S.D.), Michigan Medicine, University of Michigan, Ann Arbor, Mich; and Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass (S.G.S.)
| | - Satheesh Krishna
- From the Department of Medical Imaging, The Ottawa Hospital, University of Ottawa, 1053 Carling Ave, Ottawa, ON, Canada K1H 1H6 (N.S.); Joint Department of Medical Imaging, University Health Network, Mount Sinai Hospital and Women's College Hospital, University of Toronto, Toronto, Canada (S.K.); Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (I.P.); Departments of Urology (S.D.K., M.S.D.) and Radiology (M.S.D.), Michigan Medicine, University of Michigan, Ann Arbor, Mich; and Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass (S.G.S.)
| | - Ivan Pedrosa
- From the Department of Medical Imaging, The Ottawa Hospital, University of Ottawa, 1053 Carling Ave, Ottawa, ON, Canada K1H 1H6 (N.S.); Joint Department of Medical Imaging, University Health Network, Mount Sinai Hospital and Women's College Hospital, University of Toronto, Toronto, Canada (S.K.); Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (I.P.); Departments of Urology (S.D.K., M.S.D.) and Radiology (M.S.D.), Michigan Medicine, University of Michigan, Ann Arbor, Mich; and Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass (S.G.S.)
| | - Samuel D Kaffenberger
- From the Department of Medical Imaging, The Ottawa Hospital, University of Ottawa, 1053 Carling Ave, Ottawa, ON, Canada K1H 1H6 (N.S.); Joint Department of Medical Imaging, University Health Network, Mount Sinai Hospital and Women's College Hospital, University of Toronto, Toronto, Canada (S.K.); Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (I.P.); Departments of Urology (S.D.K., M.S.D.) and Radiology (M.S.D.), Michigan Medicine, University of Michigan, Ann Arbor, Mich; and Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass (S.G.S.)
| | - Matthew S Davenport
- From the Department of Medical Imaging, The Ottawa Hospital, University of Ottawa, 1053 Carling Ave, Ottawa, ON, Canada K1H 1H6 (N.S.); Joint Department of Medical Imaging, University Health Network, Mount Sinai Hospital and Women's College Hospital, University of Toronto, Toronto, Canada (S.K.); Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (I.P.); Departments of Urology (S.D.K., M.S.D.) and Radiology (M.S.D.), Michigan Medicine, University of Michigan, Ann Arbor, Mich; and Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass (S.G.S.)
| | - Stuart G Silverman
- From the Department of Medical Imaging, The Ottawa Hospital, University of Ottawa, 1053 Carling Ave, Ottawa, ON, Canada K1H 1H6 (N.S.); Joint Department of Medical Imaging, University Health Network, Mount Sinai Hospital and Women's College Hospital, University of Toronto, Toronto, Canada (S.K.); Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (I.P.); Departments of Urology (S.D.K., M.S.D.) and Radiology (M.S.D.), Michigan Medicine, University of Michigan, Ann Arbor, Mich; and Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass (S.G.S.)
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Evaluation of radiomics and machine learning in identification of aggressive tumor features in renal cell carcinoma (RCC). Abdom Radiol (NY) 2021; 46:4278-4288. [PMID: 33855609 DOI: 10.1007/s00261-021-03083-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Revised: 03/22/2021] [Accepted: 03/31/2021] [Indexed: 12/11/2022]
Abstract
PURPOSE The purpose of this study was to evaluate the use of CT radiomics features and machine learning analysis to identify aggressive tumor features, including high nuclear grade (NG) and sarcomatoid (sarc) features, in large renal cell carcinomas (RCCs). METHODS CT-based volumetric radiomics analysis was performed on non-contrast (NC) and portal venous (PV) phase multidetector computed tomography images of large (> 7 cm) untreated RCCs in 141 patients (46W/95M, mean age 60 years). Machine learning analysis was applied to the extracted radiomics data to evaluate for association with high NG (grade 3-4), with multichannel analysis for NG performed in a subset of patients (n = 80). A similar analysis was performed in a sarcomatoid rich cohort (n = 43, 31M/12F, mean age 63.7 years) using size-matched non-sarcomatoid controls (n = 49) for identification of sarcomatoid change. RESULTS The XG Boost Model performed best on the tested data. After manual and machine feature extraction, models consisted of 3, 7, 5, 10 radiomics features for NC sarc, PV sarc, NC NG and PV NG, respectively. The area under the receiver operating characteristic curve (AUC) for these models was 0.59, 0.65, 0.69 and 0.58 respectively. The multichannel NG model extracted 6 radiomic features using the feature selection strategy and showed an AUC of 0.67. CONCLUSIONS Statistically significant but weak associations between aggressive tumor features (high nuclear grade, sarcomatoid features) in large RCC were identified using 3D radiomics and machine learning analysis.
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Okhunov Z, Gorin MA, Jefferson FA, Afyouni AS, Allaf ME, Pierorazio PM, Patel RM, Huynh LM, Tapiero S, Osann K, Kavoussi LR, Clayman RV, Landman J. Can preoperative renal mass biopsy change clinical practice and reduce surgical intervention for small renal masses? Urol Oncol 2021; 39:735.e17-735.e23. [PMID: 34364751 DOI: 10.1016/j.urolonc.2021.05.024] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 04/27/2021] [Accepted: 05/21/2021] [Indexed: 10/20/2022]
Abstract
INTRODUCTION The role of renal biopsy prior to surgical intervention for a renal mass remains controversial despite the fact that for all other urological organs except the testicle, biopsy inevitably precedes treatment as is true for all other specialties dealing with solid masses (e.g. thyroid, breast, colon, liver, etc.). Accordingly, we sought to determine the impact of a routine biopsy regimen on the course of patients with cT1a lesions in comparison with a contemporary series of cT1a individuals who went directly to treatment without a preoperative biopsy. METHODS We analyzed a multi-institutional, prospectively maintained database of patients who underwent an office-based, ultrasound-guided, renal mass biopsy (RMB) for a cT1a renal mass (i.e. ≤4cm in largest dimension). Controls were selected from all patients in the database who had a cT1a renal lesion but did not undergo RMB. Both groups were analyzed for differences in treatment modality and surgical pathology results. RESULTS A total of 72 RMB and 73 control patients were analyzed. The groups were similar in regards to their baseline characteristics. Overall RMB diagnostic rate was 75%. Surgical pathology revealed that excision of benign tumors was eight-fold less in the RMB cohort compared to the control group (3% vs. 23%; P < 0.001). Additionally, the rate of active surveillance in the RMB cohort was nearly three times higher at 35% vs. 14% for the controls (P < 0.001). Biopsy was concordant with surgical pathology in 97% of cases for primary histology (i.e. benign vs. malignant), 97% for histologic subtype, and 46% for low (I or II) vs. high (III or IV) grade. On multivariate analysis patients who underwent surgical intervention without preoperative RMB were 6.7 times more likely to have benign histopathology compared to patients who underwent preoperative RMB (OR 6.7, 95% CI = 0.714 - 63.626, P = 0.096). There were no procedural or post-procedural RMB complications. CONCLUSIONS For patients with cT1a lesions, the implementation of routine office-based RMB led to a significant decrease in the rate of surgical intervention for benign tumors. This practice also resulted in a higher rate of active surveillance for the management of renal cortical neoplasms with benign histopathology compared to a control group.
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Affiliation(s)
| | - Michael A Gorin
- The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD
| | | | | | - Mohamad E Allaf
- The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Phillip M Pierorazio
- The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD
| | | | - Linda M Huynh
- Department of Urology, University of California, Irvine
| | | | - Kathryn Osann
- Department of Urology, University of California, Irvine
| | - Louis R Kavoussi
- The Smith Institute for Urology, Northwell Health System, New Hyde Park, NY
| | | | - Jaime Landman
- Department of Urology, University of California, Irvine.
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Patel AK, Lane BR, Chintalapati P, Fouad L, Butaney M, Budzyn J, Johnson A, Qi J, Schervish E, Rogers CG. Utilization of Renal Mass Biopsy for T1 Renal Lesions across Michigan: Results from MUSIC-KIDNEY, A Statewide Quality Improvement Collaborative. EUR UROL SUPPL 2021; 30:37-43. [PMID: 34337546 PMCID: PMC8317904 DOI: 10.1016/j.euros.2021.06.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/04/2021] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Renal mass biopsy (RMB) has had limited and varied utilization to guide management of renal masses (RM). OBJECTIVE To evaluate utilization of RMB for newly diagnosed cT1 RMs across diverse practice types and assess associations of outcomes with RMB. DESIGN SETTING AND PARTICIPANTS MUSIC-KIDNEY commenced data collection in September 2017 for all newly presenting patients with a cT1 RM at 14 diverse practices. Patients were assessed at ≥120 d after initial evaluation. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Demographics and outcomes were compared for patients undergoing RMB versus no RMB. Clinical and demographic characteristics were summarized by RMB status using a χ2 test for categorical variables and Student t test for continuous variables. A mixed-effects logistic regression model was constructed to identify associations with RMB receipt. RESULTS AND LIMITATIONS RMB was performed in 15.5% (n = 282) of 1808 patients with a cT1 RM. Practice level rates varied from 0% to 100% (p = 0.001), with only five of 14 practices using RMB in >20% of patients. On multivariate analysis, predictors of RMB included greater comorbidity (Charlson comorbidity index ≥2 vs 0: odds ratio [OR] 1.44; p = 0.025) and solid lesion type (cystic vs solid: OR 0.17; p = 0.001; indeterminate vs solid: OR 0.58; p = 0.01). RMB patients were less likely to have benign pathology at intervention (5.0% vs 13.5%; p = 0.01). No radical nephrectomies were performed for patients with benign histology at RMB. The limitations include short follow-up and inclusion of practices with low numbers of RMBs. CONCLUSIONS Utilization of RMB varied widely across practices. Factors associated with RMB include comorbidities and lesion type. Patients undergoing RMB were less likely to have benign histology at intervention. PATIENT SUMMARY Current use of biopsy for kidney tumors is low and varies across our collaborative. Biopsy was performed in patients with greater comorbidity (more additional medical conditions) and for solid kidney tumors. Pretreatment biopsy is associated with lower nonmalignant pathology detected at treatment.
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Affiliation(s)
| | - Brian R. Lane
- Michigan State University College of Human Medicine, Grand Rapids, MI, USA
- Spectrum Health Hospital System, Grand Rapids, MI, USA
| | | | - Lina Fouad
- Wayne State School of Medicine, Detroit, MI, USA
| | | | | | - Anna Johnson
- Department of Urology, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Ji Qi
- Department of Urology, University of Michigan Medical School, Ann Arbor, MI, USA
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Liu T, Chen L, Liu G. A commentary on "Prevalence of benign pathology after partial nephrectomy for suspected renal tumor: A systematic review and meta-analysis" (Int J Surg 2020; 84: 161-170). Int J Surg 2021; 91:105999. [PMID: 34139366 DOI: 10.1016/j.ijsu.2021.105999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 06/07/2021] [Indexed: 11/28/2022]
Affiliation(s)
- Tian Liu
- Department of Urology, Pingxiang People's Hospital, Jiangxi, 337000, China.
| | - Liang Chen
- Department of Urology, Pingxiang People's Hospital, Jiangxi, 337000, China
| | - Geliang Liu
- Department of Urology, Pingxiang People's Hospital, Jiangxi, 337000, China
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Shao Y, Zhang YX, Chen HH, Lu SS, Zhang SC, Zhang JX. Advances in the application of artificial intelligence in solid tumor imaging. Artif Intell Cancer 2021; 2:12-24. [DOI: 10.35713/aic.v2.i2.12] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 04/02/2021] [Accepted: 04/20/2021] [Indexed: 02/06/2023] Open
Abstract
Early diagnosis and timely treatment are crucial in reducing cancer-related mortality. Artificial intelligence (AI) has greatly relieved clinical workloads and changed the current medical workflows. We searched for recent studies, reports and reviews referring to AI and solid tumors; many reviews have summarized AI applications in the diagnosis and treatment of a single tumor type. We herein systematically review the advances of AI application in multiple solid tumors including esophagus, stomach, intestine, breast, thyroid, prostate, lung, liver, cervix, pancreas and kidney with a specific focus on the continual improvement on model performance in imaging practice.
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Affiliation(s)
- Ying Shao
- Department of Laboratory Medicine, People Hospital of Jiangying, Jiangying 214400, Jiangsu Province, China
| | - Yu-Xuan Zhang
- Department of Laboratory Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, Jiangsu Province, China
| | - Huan-Huan Chen
- Department of Laboratory Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, Jiangsu Province, China
| | - Shan-Shan Lu
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, Jiangsu Province, China
| | - Shi-Chang Zhang
- Department of Laboratory Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, Jiangsu Province, China
| | - Jie-Xin Zhang
- Department of Laboratory Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, Jiangsu Province, China
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Comparison of CT Texture Analysis Software Platforms in Renal Cell Carcinoma: Reproducibility of Numerical Values and Association With Histologic Subtype Across Platforms. AJR Am J Roentgenol 2021; 216:1549-1557. [PMID: 33852332 DOI: 10.2214/ajr.20.22823] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE. The purpose of this article is to evaluate interobserver, intraobserver, and interplatform variability and compare the previously established association between texture metrics and tumor histologic subtype using three commercially available CT texture analysis (CTTA) software platforms on the same dataset of large (> 7 cm) renal cell carcinomas (RCCs). MATERIALS AND METHODS. CT-based texture analysis was performed on contrast-enhanced MDCT images of large (> 7 cm) untreated RCCs in 124 patients (median age, 62 years; 82 men and 42 women) using three different software platforms. Using this previously studied cohort, texture features were compared across platforms. Features were correlated with histologic subtype, and strength of association was compared between platforms. Single-slice and volumetric measures from one platform were compared. Values for interobserver and intraobserver variability on a tumor subset (n = 30) were assessed across platforms. RESULTS. Metrics including mean gray-level intensity, SD, and volume correlated fairly well across platforms (concordance correlation coefficient [CCC], 0.66-0.99; mean relative difference [MRD], 0.17-5.97%). Entropy showed high variability (CCC, 0.04; MRD, 44.5%). Mean, SD, mean of positive pixels (MPP), and entropy were associated with clear cell histologic subtype on almost all platforms (p < .05). Mean, SD, entropy, and MPP were highly reproducible on most platforms on both interobserver and intraobserver analysis. CONCLUSION. Select texture metrics were reproducible across platforms and readers, but other metrics were widely variable. If clinical models are developed that use CTTA for medical decision making, these differences in reproducibility of some features across platforms need to be considered, and standardization is critical for more widespread adaptation and implementation.
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Patel AK, Rogers CG, Johnson A, Noyes SL, Qi J, Miller D, Shervish E, Stockton B, Lane BR. Initial Observation of a Large Proportion of Patients Presenting with Clinical Stage T1 Renal Masses: Results from the MUSIC-KIDNEY Statewide Collaborative. EUR UROL SUPPL 2021; 23:13-19. [PMID: 34337485 PMCID: PMC8317780 DOI: 10.1016/j.euros.2020.11.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/03/2020] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND While surgical excision remains the principal management strategy for clinical T1 renal masses (cT1RMs), the rates of noninterventional approaches are not well known. Most single-institution and population-based series suggest rates below 10%. OBJECTIVE To evaluate the use of observation for newly diagnosed cT1RM patients in academic and community-based practices across a statewide collaborative. DESIGN SETTING AND PARTICIPANTS The Michigan Urological Surgery Improvement Collaborative-Kidney mass: Identifying and Defining Necessary Evaluation and therapY (MUSIC-KIDNEY) commenced data collection in September 2017 by recording clinical, radiographic, pathologic, and short-term follow-up data for cT1RM patients at 13 diverse practices. Patients with complete data were assessed at >90 d after initial evaluation as to whether observation or treatment was performed. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Relationships with outcomes were analyzed using multivariable logistic regression, chi-square test, and Wilcoxon rank-sum test. RESULTS AND LIMITATIONS Out of 965 patients, observation was employed in 48% (n = 459), with practice-level rates ranging from 0% to 68%. Patients managed with observation (vs treatment) were significantly older (71.2 vs 62.8 yr, p < 0.0001) and had smaller tumors (2.3 vs 3.4 cm, p < 0.0001). Observation was used for 53.5% of cT1a renal masses, for 29.9% of cT1b renal masses, and for 42.5%, 53.7%, and 63.9% of radiographically solid, Bosniak III-IV cystic, and indeterminate cT1RMs, respectively. Factors significantly associated with observation in multivariable analysis included lesion type (Bosniak III-IV vs solid, p = 0.017), tumor stage (cT1a vs cT1b, p < 0.001), and higher age (p < 0.001). A short duration of follow-up limits the assessment of longer-term patient management. CONCLUSIONS Noninterventional management of cT1RMs is common across the MUSIC-KIDNEY collaborative, with wide variability across practices. Factors associated with observation were advanced age, smaller tumor size, and cystic tumor type. Durability of the initial decision for observation (delayed intervention vs active surveillance vs less active surveillance) will be a focus of subsequent study. PATIENT SUMMARY The Michigan Urological Surgery Improvement Collaborative: Kidney mass: Identifying and Defining Necessary Evaluation and therapY (MUSIC-KIDNEY) quality improvement collaborative assessed the current utilization of initial observation of a renal mass ≤7 cm across a diverse group of urology practices and found it to be used in 48% of patients. We found that the factors predicting observation were advanced age, smaller tumor size, and cystic tumor type.
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Affiliation(s)
| | | | - Anna Johnson
- Department of Urology, Michigan Medicine, Ann Arbor, MI, USA
| | | | - Ji Qi
- Department of Urology, Michigan Medicine, Ann Arbor, MI, USA
| | - David Miller
- Department of Urology, Michigan Medicine, Ann Arbor, MI, USA
| | | | | | - Brian R. Lane
- Spectrum Health Hospital System, Grand Rapids, MI, USA
- Michigan State University College of Human Medicine, Grand Rapids, MI, USA
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Algaba F. [Criteria for an improved prognostic stratification in category pT renal carcinoma]. REVISTA ESPAÑOLA DE PATOLOGÍA : PUBLICACIÓN OFICIAL DE LA SOCIEDAD ESPAÑOLA DE ANATOMÍA PATOLÓGICA Y DE LA SOCIEDAD ESPAÑOLA DE CITOLOGÍA 2020; 54:171-181. [PMID: 34175029 DOI: 10.1016/j.patol.2020.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 09/14/2020] [Accepted: 09/15/2020] [Indexed: 11/20/2022]
Abstract
Asymptomatic renal carcinomas are usually small and localized and thus, for the assessment of pT, precise criteria are required, able to identify the initial phases of a local extension and correlate them with current prognostic prospects. Various studies and consensus meetings have defined precisely how to measure tumoral nodules (solid, cystic and multiple). Furthermore, they have distinguished tumoral extension to the renal sinus, which has a worse prognosis, from that to the perirenal adipose tissue. They have also analyzed the clinical significance of invasion of the sinus vessels, the hilar veins and parenchymal vascular retroinvasion. Our aim is to revise and update the criteria of the different pT subcategories and consider those morphological aspects which could be clinically significant and that are not currently included in the TNM classification.
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Affiliation(s)
- Ferran Algaba
- Sección de Patología, Fundación Puigvert, Universitat Autònoma de Barcelona, Barcelona, España.
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22
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Tosoian JJ, Feldman AS, Abbott MR, Mehra R, Tiemeny P, Wolf JS, Stone S, Wu S, Daignault-Newton S, Taylor JM, Wu CL, Morgan TM. Biopsy Cell Cycle Proliferation Score Predicts Adverse Surgical Pathology in Localized Renal Cell Carcinoma. Eur Urol 2020; 78:657-660. [DOI: 10.1016/j.eururo.2020.08.032] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Accepted: 08/21/2020] [Indexed: 10/23/2022]
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Ozambela M, Wang Y, Leow JJ, Silverman SG, Chung BI, Chang SL. Contemporary trends in percutaneous renal mass biopsy utilization in the United States. Urol Oncol 2020; 38:835-843. [PMID: 32912815 DOI: 10.1016/j.urolonc.2020.07.022] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Revised: 07/11/2020] [Accepted: 07/17/2020] [Indexed: 01/03/2023]
Abstract
INTRODUCTION Patients with a renal mass traditionally proceed directly to surgery without a preoperative tissue diagnosis confirming malignancy. Many surgically treated renal masses represent benign tumors or indolent malignancies on final pathology. This has led to a growing body of literature supporting an expanded role for percutaneous renal mass biopsy (RMB). This study aims to characterize national trends in RMB utilization. METHODS Patients undergoing renal biopsy during a 12-year period (2006-2017) in the Premier Hospital Database were captured using International Classification of Diseases, Ninth Revision and Tenth Revision codes. We restricted our analysis to patients with a concurrent diagnosis of a renal mass. We determined utilization rate, subsequent interventions within 90 days of biopsy, predictors of RMB, and 30-day RMB complication rates. We applied sampling weights and adjusted for hospital clustering to achieve a nationally representative analysis. RESULTS Among 115,511 patients who met the inclusion criteria, the annual number of RMB rose from 7,196 in 2006 to 11,528 in 2017; during this period, more than 3 times as many patients proceeded directly to surgery without a prior RMB. After RMB, 85,848 (74.32%) patients were not treated within 90 days. Of those treated, thermal ablation was more common than surgery (17,269 vs. 12,394). Trend analysis showed that patients with metastatic disease represented a decreasing proportion of patients receiving RMB (27.0%-21.8%; P < 0.001). Compared to patients who proceeded directly to surgery, RMB was more commonly performed in patients in the highest age group (80 years and older, 15.9% vs. 9.2%), unmarried (50% vs. 45.9%), with more medical comorbidities (Charlson comorbidity index ≥4, 30.9% vs. 17.4%), or with metastatic disease (24.5% vs. 10.4%). Multivariable regression analysis determined the primary predictor of RMB was the presence of metastatic disease. Hematuria was the most common complication present in 5.18% of patients followed by pneumothorax in 1.75%. All other complications were rare (<0.4%). CONCLUSION Although there has been progressive adoption of RMB for the management of renal masses in the United States, utilization remains relatively limited and differentially employed across the population based on both clinical and nonclinical patient factors. More research is needed to understand which factors are considered when determining whether to utilize RMB in the evaluation of a renal mass.
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Affiliation(s)
- Manuel Ozambela
- Division of Urology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Ye Wang
- Division of Urology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Jeffrey J Leow
- Department of Urology, Tan Tock Seng Hospital, Singapore
| | - Stuart G Silverman
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Benjamin I Chung
- Department of Urology, Stanford University Medical Center, Stanford, CA
| | - Steven L Chang
- Division of Urology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, MA.
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Cazzato RL, De Marini P, Auloge P, Leclerc L, Tricard T, Linder V, Jost M, Ramamurthy N, Lang H, Garnon J, Gangi A. Diagnostic accuracy and safety of percutaneous MRI-guided biopsy of solid renal masses: single-center results after 4.5 years. Eur Radiol 2020; 31:580-590. [PMID: 32851448 DOI: 10.1007/s00330-020-07160-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Revised: 06/13/2020] [Accepted: 08/06/2020] [Indexed: 12/31/2022]
Abstract
OBJECTIVES To retrospectively evaluate diagnostic accuracy and complications of magnetic resonance imaging (MRI)-guided biopsy of radiologically indeterminate solid renal masses (RM). METHODS Electronic records of all consecutive patients undergoing MRI-guided biopsy of solid RM (using free-breathing T2-BLADE and BEAT-IRTTT sequences) between April 2014 and October 2018 were reviewed; 101 patients (69 men, 32 women; median age 68 years; range 32-76) were included. Patient and RM characteristics, procedural details/complications, pathologic diagnosis, and clinical management were recorded. Diagnostic accuracy was calculated on an intention-to-diagnose basis. Diagnostic yield was also evaluated. Multi-variable analysis was performed for variables with p < .20, including patient age/sex; RM size/location/contact with vascular pedicle, RENAL score, number and total length of biopsy samples, and biopsy tract embolization, to determine factors associated with diagnostic samples, diagnostic accuracy, and complications. RESULTS Median RM size was 2.4 cm (range 1-8.4 cm). There were 86 (85%; 95%CI 77-91%) diagnostic and 15 (15%; 95%CI 9-23%) non-diagnostic samples; 6/15 (40%) non-diagnostic biopsies were repeated with 50% malignancy rate. Sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy were 96% (95%CI 89-99%), 100% (95%CI 77-100%), 100% (95%CI 95-100%), 82% (95%CI 57-96%), and 97% (95%CI 90-99%), respectively. Primary and secondary diagnostic yields were 85% (95%CI 77-91%) and 91% (95%CI 84-96%), respectively. Seven (7%; 95%CI 1-10%) complications were observed. No tested variables were associated with diagnostic samples, diagnostic accuracy, or complications. CONCLUSIONS MRI-guided biopsy of solid RM is associated with high diagnostic accuracy and low complication rate. The technique might be helpful for inaccessible tumors. KEY POINTS • MRI-guided biopsy of radiologically indeterminate solid renal masses (RM) appears safe, with a low rate of minor self-limiting hemorrhagic complications. • Diagnostic accuracy and primary/secondary diagnostic yield are high and appear similar to reported estimates for US- and CT-guided RM biopsy. • MRI guidance may be particularly useful for RM with poor conspicuity on US and CT, for relatively inaccessible tumors (e.g., tumors requiring double-oblique steep-angled approaches), and for young patients or those with renal failure.
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Affiliation(s)
- Roberto Luigi Cazzato
- Department of Interventional Radiology, University Hospital of Strasbourg, 1, place de l'hôpital, 67000, Strasbourg, France.
| | - Pierre De Marini
- Department of Interventional Radiology, University Hospital of Strasbourg, 1, place de l'hôpital, 67000, Strasbourg, France
| | - Pierre Auloge
- Department of Interventional Radiology, University Hospital of Strasbourg, 1, place de l'hôpital, 67000, Strasbourg, France
| | - Loic Leclerc
- Department of Interventional Radiology, University Hospital of Strasbourg, 1, place de l'hôpital, 67000, Strasbourg, France
| | - Thibault Tricard
- Department of Urology, University Hospital of Strasbourg, 1, place de l'hôpital, 67000, Strasbourg, France
| | - Veronique Linder
- Department of Pathology, University Hospital of Strasbourg, 1, place de l'hôpital, 67000, Strasbourg, France
| | - Marion Jost
- Department of Pathology, University Hospital of Strasbourg, 1, place de l'hôpital, 67000, Strasbourg, France
| | - Nitin Ramamurthy
- Department of Radiology, Norfolk and Norwich University Hospital, Colney Ln, Norwich, NR4 7UY, UK
| | - Hervé Lang
- Department of Urology, University Hospital of Strasbourg, 1, place de l'hôpital, 67000, Strasbourg, France
| | - Julien Garnon
- Department of Interventional Radiology, University Hospital of Strasbourg, 1, place de l'hôpital, 67000, Strasbourg, France
| | - Afshin Gangi
- Department of Interventional Radiology, University Hospital of Strasbourg, 1, place de l'hôpital, 67000, Strasbourg, France
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Garbens A, Wallis CJD, Klaassen Z, Saskin R, Plumptre L, Kodama R, Herschorn S, Nam RK. Comprehensive assessment of the morbidity of renal mass biopsy: A population-based assessment of biopsy-related complications. Can Urol Assoc J 2020; 15:42-47. [PMID: 32744997 DOI: 10.5489/cuaj.6477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION We sought to assess seven-day and 30-day complications following renal mass biopsy (RMB), including mortality, hospitalizations, emergency department (ED) visits, and operative and non-operative complications and compare these to rates in population-matched controls. METHODS We performed a population-based, matched, retrospective cohort study of patients undergoing RMB following consultation with a urologist and axial imaging from 2003-2015 in Ontario, Canada. Data on seven-day and 30-day rates of mortality, as well as operative and non operative complications after RMB were reported. The seven-day and 30-day rates of mortality, operative and non-operative interventions, hospitalizations, and ED visits were compared to matched controls using multivariable logistic regression. RESULTS Among 6840 patients who underwent RMB in the study period, 24 (0.4%) and 159 (2.3%) died within seven and 30 days of their biopsy, respectively. Seven- and 30-day operative intervention rates were 79 (1.2%) and 236 (3.4%), respectively. Seven- and 30-day non-operative intervention rates were 227 (3.3%) and 529 (7.7%), respectively. Thirty-day mortality (odds ratio [OR] 8.1, 95% confidence interval [CI] 5.1-13.0), hospitalizations (OR 12.6, 95% CI 10.6-15.2), and ED visits (OR 3.8, 95% CI 3.4-4.3) were more common among patients who underwent RMB than the matched controls (p<0.001 for each). CONCLUSIONS Patients undergoing RMB may have a small but non-negligible increased risk of mortality, hospital readmission, and ED visits compared to matched controls. However, limitations in the granularity of the dataset limits the strength of these conclusions. Further studies are needed to confirm our results. These risks should be discussed with patients for shared decision-making and considered in the risk/benefit tradeoff for the management of small renal masses.
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Affiliation(s)
- Alaina Garbens
- Division of Urology, Department of Surgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - Christopher J D Wallis
- Division of Urology, Department of Surgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - Zachary Klaassen
- Section of Urology, Department of Surgery, Medical College of Georgia-Augusta University, Augusta, GA, United States
| | - Refik Saskin
- Institute of Health Policy, Management & Evaluation, University of Toronto, Toronto, ON, Canada
| | | | - Ronald Kodama
- Division of Urology, Department of Surgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - Sender Herschorn
- Division of Urology, Department of Surgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - Robert K Nam
- Division of Urology, Department of Surgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
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Wilson MP, Katlariwala P, Murad MH, Abele J, McInnes MDF, Low G. Diagnostic accuracy of 99mTc-sestamibi SPECT/CT for detecting renal oncocytomas and other benign renal lesions: a systematic review and meta-analysis. Abdom Radiol (NY) 2020; 45:2532-2541. [PMID: 32193593 DOI: 10.1007/s00261-020-02469-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
PURPOSE The primary objectives of this systematic review and meta-analysis were to evaluate the diagnostic accuracy of 99mTc-sestamibi SPECT/CT for detecting renal oncocytoma versus (1) all other renal lesions and (2) chromophobe renal cell carcinoma (ChrRCC) alone. METHODS A systematic review of MEDLINE, EMBASE, Scopus, the Cochrane Library, and the Gray Literature was performed. Original articles with > 5 patients evaluating oncocytomas versus other renal lesions with SPECT/CT using a pathological reference standard were included. Patient, clinical, imaging, and performance parameters were independently acquired by two reviewers. Meta-analysis was performed using a bivariate mixed-effects regression model. RESULTS Four articles with a total of 117 renal lesions were included in analysis. The pooled and weighted sensitivity and specificity values of 99mTc-sestamibi SPECT/CT for detecting (1) renal oncocytoma versus other renal lesions were 92% (95% CI 72-98%) and 88% (95% CI 79-94%), respectively, and (2) 89% and 67%, respectively, for renal oncocytoma versus ChrRCC. The specificity for the detecting the oncocytoma-ChrRCC spectrum was 96% (95% CI 84-99%). The sensitivity and specificity for detecting benign versus malignant renal lesions were 86% (95% CI 66-95%) and 90% (95% CI 80-95%), and 88% and 95% when HOCTs were characterized as benign. All reporting studies used a cut-off tumor-to-background renal parenchyma radiotracer uptake ratio of > 0.6 for positive studies. CONCLUSION 99mTc-sestamibi SPECT/CT demonstrates a high sensitivity and specificity for characterizing benign and low-grade renal lesions. This test can help improve the diagnostic confidence for patients with indeterminate renal masses being considered for active surveillance.
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Cazzato RL, Garnon J, De Marini P, Auloge P, Koch G, Dalili D, Buy X, Palussiere J, Rao PP, Tricard T, Lang H, Gangi A. Is percutaneous image-guided renal tumour ablation ready for prime time? Br J Radiol 2020; 93:20200284. [PMID: 32543890 DOI: 10.1259/bjr.20200284] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
In the last few decades, thermal ablation (TA) techniques have been increasingly applied to treat small localised renal cell carcinomas. Despite this trend, there is still an underuse of TA compared to surgery and a substantial lack of high-quality evidence derived from large, prospective, randomised controlled trials comparing the long-term oncologic outcomes of TA and surgery. Therefore, in this narrative review, we assess published guidelines and recent literature concerning the diagnosis and management of kidney-confined renal cell carcinoma to understand whether percutaneous image-guided TA is ready to be proposed as a first-line treatment.
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Affiliation(s)
- Roberto Luigi Cazzato
- Interventional Radiology, University Hospital of Strasbourg; 1 place de l'hôpital, 67000, Strasbourg, France
| | - Julien Garnon
- Interventional Radiology, University Hospital of Strasbourg; 1 place de l'hôpital, 67000, Strasbourg, France
| | - Pierre De Marini
- Interventional Radiology, University Hospital of Strasbourg; 1 place de l'hôpital, 67000, Strasbourg, France
| | - Pierre Auloge
- Interventional Radiology, University Hospital of Strasbourg; 1 place de l'hôpital, 67000, Strasbourg, France
| | - Guillaume Koch
- Interventional Radiology, University Hospital of Strasbourg; 1 place de l'hôpital, 67000, Strasbourg, France
| | - Danoob Dalili
- Department of Diagnostic and Interventional Radiology, Guy's and St. Thomas' Hospitals NHS Foundation Trust, 0 St Thomas St, London SE1 9RS, United Kingdom
| | - Xavier Buy
- Interventional Radiology, Institut Bergonié, 229 Cours de l'Argonne, 33000 Bordeaux, France
| | - Jean Palussiere
- Interventional Radiology, Institut Bergonié, 229 Cours de l'Argonne, 33000 Bordeaux, France
| | - Pramod Prabhakar Rao
- Interventional Radiology, Civil Hospital of Colmar; 39 Avenue de la Liberté, 68024 Colmar, France
| | - Thibault Tricard
- Urology, University Hospital of Strasbourg; 1 place de l'hôpital, 67000, Strasbourg, France
| | - Hervé Lang
- Urology, University Hospital of Strasbourg; 1 place de l'hôpital, 67000, Strasbourg, France
| | - Afshin Gangi
- Interventional Radiology, University Hospital of Strasbourg; 1 place de l'hôpital, 67000, Strasbourg, France
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Texture analysis and machine learning algorithms accurately predict histologic grade in small (< 4 cm) clear cell renal cell carcinomas: a pilot study. Abdom Radiol (NY) 2020; 45:789-798. [PMID: 31822969 DOI: 10.1007/s00261-019-02336-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
PURPOSE To predict the histologic grade of small clear cell renal cell carcinomas (ccRCCs) using texture analysis and machine learning algorithms. METHODS Fifty-two noncontrast (NC), 26 corticomedullary (CM) phase, and 35 nephrographic (NG) phase CTs of small (< 4 cm) surgically resected ccRCCs were retrospectively identified. Surgical pathology classified the tumors as low- or high-Fuhrman histologic grade. The axial image with the largest cross-sectional tumor area was exported and segmented. Six histogram and 31 texture (gray-level co-occurrences (GLC) and gray-level run-lengths (GLRL)) features were calculated for each tumor in each phase. T testing compared feature values in low- and high-grade ccRCCs, with a (Benjamini-Hochberg) false discovery rate of 10%. Area under the receiver operating curve (AUC) was calculated for each feature to assess prediction of low- and high-grade ccRCCs in each phase. Histogram, texture, and combined histogram and texture data sets were used to train and test four algorithms (k-nearest neighbor (KNN), support vector machine (SVM), random forests, and decision tree) with tenfold cross-validation; AUCs were calculated for each algorithm in each phase to assess prediction of low- and high-grade ccRCCs. RESULTS Zero, 23, and 0 features in the NC, CM, and NG phases had statistically significant differences between low and high-grade ccRCCs. CM histogram skewness and GLRL short run emphasis had the highest AUCs (0.82) in predicting histologic grade. All four algorithms had the highest AUCs (0.97) predicting histologic grade using CM histogram features. The algorithms' AUCs decreased using histogram or texture features from NC or NG phases. CONCLUSION The histologic grade of small ccRCCs can be accurately predicted with machine learning algorithms using CM histogram features, which outperform NC and NG phase image data.
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Rosiello G, Palumbo C, Knipper S, Pecoraro A, Luzzago S, Tian Z, Larcher A, Capitanio U, Montorsi F, Shariat SF, Saad F, Briganti A, Karakiewicz PI. Histotype predicts the rate of lymph node invasion at nephrectomy in patients with nonmetastatic renal cell carcinoma. Urol Oncol 2020; 38:537-544. [PMID: 32122729 DOI: 10.1016/j.urolonc.2020.01.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2019] [Revised: 10/15/2019] [Accepted: 01/27/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND Lymph node invasion (LNI) at nephrectomy is one of the most important predictors of mortality in patients with nonmetastatic renal cell carcinoma (RCC). We analyzed the effect of histology on lymph node metastases at nephrectomy and its effect on survival in a contemporary cohort of patients with nonmetastatic RCC. METHODS Within the Surveillance, Epidemiology, and End Results database (2004-2015), we identified 100,060 patients with clear-cell, papillary, chromophobe, sarcomatoid, and collecting duct RCC, who underwent nephrectomy with or without lymph node dissection for nonmetastatic RCC. Logistic regression models, cumulative incidence plots, and competing-risks regression models were performed. RESULTS Overall, 10,590 patients underwent lymph node dissection for nonmetastatic RCC. Of these, LNI was recorded in 52 (7.0%), 615 (8.7%), 282 (13.9%), 316 (25.1%), 129 (38.3%), 45 (71.4%) patients with chromophobe, clear-cell, nonotherwise specified RCC, papillary, sarcomatoid, and collecting duct RCC histological subtypes, respectively. In logistic regression models, relative to clear-cell, papillary Odds ratio (OR 3.9), sarcomatoid (OR 6.3), collecting duct (OR 14.6) but not chromophobe RCC (OR 0.9; P = 0.5) independently predicted LNI at surgery. Moreover, in competing-risks regression models, LNI increased the risk of CSM 1.8-fold for sarcomatoid, 3.6-fold for clear-cell, 4.1-fold for papillary, and 6.7-fold for chromophobe histological subtype. CONCLUSIONS Histology is an independent predictor of increased risk of LNI at nephrectomy. Moreover, the effect of pathological nodal stage on survival differs according to different histology.
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Affiliation(s)
- Giuseppe Rosiello
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montreal Health Center, Montreal, Quebec, Canada; Department of Urology and Division of Experimental Oncology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy.
| | - Carlotta Palumbo
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montreal Health Center, Montreal, Quebec, Canada; Urology Unit, ASST Spedali Civili of Brescia. Department of Medical and Surgical Specialties, Radiological Science and Public Health, University of Brescia, Italy
| | - Sophie Knipper
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montreal Health Center, Montreal, Quebec, Canada; Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Angela Pecoraro
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montreal Health Center, Montreal, Quebec, Canada; Department of Urology, San Luigi Gonzaga Hospital, University of Turin, Turin, Italy
| | - Stefano Luzzago
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montreal Health Center, Montreal, Quebec, Canada; Department of Urology, European Institute of Oncology, Milan, Italy
| | - Zhe Tian
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montreal Health Center, Montreal, Quebec, Canada
| | - Alessandro Larcher
- Department of Urology and Division of Experimental Oncology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Umberto Capitanio
- Department of Urology and Division of Experimental Oncology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Francesco Montorsi
- Department of Urology and Division of Experimental Oncology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Shahrokh F Shariat
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Institute of Urology and Reproductive Health, I.M. Sechenov First Moscow State Medical University, Moscow, Russia
| | - Fred Saad
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montreal Health Center, Montreal, Quebec, Canada
| | - Alberto Briganti
- Department of Urology and Division of Experimental Oncology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Pierre I Karakiewicz
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montreal Health Center, Montreal, Quebec, Canada
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Cui E, Li Z, Ma C, Li Q, Lei Y, Lan Y, Yu J, Zhou Z, Li R, Long W, Lin F. Predicting the ISUP grade of clear cell renal cell carcinoma with multiparametric MR and multiphase CT radiomics. Eur Radiol 2020; 30:2912-2921. [PMID: 32002635 DOI: 10.1007/s00330-019-06601-1] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Revised: 11/13/2019] [Accepted: 11/26/2019] [Indexed: 12/21/2022]
Abstract
OBJECTIVE To investigate externally validated magnetic resonance (MR)-based and computed tomography (CT)-based machine learning (ML) models for grading clear cell renal cell carcinoma (ccRCC). MATERIALS AND METHODS Patients with pathologically proven ccRCC in 2009-2018 were retrospectively included for model development and internal validation; patients from another independent institution and The Cancer Imaging Archive dataset were included for external validation. Features were extracted from T1-weighted, T2-weighted, corticomedullary-phase (CMP), and nephrographic-phase (NP) MR as well as precontrast-phase (PCP), CMP, and NP CT. CatBoost was used for ML-model investigation. The reproducibility of texture features was assessed using intraclass correlation coefficient (ICC). Accuracy (ACC) was used for ML-model performance evaluation. RESULTS Twenty external and 440 internal cases were included. Among 368 and 276 texture features from MR and CT, 322 and 250 features with good to excellent reproducibility (ICC ≥ 0.75) were included for ML-model development. The best MR- and CT-based ML models satisfactorily distinguished high- from low-grade ccRCCs in internal (MR-ACC = 73% and CT-ACC = 79%) and external (MR-ACC = 74% and CT-ACC = 69%) validation. Compared to single-sequence or single-phase images, the classifiers based on all-sequence MR (71% to 73% in internal and 64% to 74% in external validation) and all-phase CT (77% to 79% in internal and 61% to 69% in external validation) images had significant increases in ACC. CONCLUSIONS MR- and CT-based ML models are valuable noninvasive techniques for discriminating high- from low-grade ccRCCs, and multiparameter MR- and multiphase CT-based classifiers are potentially superior to those based on single-sequence or single-phase imaging. KEY POINTS • Both the MR- and CT-based machine learning models are reliable predictors for differentiating high- from low-grade ccRCCs. • ML models based on multiparameter MR sequences and multiphase CT images potentially outperform those based on single-sequence or single-phase images in ccRCC grading.
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Affiliation(s)
- Enming Cui
- Department of Radiology, Jiangmen Central Hospital, Affiliated Jiangmen Hospital of SUN YAT-SEN University, 23 Beijie Haibang Street, Jiangmen, 529030, China
| | - Zhuoyong Li
- Department of Radiology, Jiangmen Central Hospital, Affiliated Jiangmen Hospital of SUN YAT-SEN University, 23 Beijie Haibang Street, Jiangmen, 529030, China
| | - Changyi Ma
- Department of Radiology, Jiangmen Central Hospital, Affiliated Jiangmen Hospital of SUN YAT-SEN University, 23 Beijie Haibang Street, Jiangmen, 529030, China
| | - Qing Li
- Department of Pathology, Jiangmen Central Hospital, Affiliated Jiangmen Hospital of SUN YAT-SEN University, 23 Beijie Haibang Street, Jiangmen, 529030, China
| | - Yi Lei
- Department of Radiology, The First Affiliated Hospital of Shenzhen University, Health Science Center, Shenzhen Second People's Hospital, 3002 SunGangXi Road, Shenzhen, 518035, China
| | - Yong Lan
- Department of Radiology, Jiangmen Central Hospital, Affiliated Jiangmen Hospital of SUN YAT-SEN University, 23 Beijie Haibang Street, Jiangmen, 529030, China
| | - Juan Yu
- Department of Radiology, The First Affiliated Hospital of Shenzhen University, Health Science Center, Shenzhen Second People's Hospital, 3002 SunGangXi Road, Shenzhen, 518035, China
| | - Zhipeng Zhou
- Department of Radiology, Jiangmen Central Hospital, Affiliated Jiangmen Hospital of SUN YAT-SEN University, 23 Beijie Haibang Street, Jiangmen, 529030, China
| | - Ronggang Li
- Department of Pathology, Jiangmen Central Hospital, Affiliated Jiangmen Hospital of SUN YAT-SEN University, 23 Beijie Haibang Street, Jiangmen, 529030, China
| | - Wansheng Long
- Department of Radiology, Jiangmen Central Hospital, Affiliated Jiangmen Hospital of SUN YAT-SEN University, 23 Beijie Haibang Street, Jiangmen, 529030, China.
| | - Fan Lin
- Department of Radiology, The First Affiliated Hospital of Shenzhen University, Health Science Center, Shenzhen Second People's Hospital, 3002 SunGangXi Road, Shenzhen, 518035, China.
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Renal Mass Biopsy. KIDNEY CANCER 2020. [DOI: 10.1007/978-3-030-28333-9_7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Kim JH, Li S, Khandwala Y, Chung KJ, Park HK, Chung BI. Association of Prevalence of Benign Pathologic Findings After Partial Nephrectomy With Preoperative Imaging Patterns in the United States From 2007 to 2014. JAMA Surg 2019; 154:225-231. [PMID: 30516801 DOI: 10.1001/jamasurg.2018.4602] [Citation(s) in RCA: 68] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Importance Although the intent of nephron-sparing surgery is to eradicate malignant tumors found on preoperative imaging, benign masses often cannot be differentiated from malignant tumors. However, in the past there have been discrepancies in the reported percentages of benign masses removed by partial nephrectomy (PNx). Objective To investigate the annual trend of prevalence of benign pathologic findings after PNx and to investigate what potential factors are associated with this prevalence. Design, Setting, and Participants A total of 18 060 patients who underwent PNx between 2007 and 2014 were selected from Truven Health MarketScan Research Databases. We selected those patients who underwent PNx as an inpatient from 2007 and set the surgery date as the index date. Overall, a total of 21 445 patients with International Classification of Diseases, Ninth Revision, Clinical Modification code of 55.4 were identified from 2007 to 2015. Main Outcomes and Measures The annual trend of benign pathologic findings was described as an actual number and as a proportion. Univariate and multiple analyses were performed to investigate factors predictive of a benign final pathologic diagnosis, including type of preoperative imaging modality or performance of a renal mass biopsy. Results Among the 18 060 patients, mean (SD) age was 57 (12) years, and there were 10637 (58.9%) men and 7423 (41.1%) women. The overall prevalence of benign pathologic findings was 30.9% and the annual trends demonstrated a prevalence of over 30% for nearly every year of the study period. On univariate analysis, the performance of magnetic resonance imaging (MRI) and renal mass biopsy was associated with benign pathologic findings (P = .02 and P < .001, respectively). On multivariable analysis, female sex (odds ratio [OR], 0.62; 95% CI, 0.58-0.66; P < .001), older age (>65 years) (OR, 0.99; 95% CI, 0.99-0.99; P < .001), and computed tomography (CT) only preoperative imaging (OR, 1.16; 95% CI, 1.05-1.28; P = .004) were associated with benign pathologic findings after PNx. Conclusions and Relevance We found that the overall prevalence of benign pathologic findings after PNx was higher than the literature suggests, with consistent year-over-year rates exceeding 30%. Female sex, older age (>65 years), and CT only preoperative imaging were predictive of a benign tumor. Further elucidation concerning covariates associated with a benign diagnosis should be the focus of future investigations to identify a cohort of patients who could potentially avoid unnecessary surgical intervention.
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Affiliation(s)
- Jae Heon Kim
- Department of Urology, Stanford University Medical Center, Stanford, California.,Department of Urology, Soonchunhyang University Hospital, Soonchuhyang University Medical College, Seoul, Korea
| | - Shufeng Li
- Department of Urology and Dermatology, Stanford University Medical Center, Stanford, California
| | - Yash Khandwala
- Department of Urology, Stanford University Medical Center, Stanford, California.,San Diego School of Medicine, University of California, San Diego
| | - Kyung Jin Chung
- Department of Urology, Stanford University Medical Center, Stanford, California
| | - Hyung Keun Park
- Department of Urology, Stanford University Medical Center, Stanford, California
| | - Benjamin I Chung
- Department of Urology, Stanford University Medical Center, Stanford, California
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Shahait M, Jackman S, Landman J, Lechevallier E, Billiet I, Fossion L, Aslan Y, Laguna MP. Utilization and Operative Influence of Renal Mass Biopsy in the Small Renal Mass: Analysis from the Clinical Research Office of the Endourological Society Small Renal Mass registry. J Endourol 2019; 34:99-106. [PMID: 31559847 DOI: 10.1089/end.2019.0297] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Introduction and Objective: Definitive inclusion of renal mass biopsy (RMB) in small renal mass (SRM) diagnostic algorithm remains controversial. We assessed incidence and accuracy of RMB in SRMs in the CROES Renal Mass registry and the influence of preoperative RMB on perioperative complications after SRM nephron-sparing surgery (NSS). Materials and Methods: "ad hoc" description of incidence of preoperative RMB and characteristics of SRM cases with and without RMB. Accuracy of RMB was calculated in the SRM subcohort that received extirpative treatment and complication rate after NSS compared to between the two groups. Continuous variables were compared using t-test; categorical variables were compared using the chi-square test. K-statistics was used to analyze agreement between the biopsy histology and surgical pathology. Logistic regression was used to assess the association between RMB and NSS complications. All tests were two sided, and p-values <0.05 were considered statistically significant. Results: The rate of preoperative RMB in SRMs was 11.6% (175/1597) in Europe and the United States. RMB patients were more likely to have hypertension (p < 0.04), be on dialysis (p < 0.024), or smokers (p = 0.005), with multiple/bilateral tumors (0.008 and 0.010) and previous other malignancy (p = 0.021). They underwent radical nephrectomy more frequently than non-RMB group (p = 0.034). RMB was nondiagnostic in 16 cases (9%). Accuracy of RMB in distinguishing malignant from benign was 89.5%. Agreement between biopsy and final surgical pathology was 93% for malignant vs benign tumors (kappa = 0.655). Upstaging to pT3a occurred more frequently in the RMB group (12.6% vs 6.25% [p = 0.022]). Complication rate in renal mass-NSS subcohort was 15.8%, not statistically different between RMB and non-RMB groups. On logistic regression analysis, RMB was not associated with increased risk of postoperative complication after NSS (OR: 0.9, 95% CI: 0.43-1.89). Conclusion: The practice of RMB in SRM is still scarce despite high accuracy and concordance with final pathology. RMB does not seem to increase complication rate after NSS.
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Affiliation(s)
- Mohammed Shahait
- Department of Urology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Stephen Jackman
- Department of Urology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Jaime Landman
- Department of Urology, University of California Irvine, Orange, California
| | | | | | - Laurent Fossion
- Department of Urology, Maxima Medical Center, Veldhoven, The Netherlands
| | - Yilmaz Aslan
- Clinic of Urology, Ankara Numune Training and Research Hospital, Hacettepe, Ankara, Turkey
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Wallis CJD, Garbens A, Klaassen Z, Kodama RT, Herschorn S, Nam RK. Effect of Renal Mass Biopsy on Subsequent Nephrectomy Outcomes: A Population-based Assessment. Eur Urol 2019; 77:136-137. [PMID: 31585679 DOI: 10.1016/j.eururo.2019.09.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Accepted: 09/18/2019] [Indexed: 11/29/2022]
Affiliation(s)
- Christopher J D Wallis
- Division of Urology, Department of Surgery, University of Toronto, Toronto, Canada; Department of Urology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Alaina Garbens
- Division of Urology, Department of Surgery, University of Toronto, Toronto, Canada
| | - Zachary Klaassen
- Department of Surgery, Division of Urology, Medical College of Georgia at Augusta University, Augusta, GA, USA; Georgia Cancer Center, Augusta University, Augusta, GA, USA
| | - Ronald T Kodama
- Division of Urology, Department of Surgery, University of Toronto, Toronto, Canada
| | - Sender Herschorn
- Division of Urology, Department of Surgery, University of Toronto, Toronto, Canada
| | - Robert K Nam
- Division of Urology, Department of Surgery, University of Toronto, Toronto, Canada.
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Maldiney T, Leguy-Seguin V, Prevel O, Rajillah A, Thibault T, Chabannes M, Nicolas B, Guilhem A, Berthier S, Audia S, Samson M, Bonnotte B. Une pseudotumeur rénale. Rev Med Interne 2019; 40:698-699. [DOI: 10.1016/j.revmed.2018.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Accepted: 12/18/2018] [Indexed: 11/28/2022]
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Patel HD, Nichols PE, Su ZT, Gupta M, Cheaib JG, Allaf ME, Pierorazio PM. Renal Mass Biopsy is Associated with Reduction in Surgery for Early-Stage Kidney Cancer. Urology 2019; 135:76-81. [PMID: 31536739 DOI: 10.1016/j.urology.2019.08.043] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Revised: 07/30/2019] [Accepted: 08/29/2019] [Indexed: 01/20/2023]
Abstract
OBJECTIVE To determine whether use of renal mass biopsy may be associated with a reduction in surgery for patients with small, localized renal cell carcinoma (cT1aN0M0), especially among older patients and patients with greater comorbidity burden. METHODS A total of 106,258 patients with cT1aN0M0 renal cell carcinoma from 2004 to 2015 were analyzed in the National Cancer Data Base. Multivariable logistic regression identified independent associations with nonsurgical management, receipt of biopsy, and pathologic upstaging. Marginal effects were derived by age and comorbidity. A sensitivity analysis was conducted in years identifying patients undergoing active surveillance (2010-2015). RESULTS There was increased use of biopsy (8.0%-15.3%) and nonsurgical management (11.7%-15.6%) over time. Biopsy was significantly associated with use of nonsurgical management (OR 4.80 [95%CI 4.58-5.02], P <.001) as well as active surveillance (OR 1.87 [1.69-2.07], P <.001) in the sensitivity analysis. Individual predicted probability of undergoing nonsurgical management ranged from 3% to 92% (median 31.4% with use of biopsy) and increased with age and comorbidity. Pathologic tumor upstaging (≥pT3a) occurred more frequently for patients receiving biopsy compared to no biopsy (5.8% vs 3.3%, P <.001). After adjustment, biopsy remained a statistically significant predictor of upstaging (OR 1.31 [95%CI 1.24-1.38], P <.001). CONCLUSION Overall, biopsy demonstrated a strong, independent association with reduced use of surgery for cT1aN0M0 kidney cancer, especially with increasing age and comorbidity. The potential association of renal mass biopsy with upstaging warrants caution, but it is uncertain whether it impacts prognosis relative to true perinephric fat invasion.
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Affiliation(s)
- Hiten D Patel
- The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD.
| | | | - Zhuo Tony Su
- The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Mohit Gupta
- The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Joseph G Cheaib
- The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Mohamad E Allaf
- The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Phillip M Pierorazio
- The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD
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Williamson SR, Cheng L, Gadde R, Giannico GA, Wasco MJ, Taylor Smith PJ, Gupta NS, Grignon DJ, Jorda M, Kryvenko ON. Renal cell tumors with an entrapped papillary component: a collision with predilection for oncocytic tumors. Virchows Arch 2019; 476:399-407. [DOI: 10.1007/s00428-019-02648-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Revised: 07/30/2019] [Accepted: 08/13/2019] [Indexed: 01/30/2023]
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Abstract
PURPOSE OF REVIEW This article provides a review of recent advances and issues regarding the controversial topic of renal mass biopsy (RMB). The purpose of this review is to provide an update on the current status of renal biopsy based on recently published literature. Here, we particularly focus on articles that have been published within the last 12 months. RECENT FINDINGS The main topics covered in this review are the approach, diagnostic accuracy and risks related to RMB. SUMMARY Current literature suggests that improvements in both technique and technological advancements of RMB have led to greater diagnostic accuracy and low risks to the patient. Newer technologies are leading toward innovative and harmless ways to diagnose kidney cancer, including liquid and image-based biopsy. However, it appears that the question of whether or not to instate renal biopsy as standard clinical practice has remained a highly debated controversy.
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Best SL, Liu Y, Keikhosravi A, Drifka CR, Woo KM, Mehta GS, Altwegg M, Thimm TN, Houlihan M, Bredfeldt JS, Abel EJ, Huang W, Eliceiri KW. Collagen organization of renal cell carcinoma differs between low and high grade tumors. BMC Cancer 2019; 19:490. [PMID: 31122202 PMCID: PMC6533752 DOI: 10.1186/s12885-019-5708-z] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2018] [Accepted: 05/13/2019] [Indexed: 12/31/2022] Open
Abstract
Background The traditional pathologic grading for human renal cell carcinoma (RCC) has low concordance between biopsy and surgical specimen. There is a need to investigate adjunctive pathology technique that does not rely on the nuclear morphology that defines the traditional grading. Changes in collagen organization in the extracellular matrix have been linked to prognosis or grade in breast, ovarian, and pancreatic cancers, but collagen organization has never been correlated with RCC grade. In this study, we used Second Harmonic Generation (SHG) based imaging to quantify possible differences in collagen organization between high and low grades of human RCC. Methods A tissue microarray (TMA) was constructed from RCC tumor specimens. Each TMA core represents an individual patient. A 5 μm section from the TMA tissue was stained with standard hematoxylin and eosin (H&E). Bright field images of the H&E stained TMA were used to annotate representative RCC regions. In this study, 70 grade 1 cores and 51 grade 4 cores were imaged on a custom-built forward SHG microscope, and images were analyzed using established software tools to automatically extract and quantify collagen fibers for alignment and density assessment. A linear mixed-effects model with random intercepts to account for the within-patient correlation was created to compare grade 1 vs. grade 4 measurements and the statistical tests were two-sided. Results Both collagen density and alignment differed significantly between RCC grade 1 and RCC grade 4. Specifically, collagen fiber density was greater in grade 4 than in grade 1 RCC (p < 0.001). Collagen fibers were also more aligned in grade 4 compared to grade 1 (p < 0.001). Conclusions Collagen density and alignment were shown to be significantly higher in RCC grade 4 vs. grade 1. This technique of biopsy sampling by SHG could complement classical tumor grading approaches. Furthermore it might allow biopsies to be more clinically relevant by informing diagnostics. Future studies are required to investigate the functional role of collagen organization in RCC.
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Affiliation(s)
- Sara L Best
- Department of Urology, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Yuming Liu
- Laboratory for Optical and Computational Instrumentation, University of Wisconsin-Madison, 1675 Observatory Drive, Madison, Wisconsin, 53706, USA
| | - Adib Keikhosravi
- Laboratory for Optical and Computational Instrumentation, University of Wisconsin-Madison, 1675 Observatory Drive, Madison, Wisconsin, 53706, USA
| | - Cole R Drifka
- Laboratory for Optical and Computational Instrumentation, University of Wisconsin-Madison, 1675 Observatory Drive, Madison, Wisconsin, 53706, USA.,Morgridge Institute for Research, Madison, Wisconsin, USA
| | - Kaitlin M Woo
- Department of Biostatistics and Medical Informatics, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Guneet S Mehta
- Laboratory for Optical and Computational Instrumentation, University of Wisconsin-Madison, 1675 Observatory Drive, Madison, Wisconsin, 53706, USA
| | - Marie Altwegg
- Laboratory for Optical and Computational Instrumentation, University of Wisconsin-Madison, 1675 Observatory Drive, Madison, Wisconsin, 53706, USA
| | - Terra N Thimm
- Laboratory for Optical and Computational Instrumentation, University of Wisconsin-Madison, 1675 Observatory Drive, Madison, Wisconsin, 53706, USA
| | - Matthew Houlihan
- Department of Urology, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Jeremy S Bredfeldt
- Laboratory for Optical and Computational Instrumentation, University of Wisconsin-Madison, 1675 Observatory Drive, Madison, Wisconsin, 53706, USA.,Morgridge Institute for Research, Madison, Wisconsin, USA
| | - E Jason Abel
- Department of Urology, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Wei Huang
- Department of Pathology and Laboratory Medicine, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Kevin W Eliceiri
- Laboratory for Optical and Computational Instrumentation, University of Wisconsin-Madison, 1675 Observatory Drive, Madison, Wisconsin, 53706, USA. .,Morgridge Institute for Research, Madison, Wisconsin, USA.
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Cotta BH, Meagher MF, Bradshaw A, Ryan ST, Rivera-Sanfeliz G, Derweesh IH. Percutaneous renal mass biopsy: historical perspective, current status, and future considerations. Expert Rev Anticancer Ther 2019; 19:301-308. [DOI: 10.1080/14737140.2019.1571915] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- Brittney H. Cotta
- Department of Urology, University of California San Diego School of Medicine, La Jolla, CA, USA
| | - Margaret F. Meagher
- Department of Urology, University of California San Diego School of Medicine, La Jolla, CA, USA
| | - Aaron Bradshaw
- Department of Urology, University of California San Diego School of Medicine, La Jolla, CA, USA
| | - Stephen T. Ryan
- Department of Urology, University of California San Diego School of Medicine, La Jolla, CA, USA
| | - Gerant Rivera-Sanfeliz
- Department of Urology, University of California San Diego School of Medicine, La Jolla, CA, USA
- Department of Radiology, University of California San Diego School of Medicine, La Jolla, CA, USA
| | - Ithaar H. Derweesh
- Department of Urology, University of California San Diego School of Medicine, La Jolla, CA, USA
- Department of Radiology, University of California San Diego School of Medicine, La Jolla, CA, USA
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Prendeville S, Richard PO, Jewett MAS, Kachura JR, Sweet JM, van der Kwast TH, Cheung CC, Finelli A, Evans AJ. Accuracy of renal tumour biopsy for the diagnosis and subtyping of papillary renal cell carcinoma: analysis of paired biopsy and nephrectomy specimens with focus on discordant cases. J Clin Pathol 2019; 72:363-367. [DOI: 10.1136/jclinpath-2018-205655] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Revised: 01/14/2019] [Accepted: 01/14/2019] [Indexed: 01/20/2023]
Abstract
AimsRenal tumour biopsy (RTB) is increasingly recognised as a useful diagnostic tool in the management of small renal masses, particularly those that are incidentally found. Intratumoural heterogeneity with respect to morphology, grade and molecular features represents a frequently identified limitation to the use of RTB. While previous studies have evaluated pathological correlation between RTB and nephrectomy, no studies to date have focused specifically on the role of RTB for the diagnosis of papillary renal cell carcinoma (PRCC) and its further subclassification into clinically relevant subtypes.MethodsThis single-institution study evaluated 60 cases of PRCC for concordance between RTB and nephrectomy with respect to diagnosis, grading and subtyping (type 1/type 2).ResultsWe observed 93% concordance (55 of 59 evaluable cases) between RTB and nephrectomy for the diagnosis of PRCC, although seven tumours (12%) were undergraded on RTB. Subtyping of PRCC on RTB was concordant with nephrectomy in 89% of cases reported as type 1 PRCC on RTB (31/35), but only 40% of cases reported as type 2 PRCC on RTB (4/10). Morphological misclassification of PRCC on RTB was most likely to occur in tumours showing a solid growth pattern. Discordant PRCC subtyping most often occurred in tumours with eosinophilia/oncocytic change.ConclusionThere was good concordance between RTB and nephrectomy for the primary diagnosis of PRCC. Although further subtyping of PRCC can aid therapeutic stratification, this can be challenging on RTB and tumours with overlapping or ambiguous features are best reported as PRCC not otherwise specified pending development of more robust methods to facilitate definitive subclassification.
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Coy H, Young JR, Douek ML, Pantuck A, Brown MS, Sayre J, Raman SS. Association of qualitative and quantitative imaging features on multiphasic multidetector CT with tumor grade in clear cell renal cell carcinoma. Abdom Radiol (NY) 2019; 44:180-189. [PMID: 29987358 DOI: 10.1007/s00261-018-1688-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
PURPOSE The purpose of the study was to determine if enhancement features and qualitative imaging features on multiphasic multidetector computed tomography (MDCT) were associated with tumor grade in patients with clear cell renal cell carcinoma (ccRCC). METHODS In this retrospective, IRB approved, HIPAA-compliant, institutional review board-approved study with waiver of informed consent, 127 consecutive patients with 89 low grade (LG) and 43 high grade (HG) ccRCCs underwent preoperative four-phase MDCT in unenhanced (UN), corticomedullary (CM), nephrographic (NP), and excretory (EX) phases. Previously published quantitative (absolute peak lesion enhancement, absolute peak lesion enhancement relative to normal enhancing renal cortex, 3D whole lesion enhancement and the wash-in/wash-out of enhancement within the 3D whole lesion ROI) and qualitative (enhancement pattern; presence of necrosis; pattern of; tumor margin; tumor-parenchymal interface, tumor-parenchymal interaction; intratumoral vascularity; collecting system infiltration; renal vein invasion; and calcification) assessments were obtained for each lesion independently by two fellowship-trained genitourinary radiologists. Comparisons between variables included χ2, ANOVA, and student t test. p values less than 0.05 were considered to be significant. Inter-reader agreement was obtained with the Gwet agreement coefficient (AC1) and standard error (SE) was reported. RESULTS No significant differences were observed between the LG and HG ccRCC cohorts with respect to absolute peak lesion enhancement and relative lesion enhancement ratio. There was a significant inverse correlation between low and high grade ccRCC and tumor enhancement the NP (71 HU vs. 54 HU, p < 0.001) and EX (52 HU vs. 39 HU, p < 0.001) phases using the 3D whole lesion ROI method. The percent wash-in of 3D enhancement from the UN to the CM phase was also significantly different between LG and HG ccRCCs (352% vs. 255%, p = 0.003). HG lesions showed significantly more calcification, necrosis, collecting system infiltration and ill-defined tumor margins (p < 0.05). Overall agreement between the two readers had a mean AC1 of 0.8172 (SE 0.0235). CONCLUSIONS Quantitatively, high grade ccRCC had significantly lower whole lesion enhancement in the NP and EX phases on MDCT. Qualitatively, high grade ccRCC were significantly more likely to be associated with calcifications, necrosis, collecting system infiltration, and an ill-defined tumor margin.
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Affiliation(s)
- Heidi Coy
- Department of Radiological Sciences, David Geffen School of Medicine at UCLA, Ronald Reagan-UCLA Medical Center, 924 Westwood Boulevard, Suite 650, Los Angeles, CA, 90024, USA.
| | - Jonathan R Young
- Department of Radiology, University of California, Davis, 4860 Y Street, Suite 3100, Sacramento, CA, 95817, USA
| | - Michael L Douek
- Department of Radiological Sciences, David Geffen School of Medicine at UCLA, Ronald Reagan-UCLA Medical Center, 924 Westwood Boulevard, Suite 650, Los Angeles, CA, 90024, USA
| | - Alan Pantuck
- Department of Urology, David Geffen School of Medicine at UCLA, Ronald Reagan-UCLA Medical Center, Clark Urology Center-Westwood, 200 Medical Plaza, Suite 140, Los Angeles, CA, 90095, USA
| | - Matthew S Brown
- Department of Radiological Sciences, David Geffen School of Medicine at UCLA, Ronald Reagan-UCLA Medical Center, 924 Westwood Boulevard, Suite 650, Los Angeles, CA, 90024, USA
| | - James Sayre
- Department of Biostatistics, UCLA School of Public Heath, Room 51-253A, Los Angeles, CA, 90095, USA
| | - Steven S Raman
- UCLA Department of Radiological Sciences, Ronald Reagan UCLA Medical Center, 757 Westwood Plaza, RRUMC 1621H, Box 957437, Los Angeles, CA, 90095, USA
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Sanchez A, Feldman AS, Hakimi AA. Current Management of Small Renal Masses, Including Patient Selection, Renal Tumor Biopsy, Active Surveillance, and Thermal Ablation. J Clin Oncol 2018; 36:3591-3600. [PMID: 30372390 PMCID: PMC6804853 DOI: 10.1200/jco.2018.79.2341] [Citation(s) in RCA: 87] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Renal cancer represents 2% to 3% of all cancers, and its incidence is rising. The increased use of ultrasonography and cross-sectional imaging has resulted in the clinical dilemma of incidentally detected small renal masses (SRMs). SRMs represent a heterogeneous group of tumors that span the full spectrum of metastatic potential, including benign, indolent, and more aggressive tumors. Currently, no composite model or biomarker exists that accurately predicts the diagnosis of kidney cancer before treatment selection, and the use of renal mass biopsy remains controversial. The management of SRMs has changed dramatically over the last two decades as our understanding of tumor biology and competing risks of mortality in this population has improved. In this review, we critically assess published consensus guidelines and recent literature on the diagnosis and management of SRMs, with a focus on patient treatment selection and use of renal mass biopsy, active surveillance, and thermal ablation. Finally, we highlight important opportunities for leveraging recent research discoveries to identify patients with SRMs at high risk for renal cell carcinoma-related mortality and minimize overtreatment and patient morbidity.
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Affiliation(s)
- Alejandro Sanchez
- Alejandro Sanchez and A. Ari Hakimi, Memorial Sloan Kettering Cancer Center, New York, NY; and Adam S. Feldman, Massachusetts General Hospital, Boston, MA
| | - Adam S. Feldman
- Alejandro Sanchez and A. Ari Hakimi, Memorial Sloan Kettering Cancer Center, New York, NY; and Adam S. Feldman, Massachusetts General Hospital, Boston, MA
| | - A. Ari Hakimi
- Alejandro Sanchez and A. Ari Hakimi, Memorial Sloan Kettering Cancer Center, New York, NY; and Adam S. Feldman, Massachusetts General Hospital, Boston, MA
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Re: Diagnostic Performance and Interreader Agreement of a Standardized MR Imaging Approach in the Prediction of Small Renal Mass Histology. J Urol 2018. [DOI: 10.1016/j.juro.2018.09.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Perrino CM, Cramer HM, Chen S, Idrees MT, Wu HH. World Health Organization (WHO)/International Society of Urological Pathology (ISUP) grading in fine-needle aspiration biopsies of renal masses. Diagn Cytopathol 2018; 46:895-900. [DOI: 10.1002/dc.23979] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Accepted: 05/09/2018] [Indexed: 01/20/2023]
Affiliation(s)
- Carmen M. Perrino
- Department of Pathology and Laboratory Medicine; Indiana University School of Medicine; Indianapolis Indiana
| | - Harvey M. Cramer
- Department of Pathology and Laboratory Medicine; Indiana University School of Medicine; Indianapolis Indiana
| | - Shaoxiong Chen
- Department of Pathology and Laboratory Medicine; Indiana University School of Medicine; Indianapolis Indiana
| | - Muhammad T. Idrees
- Department of Pathology and Laboratory Medicine; Indiana University School of Medicine; Indianapolis Indiana
| | - Howard H. Wu
- Department of Pathology and Laboratory Medicine; Indiana University School of Medicine; Indianapolis Indiana
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Song JB, Morrissey JJ, Mobley JM, Figenshau KG, Vetter JM, Bhayani SB, Kharasch ED, Figenshau RS. Urinary aquaporin 1 and perilipin 2: Can these novel markers accurately characterize small renal masses and help guide patient management? Int J Urol 2018; 26:260-265. [PMID: 30467901 DOI: 10.1111/iju.13854] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Accepted: 08/09/2018] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To evaluate the role of urine aquaporin 1 and perilipin 2 as biomarkers adjunct to renal mass biopsy in guiding the management of patients with small renal masses. METHODS Preoperative aquaporin 1 and perilipin 2 levels in 57 patients with small renal masses undergoing partial nephrectomy were analyzed and compared with postoperative tumor histology. An algorithm was created utilizing aquaporin 1 and perilipin 2 in conjunction with renal mass biopsy. Cut-off values were implemented to maximize biomarker sensitivity and specificity. Renal mass biopsy utilization and intervention were then compared with rates in traditional renal mass biopsy algorithms. RESULTS All clear cell and papillary renal cell carcinomas were correctly identified and assigned to the treatment path. All benign lesions were correctly sorted to a confirmatory renal mass biopsy path. Two chromophobe masses did not have elevated aquaporin 1 and perilipin 2, and would require renal mass biopsy. Compared with protocols that call for all small renal masses to be biopsied, confirmatory renal mass biopsy could have been safely avoided in 74% of patients with elevated aquaporin 1 and perilipin 2. Compared with protocols that do not utilize renal mass biopsy, surgical intervention would have been avoided in 23% of patients with benign masses. CONCLUSIONS Aquaporin 1 and perilipin 2 possess high sensitivity and specificity for detecting clear cell and papillary renal cell carcinoma. Use of these markers might compliment renal mass biopsy in the characterization of small renal masses.
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Affiliation(s)
- Joseph B Song
- Division of Urology, Washington University School of Medicine in St. Louis, St. Louis, Missouri,, USA
| | - Jeremiah J Morrissey
- Department of Anesthesiology, Division of Clinical and Translational Research, Washington University School of Medicine in St. Louis, St. Louis, Missouri,, USA.,Siteman Cancer Center, Washington University School of Medicine in St. Louis, St. Louis, Missouri,, USA
| | - Jonathan M Mobley
- Division of Urology, Washington University School of Medicine in St. Louis, St. Louis, Missouri,, USA
| | - Karen G Figenshau
- Division of Urology, Washington University School of Medicine in St. Louis, St. Louis, Missouri,, USA
| | - Joel M Vetter
- Division of Urology, Washington University School of Medicine in St. Louis, St. Louis, Missouri,, USA
| | - Sam B Bhayani
- Division of Urology, Washington University School of Medicine in St. Louis, St. Louis, Missouri,, USA.,Siteman Cancer Center, Washington University School of Medicine in St. Louis, St. Louis, Missouri,, USA
| | - Evan D Kharasch
- Department of Anesthesiology, Division of Clinical and Translational Research, Washington University School of Medicine in St. Louis, St. Louis, Missouri,, USA.,Siteman Cancer Center, Washington University School of Medicine in St. Louis, St. Louis, Missouri,, USA.,Department of Biochemistry and Molecular Biophysics, Washington University School of Medicine in St. Louis, St. Louis, Missouri,, USA.,The Center for Clinical Pharmacology, St. Louis College of Pharmacy, St. Louis, Missouri, USA
| | - Robert Sherburne Figenshau
- Division of Urology, Washington University School of Medicine in St. Louis, St. Louis, Missouri,, USA.,Siteman Cancer Center, Washington University School of Medicine in St. Louis, St. Louis, Missouri,, USA
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Abstract
Renal cell cancer (RCC) (epithelial carcinoma of the kidney) represents 2%-4% of newly diagnosed adult tumors. Over the past 2 decades, RCC has been better characterized clinically and molecularly. It is a heterogeneous disease, with multiple subtypes, each with characteristic histology, genetics, molecular profiles, and biologic behavior. Tremendous heterogeneity has been identified with many distinct subtypes characterized. There are clinical questions to be addressed at every stage of this disease, and new targets being identified for therapeutic development. The unique characteristics of the clinical presentations of RCC have led to both questions and opportunities for improvement in management. Advances in targeted drug development and understanding of immunologic control of RCC are leading to a number of new clinical trials and regimens for advanced disease, with the goal of achieving long-term disease-free survival, as has been achieved in a proportion of such patients historically. RCC management is a promising area of ongoing clinical investigation.
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48
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Richard PO, Lavallée LT, Pouliot F, Komisarenko M, Martin L, Lattouf JB, Finelli A. Is Routine Renal Tumor Biopsy Associated with Lower Rates of Benign Histology following Nephrectomy for Small Renal Masses? J Urol 2018; 200:731-736. [DOI: 10.1016/j.juro.2018.04.015] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/02/2018] [Indexed: 01/16/2023]
Affiliation(s)
- Patrick O. Richard
- Division of Urology, Department of Surgery, Centre Hospitalier Universitaire de Sherbrooke, Centre de recherche du CHUS and University of Sherbrooke, Quebec, Canada
| | - Luke T. Lavallée
- Division of Urology, Department of Surgery, Ottawa Hospital, Ottawa Hospital Research Institute and University of Ottawa, Ottawa, Ontario, Canada
| | - Frederic Pouliot
- Division of Urology, Department of Surgery, Centre Hospitalier Universitaire de Québec, Centre Hospitalier Universitaire de Québec Research Center, Université de Laval, Quebec, Canada
| | - Maria Komisarenko
- Division of Urology, Departments of Surgery, Princess Margaret Cancer Centre, University Health Network and University of Toronto, Toronto, Ontario, Canada
| | - Lisa Martin
- Division of Urology, Departments of Surgery, Princess Margaret Cancer Centre, University Health Network and University of Toronto, Toronto, Ontario, Canada
| | - Jean-Baptiste Lattouf
- Division of Urology, Department of Surgery, Centre Hospitalier Universitaire de Montreal, University of Montreal, Montreal, Quebec, Canada
| | - Antonio Finelli
- Division of Urology, Departments of Surgery, Princess Margaret Cancer Centre, University Health Network and University of Toronto, Toronto, Ontario, Canada
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49
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Paterson C, Ghaemi J, Alashkham A, Biyani CS, Coles B, Baker L, Szewczyk-Bieda M, Nabi G. Diagnostic accuracy of image-guided biopsies in small (<4 cm) renal masses with implications for active surveillance: a systematic review of the evidence. Br J Radiol 2018; 91:20170761. [PMID: 29888978 DOI: 10.1259/bjr.20170761] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVE: To determine the safety and diagnostic accuracy of renal tumour biopsies in a defined population of small renal masses (SRMs) only <4 cm using 3 × 2 table, intention to diagnose approach. 3 × 2 table approach examines indeterminate results as a separate category rather than pushing these through traditional 2 × 2 table (four-cell matrix) approach. METHODS: A highly sensitive search was performed in the Cochrane Library, Database of Abstracts of Reviews of Effects; MEDLINE and MEDLINE in Process, EMBASE and conference proceedings (1966-2016) for the acquisition of data on the diagnostic accuracy and complications of RTB in patients with SRM <4 cm. Methodological quality and risk of bias was assessed using QUADAS-2. Test characteristics were calculated using conventional 2 × 2 contingency table analysis excluding non-diagnostic biopsies, and an intention-to-diagnose approach with a 3 × 2 table for pooled estimates of the sensitivity and specificity. RESULTS: A total of 20 studies were included with a total sample size of 974. The pooled estimates for sensitivity and specificity of RTB based upon univariate analysis using 2 × 2 table observed sensitivity 0.952 [confidence interval (CI) 0.908-0.979] and specificity 0.824 (CI 0.566-0.962). Using the 3 × 2 table and intention-to-diagnose principle, sensitivity 0.947 (CI 0.925-0.965) and specificity 0.609 (CI 0.385-0.803) decreased. CONCLUSION: RTB in SRMs (<4 cm) is associated with a high diagnostic sensitivity but poor specificity when non-diagnostic results are included by a 3 × 2 table for analysis (intention to diagnose approach). Risk of non-diagnostic results and poor quality of research need addressing through future studies, preferably by a well-designed prospective study appropriately powered for diagnostic accuracy using valid reference standards. ADVANCES IN KNOWLEDGE: A comprehensive synthesis of literature on image-guided biopsies in SRMs using a different methodology and study design.
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Affiliation(s)
- Catherine Paterson
- 1 School of Nursing and Midwifery, Robert Gordon University , Garthdee, Aberdeen , UK
| | - Joseph Ghaemi
- 2 Academic Section of Urology, Division of Cancer, School of Medicine, Ninewells Hospital , Dundee , UK
| | - Abduelmenem Alashkham
- 3 Centre for Human Anatomy, School of Biomedical Sciences, University of Edinburgh , Edinburgh , UK
| | - Chandra Shekhar Biyani
- 4 Department of Urology, St James's University Hospital, Leeds Teaching Hospitals NHS Trust , Leeds, West Yorkshire , UK
| | - Bernadette Coles
- 5 Site Librarian, University Library Service, Cardiff University, Cancer Research Wales Library, Velindre Cancer Centre , Cardiff , Wales
| | - Lee Baker
- 6 Chi-Squared Innovations , Dundee , UK
| | - Magdalena Szewczyk-Bieda
- 2 Academic Section of Urology, Division of Cancer, School of Medicine, Ninewells Hospital , Dundee , UK
| | - Ghulam Nabi
- 2 Academic Section of Urology, Division of Cancer, School of Medicine, Ninewells Hospital , Dundee , UK
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50
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Patel RM, Safiullah S, Okhunov Z, Meller D, Osann K, Kaler K, Landman J, Clayman RV. Pretreatment Diagnosis of the Small Renal Mass: Status of Renal Biopsy in the United States of America. J Endourol 2018; 32:884-890. [PMID: 29978713 DOI: 10.1089/end.2018.0175] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
INTRODUCTION We surveyed United States of America-based urologists to characterize practice patterns and indications to perform a renal mass biopsy for small renal masses. MATERIALS AND METHODS Members of the American Urological Association who practice in the United States were invited to participate in a 11-question web-based survey that was distributed via SurveyMonkey® from December 2016 to January 2017. RESULTS There were 1131 respondents. The respondents equally represented all regions of the United States; the majority were in private practice. Overall, 32% of American urologists would "never" perform a biopsy of a renal mass ≤4 cm. Those who saw fewer than five small renal masses per year were more likely to "never" perform a renal biopsy on either a renal mass ≤4 cm or a renal mass 2-3 cm compared with those who saw more than five small renal masses per year (p < 0.001). Urologists who practiced at an academic hospital were more likely to perform a renal biopsy on both a renal mass ≤4 cm and a renal mass 2-3 cm compared with private practice and government-based urologists (p < 0.001 and p = 0.008 respectively). The primary reason for not performing a biopsy, cited by 68% of responding urologists, was that the results of a biopsy "would not change their management of the renal mass." Respondents independently performed only 2% of biopsies; however, almost half stated that they would be interested in learning office-based ultrasound-guided biopsy of a small renal mass. CONCLUSIONS Among members of the American Urological Association, biopsy of a small renal mass remains an underutilized diagnostic procedure, especially in light of 6000 unnecessary surgeries annually; nonuniversity-based urologists and those who see <5 renal mass cases each year infrequently perform a biopsy. Currently, interventional radiologists perform almost all small renal mass biopsies.
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Affiliation(s)
- Roshan M Patel
- Department of Urology, University of California , Irvine, Orange, California
| | - Shoaib Safiullah
- Department of Urology, University of California , Irvine, Orange, California
| | - Zhamshid Okhunov
- Department of Urology, University of California , Irvine, Orange, California
| | - Daniel Meller
- Department of Urology, University of California , Irvine, Orange, California
| | - Kathryn Osann
- Department of Urology, University of California , Irvine, Orange, California
| | - Kamaljot Kaler
- Department of Urology, University of California , Irvine, Orange, California
| | - Jaime Landman
- Department of Urology, University of California , Irvine, Orange, California
| | - Ralph V Clayman
- Department of Urology, University of California , Irvine, Orange, California
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