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Dmitry F, Evgeniy S, Vasiliy K, Alexandra P, Khalil I, Evgeny S, Mikhail C, Kirill P, Alexander T, Dmitry K, Camilla A, Andrey V, Denis B, Petr G, Leonid R. Tumor morphology evaluation using 3D-morphometric features of renal masses. Urologia 2024:3915603241261499. [PMID: 39058231 DOI: 10.1177/03915603241261499] [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: 07/28/2024]
Abstract
OBJECTIVE To assess the correlation between the general (gender, age, and maximum tumor size) and 3D morphotopometric features of the renal tumor node, following the MSCT data post-processing, and the tumor histological structure; to propose an equation allowing for kidney malignancy assessment based on general and morphometric features. MATERIALS AND METHODS In total, 304 patients with unilateral solitary renal neoplasms underwent laparoscopic (retroperitoneoscopic) or robotic partial or radical nephrectomy. Before the procedure, kidney contrast-enhanced MSCT followed by the tumor 3D-modeling was performed. 3D model of the kidney tumor, and its morphotopometric features, and histological structure were analyzed. The morphotopometric ones include the side of the lesion, location by segments, the surface where the tumor, the depth of the tumor invasion into the kidney, and the shape of tumor. RESULTS Out of 304 patients, 254 (83.6%) had malignant kidney tumors and 50 (16.4%) benign kidney tumors. In total, 231 patients, out of 254 (90.9%) were assessed for the degree of malignant tumor differentiation. Malignant tumors were more frequent in men than in women (p < 0.001). Mushroom-shaped tumors were the most common shapes among benign renal masses (35.2%). The most common malignant kidney tumors had spherical with a partially uneven surface (27.6%), multinodular (tuberous (27.2%)), and spherical with a conical base (24.8%) shapes. Logistic regression model enabled the development of prognostic equation for tumor malignancy prediction ("low" or "high"). The univariate analysis revealed the correlation only between high differentiation (G1) and a spherical tumor with a conical base (p = 0.029). CONCLUSION The resulting logistic model, based on the analysis of such predictors as gender and form of kidney lesions, demonstrated a large share (87.6%) of correct predictions of the kidney tumor malignancy.
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Affiliation(s)
- Fiev Dmitry
- Institute for Urology and Human Reproductive Health, Sechenov University, Moscow, Russia
| | - Sirota Evgeniy
- Institute for Urology and Human Reproductive Health, Sechenov University, Moscow, Russia
| | - Kozlov Vasiliy
- Semashko Department of Public Health and Healthcare, Sechenov University, Moscow, Russia
| | - Proskura Alexandra
- Institute for Urology and Human Reproductive Health, Sechenov University, Moscow, Russia
| | - Ismailov Khalil
- Institute for Urology and Human Reproductive Health, Sechenov University, Moscow, Russia
| | - Shpot Evgeny
- Institute for Urology and Human Reproductive Health, Sechenov University, Moscow, Russia
| | - Chernenkiy Mikhail
- Institute for Urology and Human Reproductive Health, Sechenov University, Moscow, Russia
| | - Puzakov Kirill
- Department of Radiology, The Second University Clinic, Sechenov University, Moscow, Russia
| | - Tarasov Alexander
- Institute of Linguistics and Intercultural Communication, Sechenov University, Moscow, Russia
| | - Korolev Dmitry
- Institute for Urology and Human Reproductive Health, Sechenov University, Moscow, Russia
| | - Azilgareeva Camilla
- Institute for Urology and Human Reproductive Health, Sechenov University, Moscow, Russia
| | - Vinarov Andrey
- Institute for Urology and Human Reproductive Health, Sechenov University, Moscow, Russia
| | - Butnaru Denis
- Institute for Urology and Human Reproductive Health, Sechenov University, Moscow, Russia
| | - Glybochko Petr
- Institute for Urology and Human Reproductive Health, Sechenov University, Moscow, Russia
| | - Rapoport Leonid
- Institute for Urology and Human Reproductive Health, Sechenov University, Moscow, Russia
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Mansour H, Tran-Dang MA, Walkden M, Boleti E, Barod R, Patki P, Mumtaz F, Tran MGB, Bex A, El Sheikh S. Renal mass biopsy - a practical and clinicopathologically relevant approach to diagnosis. Nat Rev Urol 2024:10.1038/s41585-024-00897-5. [PMID: 38907039 DOI: 10.1038/s41585-024-00897-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/09/2024] [Indexed: 06/23/2024]
Abstract
Advancements in imaging modalities have increased the frequency of renal mass discovery. Imaging has typically been considered sufficient to guide management for a large proportion of these tumours, but renal mass biopsies (RMBs) have an increasing role in determining malignancy and can be a valuable tool for preventing unnecessary surgery in patients with benign tumours. A structured approach should be used to help to navigate the expanding repertoire of renal tumours, many of which are molecularly defined. In terms of tumour subtyping, the pathologist's strategy should focus on stratifying patients into clinically different prognostic groups according to our current knowledge of tumour behaviour, including benign, low-grade or indolent, intermediate malignant or highly aggressive. Crucial pathological features and morphological mimicry of tumours can alter the tumour's prognostic group. Thus, pathologists and urologists can use RMB to select patients with tumours at a reduced risk of progression, which can be safely managed with active surveillance within a tailored imaging schedule, versus tumours for which ablation or surgical intervention is indicated. RMB is also crucial in the oncological setting to distinguish between different high-grade tumours and guide tailored management strategies.
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Affiliation(s)
- Hussein Mansour
- Research Department of Pathology, UCL Cancer Institute, London, UK
| | - My-Anh Tran-Dang
- Specialist centre for kidney cancer, Royal Free London Hospital, London, UK
| | - Miles Walkden
- Specialist centre for kidney cancer, Royal Free London Hospital, London, UK
- UCL Division of Surgery and Interventional Science, Rowland Street, London, UK
| | - Ekaterini Boleti
- Specialist centre for kidney cancer, Royal Free London Hospital, London, UK
| | - Ravi Barod
- Specialist centre for kidney cancer, Royal Free London Hospital, London, UK
- UCL Division of Surgery and Interventional Science, Rowland Street, London, UK
| | - Prasad Patki
- Specialist centre for kidney cancer, Royal Free London Hospital, London, UK
- UCL Division of Surgery and Interventional Science, Rowland Street, London, UK
| | - Faiz Mumtaz
- Specialist centre for kidney cancer, Royal Free London Hospital, London, UK
- UCL Division of Surgery and Interventional Science, Rowland Street, London, UK
| | - Maxine G B Tran
- Specialist centre for kidney cancer, Royal Free London Hospital, London, UK
- UCL Division of Surgery and Interventional Science, Rowland Street, London, UK
| | - Axel Bex
- Specialist centre for kidney cancer, Royal Free London Hospital, London, UK
- UCL Division of Surgery and Interventional Science, Rowland Street, London, UK
| | - Soha El Sheikh
- Research Department of Pathology, UCL Cancer Institute, London, UK.
- Specialist centre for kidney cancer, Royal Free London Hospital, London, UK.
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3
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Isgrò G, Rogers A, Veeratterapillay R, Rix D, Page T, Maestroni U, Bertolotti L, Pagnini F, Martini C, De Filippo M, Ziglioli F. Role of Renal Biopsy in the Management of Renal Cancer: Concordance between Ultrasound/CT-Guided Biopsy Results and Definitive Pathology, Adverse Events, and Complication Rate. J Clin Med 2023; 13:31. [PMID: 38202038 PMCID: PMC10779766 DOI: 10.3390/jcm13010031] [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: 09/15/2023] [Revised: 10/24/2023] [Accepted: 10/26/2023] [Indexed: 01/12/2024] Open
Abstract
(1) Background: In the last decade, the number of detected renal cancer cases has increased, with the highest incidence in Western countries. Although renal biopsy is reported as a safe procedure, it is not adopted in all centres. As it is not possible to accurately distinguish benign tumours using imaging, this may lead to overtreatment. Most of the cancer detected on imaging is treated by surgery, radiofrequency ablation (RFA), or cryotherapy. (2) Methods: This was a single-centre retrospective study of 225 patients studied preoperatively with ultrasound (US)/CT-guided renal biopsy, with the aim of supporting clinical management. Decisions regarding the biopsy were based on either MDT indication or physician preference. US-guided renal biopsy was the first option for all patients; CT-guided biopsy was used when US-guided biopsy was not feasible. The efficacy of renal biopsy in terms of diagnostic performance and the concordance between biopsy results and definitive pathology were investigated. Additionally, adverse events related to the biopsy were recorded and analysed. Data collected throughout the study were analysed using binary logistic regression, Fisher's exact test, and Pearson's chi-square test to investigate possible correlations between post-procedural complications and the size of the lesion. (3) Results: Renal biopsy was not diagnostic in 23/225 (10.2%) patients. A CT-guided approach was necessary in 20/225 patients after failure of US-guided biopsy. The complication rate of renal biopsy was 4.8% overall-all Clavien grade I and without any serious sequelae. Interestingly, complications occurred in patients with very different sizes of renal cell carcinoma. No correlation between complications and anticoagulant/antiplatelet drugs was found. No seeding was reported among the patients who underwent partial/radical nephrectomy. (4) Conclusions: Renal biopsy was shown to be safe and effective, with a high concordance between biopsy results and definitive pathology and a low rate of complications. The use of a CT-guided approach whenever the US-guided approach failed improved the diagnostic performance of renal biopsy.
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Affiliation(s)
- Gianmarco Isgrò
- Department of Urology, James Cook University Hospital, Middlesbrough TS4 3BW, UK
| | - Alistair Rogers
- Department of Urology, The Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne NE7 7DN, UK (R.V.)
| | - Rajan Veeratterapillay
- Department of Urology, The Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne NE7 7DN, UK (R.V.)
| | - David Rix
- Department of Urology, The Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne NE7 7DN, UK (R.V.)
| | - Toby Page
- Department of Urology, James Cook University Hospital, Middlesbrough TS4 3BW, UK
| | - Umberto Maestroni
- Department of Urology, University Hospital of Parma, 43100 Parma, Italy (F.Z.)
| | - Lorenzo Bertolotti
- Department of Medicine and Surgery, Section of Radiology, University-Hospital of Parma, 43100 Parma, Italy (M.D.F.)
| | - Francesco Pagnini
- Department of Medicine and Surgery, Section of Radiology, University-Hospital of Parma, 43100 Parma, Italy (M.D.F.)
| | - Chiara Martini
- Department of Medicine and Surgery, University-Hospital of Parma, 43100 Parma, Italy
| | - Massimo De Filippo
- Department of Medicine and Surgery, Section of Radiology, University-Hospital of Parma, 43100 Parma, Italy (M.D.F.)
| | - Francesco Ziglioli
- Department of Urology, University Hospital of Parma, 43100 Parma, Italy (F.Z.)
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4
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Kalfazade N, Özlü DN, Şam E, Akkaş F, Gürbüz N. Factors associated with pathological tumor stage and T3a upstage in clinical T1-2 renal cell carcinoma. Prog Urol 2023; 33:135-144. [PMID: 36604246 DOI: 10.1016/j.purol.2022.12.007] [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: 06/30/2022] [Revised: 11/16/2022] [Accepted: 12/10/2022] [Indexed: 01/04/2023]
Abstract
INTRODUCTION Considering the oncological outcomes, understanding the preoperative factors associated with and predicting advanced stage and T3a upstage will help in risk assessment and selection of the right treatment. MATERIAL AND METHOD Patients with postoperative pathology of Renal Cell Carcinoma (RCC) and stage T1-2 N0M0 were included in the study. Demographic and pathological characteristics of the patients, Neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), and De Ritis- the ratio of aspartate aminotransferase (AST) and alanine aminotransferase (ALT) were recorded. Patients were classified according to T stage (T1-2 vs T3-4) and T3a upstage (T3a upstaged vs non-T3a upstaged). RESULTS A total of 289 patients participated in the study when inclusion and exclusion criteria were applied. No difference was found between the groups in terms of age, gender, body mass index, laterality, ABO blood group, Rh positivity and comorbidities. According to multivariate analysis, PLR, AST/ALT, Fuhrman grade, open radical nephrectomy (RN) and Clear Cell pathological subtype were found to be significant-independent factors in predicting advanced stage (T3-4) and T3a upstage (P<0.05). CONCLUSION It was found that higher PLR and AST/ALT ratios were associated with more advanced stage and postoperative T3a upstage in RCC patients. In addition, these patients more frequently had open RN and had higher Fuhrman grades, while the clear cell subtype was less common.
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Affiliation(s)
- N Kalfazade
- Department of Urology, University of Health Sciences Bakırköy Dr. Sadi Konuk Training and Research Hospital, İstanbul, Turkey.
| | - D N Özlü
- Department of Urology, University of Health Sciences Bakırköy Dr. Sadi Konuk Training and Research Hospital, İstanbul, Turkey.
| | - E Şam
- Department of Urology, University of Health Sciences Erzurum Regional Training and Research Hospital, Erzurum, Turkey.
| | - F Akkaş
- Department of Urology, University of Health Sciences Erzurum Regional Training and Research Hospital, Erzurum, Turkey.
| | - N Gürbüz
- Department of Urology, University of Health Sciences Bakırköy Dr. Sadi Konuk Training and Research Hospital, İstanbul, Turkey.
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Heywood S, Bennett G, Tamhane R, McCredie S. Tumour seeding of a renal mass biopsy tract: more common than thought? JOURNAL OF CLINICAL UROLOGY 2022. [DOI: 10.1177/2051415819841956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Sean Heywood
- Department of Urology, Canberra Hospital, Australia
| | | | - Rohit Tamhane
- Canberra Imaging Group, John James Healthcare Campus, Australia
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6
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Michele D, Umberto B, Gaetano R, Francesco P, Davide B, Francesca C, Zagone V, Marco M. Tumour Seeding After a Thoracic Biopsy for Renal Cell Carcinoma: A Case Report and a Review of the Literature. CLINICAL MEDICINE INSIGHTS-ONCOLOGY 2021; 15:11795549211022261. [PMID: 34211307 PMCID: PMC8216389 DOI: 10.1177/11795549211022261] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 05/10/2021] [Indexed: 11/21/2022]
Abstract
The role of percutaneous tumour biopsies had gain importance in the management of renal cell carcinoma to provide diagnostic specimen for the patients with metastatic disease that could benefit a systemic treatment. Among the possible complications of this procedure, however, there is the risk of tumoral cells seeding along the biopsy’s tract; this complication, albeit being reported as anecdotal, could have devastating effects. Here we report a case of a young male who developed subcutaneous chest metastasis of renal cell carcinoma after a biopsy of a lung nodule. We subsequently reviewed other cases reported in literature
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Affiliation(s)
- Dionese Michele
- Oncology Unit 1, Istituto Oncologico Veneto IOV-IRCCS, Padua, Italy.,Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy
| | - Basso Umberto
- Oncology Unit 1, Istituto Oncologico Veneto IOV-IRCCS, Padua, Italy
| | - Ramondo Gaetano
- Radiology Unit, Istituto Oncologico Veneto IOV-IRCCS, Padua, Italy
| | | | - Bimbatti Davide
- Oncology Unit 1, Istituto Oncologico Veneto IOV-IRCCS, Padua, Italy
| | - Caumo Francesca
- Radiology Unit, Istituto Oncologico Veneto IOV-IRCCS, Padua, Italy
| | - Vittorina Zagone
- Oncology Unit 1, Istituto Oncologico Veneto IOV-IRCCS, Padua, Italy
| | - Maruzzo Marco
- Oncology Unit 1, Istituto Oncologico Veneto IOV-IRCCS, Padua, Italy
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7
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Zhou Y, Murugan P, Li F, Bu L. Needle tract seeding in renal tumor biopsies: experience from a single institution. Diagn Pathol 2021; 16:43. [PMID: 33993889 PMCID: PMC8127231 DOI: 10.1186/s13000-021-01106-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 05/04/2021] [Indexed: 01/20/2023] Open
Abstract
Background Percutaneous needle biopsy of renal masses has been increasingly utilized to aid the diagnosis and guide management. It is generally considered as a safe procedure. However, tumor seeding along the needle tract, one of the complications, theoretically poses potential risk of tumor spread by seeded malignant cells. Prior studies on the frequency of needle tract seeding in renal tumor biopsies are limited and clinical significance of biopsy-associated tumor seeding remains largely controversial. Methods Here we investigated the frequencies of biopsy needle tract tumor seeding at our institution by reviewing the histology of renal cell carcinoma nephrectomy specimens with a prior biopsy within the last seventeen years. Biopsy site changes were recognized as a combination of foreign body reaction, hemosiderin deposition, fibrosis and fat necrosis. The histologic evidence of needle tract tumor seeding was identified as clusters of tumor cells embedded in perinephric tissue spatially associated with the biopsy site. In addition, association between parameters of biopsy techniques and tumor seeding were investigated. Results We observed needle tract tumor seeding to perinephric tissue in six out of ninety-eight (6 %) renal cell carcinoma cases including clear cell renal cell carcinoma, papillary renal cell carcinoma, chromophobe, and clear cell papillary renal cell carcinoma. The needle tract tumor seeding was exclusively observed in papillary renal cell carcinomas (6/28, 21 %) that were unifocal, small-sized (≤ 4 cm), confined to the kidney and had type 1 features. No recurrence or metastasis was observed in the papillary renal cell carcinoma cases with tumor seeding or the stage-matched cases without tumor seeding. Conclusions Our study demonstrated a higher than reported frequency of needle tract tumor seeding. Effective communication between pathologists and clinicians as well as documentation of tumor seeding is recommended. Further studies with a larger patient cohort and longer follow up to evaluate the impact of needle tract tumor seeding on long term prognosis are needed. This may also help reach a consensus on appropriate pathologic staging of renal cell carcinoma when the only site of perinephric fat invasion is within a biopsy needle tract.
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Affiliation(s)
- Yan Zhou
- Department of Laboratory Medicine and Pathology, University of Minnesota, 420 Delaware St. SE, 55455, Minneapolis, MN, USA
| | - Paari Murugan
- Department of Laboratory Medicine and Pathology, University of Minnesota, 420 Delaware St. SE, 55455, Minneapolis, MN, USA
| | - Faqian Li
- Department of Laboratory Medicine and Pathology, University of Minnesota, 420 Delaware St. SE, 55455, Minneapolis, MN, USA
| | - Lihong Bu
- Department of Laboratory Medicine and Pathology, University of Minnesota, 420 Delaware St. SE, 55455, Minneapolis, MN, USA.
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Valencia-Guerrero A, Oliva E, Wu CL, Wu S, Rice-Stitt T, Sadow PM, Dahl DM, Feldman AS, Arellano RS, Cornejo KM. To stage or not to stage: determining the true clinical significance of the biopsy tract through perinephric fat in assessing renal cell carcinoma. Histopathology 2021; 78:951-962. [PMID: 33236381 DOI: 10.1111/his.14309] [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: 07/10/2020] [Accepted: 11/22/2020] [Indexed: 11/29/2022]
Abstract
AIMS Perinephric fat invasion (PFI) is a key component of renal cell carcinoma (RCC) staging, but there are limited data pertaining to biopsy tract seeding (BTS) resulting in perirenal tissue involvement [BTS with perinephric fat invasion (BTS-P)].The aim is to correlate clinical outcomes with pathologic stage to determine whether the presence of BTS-P should be considered a criterion to stage RCC as part of the pT3a category in the absence of any other upstaging variables. MATERIALS AND RESULTS We identified 304 renal biopsies from patients with subsequent nephrectomies for RCC; 33 of the tumours contained PFI. Each case was reviewed to determine the presence of BTS-P and other forms of invasion [e.g. non-BTS-P PFI, sinus fat invasion (SFI), and/or renal vein invasion (RVI)], and these findings were compared with survival outcomes. Ten (30%) of 33 tumours with PFI showed BTS-P as the only finding, and were otherwise pT1 tumours; six (60%) patients were alive without disease (AWOD) (mean, 77.5 months), three were lost to follow-up (LTF), and one died of other disease (DOOD). Two patients showed true PFI plus BTS-P; one was LTF and one is AWOD at 107 months. Ten (43%) of 23 patients with tumours with true invasion (PFI ± SFI and/or RVI) are AWOD (mean, 97.7 months), eight (35%) died of disease (DOD), four were LTF, and one DOOD. Kaplan-Meier survival curves showed that the cancer-specific survival was significantly worse in patients with true invasion (P = 0.044) than in those with BTS-P as the sole finding. CONCLUSION Patients with tumours showing BTS-P only appear to have better outcomes than those with other non-PFI invasion, suggesting that this finding should not be upstaged to pT3a. Additional studies are needed to corroborate the significance of our observations.
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Affiliation(s)
- Aida Valencia-Guerrero
- Department of Pathology, Massachusetts General Hospital, Boston, MA, USA.,Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA
| | - Esther Oliva
- Department of Pathology, Massachusetts General Hospital, Boston, MA, USA.,Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA
| | - Chin-Lee Wu
- Department of Pathology, Massachusetts General Hospital, Boston, MA, USA.,Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA
| | - Shulin Wu
- Department of Pathology, Massachusetts General Hospital, Boston, MA, USA
| | - Travis Rice-Stitt
- Department of Pathology, Massachusetts General Hospital, Boston, MA, USA.,Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA
| | - Peter M Sadow
- Department of Pathology, Massachusetts General Hospital, Boston, MA, USA.,Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA
| | - Douglas M Dahl
- Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA.,Department of Urology, Massachusetts General Hospital, Boston, MA, USA
| | - Adam S Feldman
- Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA.,Department of Urology, Massachusetts General Hospital, Boston, MA, USA
| | - Ronald S Arellano
- Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA.,Department of Radiology, Massachusetts General Hospital, Boston, MA, USA
| | - Kristine M Cornejo
- Department of Pathology, Massachusetts General Hospital, Boston, MA, USA.,Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA
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9
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Suss NR, Bruha MJ, Monaghan TF, Robins D, Flores V, Agudelo CW, Smith M, Hyacinthe L, McNeil BK, Weiss J, Winer A. Assessing the role of race in pathological upstaging of renal cell carcinoma: Results from the National Cancer Database. Int J Clin Pract 2021; 75:e13818. [PMID: 33159366 DOI: 10.1111/ijcp.13818] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Accepted: 11/02/2020] [Indexed: 12/26/2022] Open
Abstract
PURPOSE Pathologic upstaging in renal cell carcinoma (RCC) is common and confers a significant risk of poor surgical and survival outcomes. Preoperative predictors of upstaging are of great clinical relevance but empirical evidence specific to racial minorities remains scarce. METHODS National Cancer Database (NCDB) analysis of T3a-specific upstaging among White, African-American, Hispanic and Asian Pacific Islander (API) patients with AJCC cT1N0M0 RCC who underwent partial or radical nephrectomy between 2010 and 2015. Independent preoperative predictors of tumour upstaging were identified using multivariate logistic regression analyses. RESULTS A total of 81 002 patients met the criteria for inclusion (5.6% T3a-specific upstaging). Increased age, increased Charlson-Deyo comorbidity index, clinical stages cT1b and unspecified cT1, and increased Fuhrman nuclear grade were identified as independent risk factors for upstaging. Independent protective factors for upstaging were younger age, female sex, African-American race and papillary, chromophobe, and unspecified RCC histologic subtypes. Significant risk factors and protective factors within individual racial subgroups were highly consistent with those observed in the overall study sample. All independent factors identified on race-specific subgroup analyses were significant in the same direction relative to the overall study sample. Variables found to be non-significant in the overall study sample remained non-significant across all racial subgroup analyses. CONCLUSION The present study of nationally representative data found no clinically significant differences in upstaging risk across individual racial subgroups relative to the overall study sample. Preoperative factors that can be used to predict pT3a-specific tumour upstaging in CT1N0M0 RCC likely persist across different racial groups.
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Affiliation(s)
- Nicholas R Suss
- Department of Urology, SUNY Downstate Health Sciences University, Brooklyn, NY, USA
| | - Matthew J Bruha
- Department of Urology, SUNY Downstate Health Sciences University, Brooklyn, NY, USA
| | - Thomas F Monaghan
- Department of Urology, SUNY Downstate Health Sciences University, Brooklyn, NY, USA
| | - Dennis Robins
- Department of Urology, SUNY Downstate Health Sciences University, Brooklyn, NY, USA
| | - Viktor Flores
- Department of Urology, SUNY Downstate Health Sciences University, Brooklyn, NY, USA
| | - Christina W Agudelo
- Department of Urology, SUNY Downstate Health Sciences University, Brooklyn, NY, USA
| | - Matthew Smith
- Department of Urology, SUNY Downstate Health Sciences University, Brooklyn, NY, USA
| | - Llewellyn Hyacinthe
- Department of Urology, SUNY Downstate Health Sciences University, Brooklyn, NY, USA
| | - Brian K McNeil
- Department of Urology, SUNY Downstate Health Sciences University, Brooklyn, NY, USA
| | - Jeffrey Weiss
- Department of Urology, SUNY Downstate Health Sciences University, Brooklyn, NY, USA
| | - Andrew Winer
- Department of Urology, SUNY Downstate Health Sciences University, Brooklyn, NY, USA
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10
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Byrnes KG, Khan JSA, Haroon UM, McCawley N, Cheema IA. Management of colon-invading renal cell carcinoma: Operative technique and systematic review. Urol Ann 2021; 13:1-8. [PMID: 33897156 PMCID: PMC8052896 DOI: 10.4103/ua.ua_86_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 09/12/2020] [Indexed: 01/04/2023] Open
Abstract
Invasion into adjacent organs by non-metastatic renal cell carcinoma (RCC) occurs in 1% of patients suitable for resection. Colonic invasion is rare and presents technical challenges. No prospective data exists to guide management of these patients. We present the first reported case of a colon-invading RCC managed with simultaneous open right radical nephrectomy and extended right hemicolectomy. PubMed, Scopus and EMBASE databases were searched for relevant case reports reporting management of colon-invading renal cell carcinoma. Case reports, case series and cohort studies were eligible. A chart review was performed on a patient who presented with right-sided colon-invading RCC. Four previously reported cases were identified. The current case was managed with simultaneous open radical nephrectomy and extended right hemicolectomy. The patient remains well six months postoperatively with no evidence of disease recurrence. Histopathological evaluation of the resected specimen confirmed a T4 clear cell RCC with sarcomatoid differentiation. Colon-invading RCC is rare. This is the first reported case of right-sided, colon-invading RCC treated with radical resection. The current case confirms radical resection is a feasible management strategy for similar presentations. En bloc resection of involved organs remains the only potentially curative option for locally advanced disease.
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Affiliation(s)
| | | | | | - Niamh McCawley
- Department of Colorectal Surgery, Beaumont Hospital, Dublin, Ireland
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11
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Asselin C, Finelli A, Breau RH, Mallick R, Kapoor A, Rendon RA, Tanguay S, Pouliot F, Fairey A, Lavallée LT, Bladou F, Kawakami J, So AI, Richard PO. Does renal tumor biopsies for small renal carcinoma increase the risk of upstaging on final surgery pathology report and the risk of recurrence? Urol Oncol 2020; 38:798.e9-798.e16. [PMID: 32693974 DOI: 10.1016/j.urolonc.2020.06.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Revised: 05/19/2020] [Accepted: 06/01/2020] [Indexed: 12/16/2022]
Abstract
BACKGROUND Renal tumor biopsies (RTB) have been proposed as a means to diminish overtreatment of small renal masses. A potential concern of RTB is tumor seeding along the biopsy tract leading to worse clinical outcomes. OBJECTIVES To evaluate whether RTB was associated with greater upstaging to pT3a compared to patients without a biopsy and to determine if pathologic upstaging affects the risk of recurrence. DESIGN, SETTING AND PARTICIPANTS The Canadian Kidney Cancer information system was used to identify patients who underwent radical or partial nephrectomy for malignant renal tumors ≤ 4cm (cT1a) between January 1, 2011 and July 2, 2019. INTERVENTION RTB prior to nephrectomy or nephrectomy without biopsy. OUTCOMES MEASUREMENTS AND STATISTICAL ANALYSIS Upstaging to pT3a and cancer recurrence were compared between subjects that had a RTB compared to those who did not. A multivariable analysis was used to evaluate factors associated with disease upstaging and recurrence. RESULTS AND LIMITATIONS The cohort consisted of 1993 cT1a patients, followed for a median of 17.5 months. Of these patients, 502 (25%) had a preoperative RTB. There was no difference in the proportion with tumor upstaging to pT3a between patients that had RTB compared to those who did not (7.2% vs. 6.3%; P = 0.5). On multivariable analysis, RTB was not associated with pathological upstaging (Odds Ratio 0.90; 95% Confidence Interval 0.61-1.34) or recurrence (Odds Ratio 1.04; 95% Confidence Interval 0.57-1.89). The main limitation is that the study is underpowered to detect small differences between groups. CONCLUSIONS In this large, multi-institution cohort, RTB was not associated with increased risk of tumor upstaging or recurrence. Hence, tumor tract seeding, although possible, should not be a clinical deterrent to using RTBs as a means of personalizing renal masses management and diminishing overtreatment. PATIENT SUMMARY Recent evidence suggests that tumor seeding following RTB may be more common than initially perceived. Our results have demonstrated that RTB was not associated with an increased risk of tumor upstaging or disease recurrence.
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Affiliation(s)
- Charles Asselin
- Urology, Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, QC, Canada
| | | | - Rodney H Breau
- Urology, Ottawa Hospital, Ottawa, ON, Canada; Urology, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | | | - Anil Kapoor
- Urology, St. Joseph Healthcare, Hamilton, ON, Canada; Urology, Juravinski Hospital, Hamilton, ON, Canada
| | | | - Simon Tanguay
- Urology, McGill University Health Centre, Montréal, QC, Canada
| | - Frédéric Pouliot
- Urology, Centre Hospitalier Universitaire de Québec, Québec City, QC, Canada
| | | | | | - Franck Bladou
- Urology, Jewish General Hospital, Montréal, QC, Canada
| | - Jun Kawakami
- Urology, Alberta Health Service, Calgary, AB, Canada
| | - Alan I So
- Urology, British Columbia Cancer Care, Vancouver, BC, Canada
| | - Patrick O Richard
- Urology, Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, QC, Canada.
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Veccia A, Falagario U, Martini A, Marchioni M, Antonelli A, Simeone C, Cormio L, Capitanio U, Mir MC, Derweesh I, Van Poppel H, Porpiglia F, Autorino R. Upstaging to pT3a in Patients Undergoing Partial or Radical Nephrectomy for cT1 Renal Tumors: A Systematic Review and Meta-analysis of Outcomes and Predictive Factors. Eur Urol Focus 2020; 7:574-581. [PMID: 32571744 DOI: 10.1016/j.euf.2020.05.013] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 05/01/2020] [Accepted: 05/27/2020] [Indexed: 12/19/2022]
Abstract
CONTEXT Predictors of upstaging from cT1 to pT3a renal masses are poorly inquired, and this remains an area of controversial findings. OBJECTIVE To evaluate predictors and outcomes of upstaging from cT1 to pT3a in patients undergoing surgical removal of a renal tumor. EVIDENCE ACQUISITION A systematic literature search was performed to identify relevant articles using three electronic engines (PubMed, Embase, and Web of Science). Only studies looking at upstaging to pT3a in patients undergoing either partial nephrectomy (PN) or radical nephrectomy (RN) for cT1 renal tumor were included. Study selection was performed according to the Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) statement. EVIDENCE SYNTHESIS Thirteen studies, including 21869 patients (cT1/pT3a: 1256 [5.7%]; cT1/pT1: 20613 [93.3%]), were identified. Patients in the upstaged group were older (weighted mean difference [WMD]: 3.89; p < 0.00001) and mostly male (odds ratio [OR]: 1.23; p = 0.04). Renal tumors were larger (WMD: 0.98; p < 0.00001), more complex (OR: 2.38; p < 0.0001), and with a higher rate of cT1b masses (OR: 3.36; p < 0.00001). The cT1/pT3a group had a higher rate of other renal cell carcinoma histological subtypes (OR: 1.59; p = 0.04), as well as higher odds of Fuhrman grade ≥3 (OR: 2.57; p < 0.00001) and positive surgical margins (OR: 1.85; p = 0.007). Five-year recurrence-free survival (RFS) was worse in the upstaged group (OR: 0.31; p = 0.02). Age (OR: 1.03; p < 0.00001), tumor size (OR: 1.51; p < 0.00001), and RENAL score (OR: 2.80; p = 0.0004) were predictors of upstaging. Upstaging was associated with overall survival (hazard ratio [HR]: 1.94; p = 0.05), cancer-specific survival (HR: 2.24; p = 0.007), and RFS (HR: 2.17; p < 0.00001). CONCLUSIONS Upstaging to pT3a in case of surgical removal of a cT1 renal tumor is an uncommon event, which however can translate into worse oncological outcomes. Both patient (older age) and tumor (larger size and higher complexity) characteristics are associated with a higher risk of upstaging. There is very limited evidence regarding whether RN would be better than PN in these cases. There remains an unmet need for tools to better characterize renal masses in the preoperative setting. PATIENTS SUMMARY About 6% of surgically treated localized renal tumors can be found to be locally advanced on final pathology after surgery. This "upstaging" can translate into worse oncological outcomes. There are patient and tumor characteristics that are associated with an increased the risk of upstaging.
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Affiliation(s)
- Alessandro Veccia
- Division of Urology, VCU Health System, Richmond, VA, USA; Urology Unit, ASST Spedali Civili Hospital, Brescia, Italy; Department of Medical and Surgical Specialties, Radiological Science, and Public Health, University of Brescia, Brescia, Italy
| | - Ugo Falagario
- Division of Urology, VCU Health System, Richmond, VA, USA; Urology and Renal Transplantation Unit, Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Alberto Martini
- Unit of Urology, Division of Experimental Oncology, Urological Research Institute (URI), IRCCS Ospedale San Raffaele, Milan, Italy
| | - Michele Marchioni
- Urology Unit, Department of Medical, Oral and Biotechnological Sciences, G. D'Annunzio University, Chieti, Italy
| | - Alessandro Antonelli
- Urology Unit AUOI Verona, Department of Surgery, Dentistry, Pediatrics and Gynecology, University of Verona, Verona, Italy
| | - Claudio Simeone
- Urology Unit, ASST Spedali Civili Hospital, Brescia, Italy; Department of Medical and Surgical Specialties, Radiological Science, and Public Health, University of Brescia, Brescia, Italy
| | - Luigi Cormio
- Urology and Renal Transplantation Unit, Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Umberto Capitanio
- Unit of Urology, Division of Experimental Oncology, Urological Research Institute (URI), IRCCS Ospedale San Raffaele, Milan, Italy
| | - M Carmen Mir
- Department of Urology, Fundación Instituto Valenciano Oncologia, Valencia, Spain
| | | | - Hendrik Van Poppel
- Department of Urology, University Hospital Gasthuisberg, Katholieke Universiteit Leuven, Leuven, Belgium
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Krishna S, Leckie A, Kielar A, Hartman R, Khandelwal A. Imaging of Renal Cancer. Semin Ultrasound CT MR 2020; 41:152-169. [DOI: 10.1053/j.sult.2019.12.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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Macklin PS, Verrill CL, Roberts ISD, Colling R, Sullivan ME, Webster GM, Cranston DW, Tapping CR, Browning L. Tumour seeding of the renal tumour biopsy tract – a histologically under‐recognised feature? Histopathology 2020; 76:763-766. [DOI: 10.1111/his.14004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- Philip S Macklin
- Department of Cellular Pathology John Radcliffe Hospital Oxford UK
| | - Clare L Verrill
- Department of Cellular Pathology John Radcliffe Hospital Oxford UK
- Nuffield Department of Surgical Sciences University of Oxford Oxford UK
- National Institute for Health Research (NIHR) Oxford Biomedical Research Centre (BRC) Oxford UK
| | - Ian S D Roberts
- Department of Cellular Pathology John Radcliffe Hospital Oxford UK
| | - Richard Colling
- Department of Cellular Pathology John Radcliffe Hospital Oxford UK
- Nuffield Department of Surgical Sciences University of Oxford Oxford UK
| | | | | | | | | | - Lisa Browning
- Department of Cellular Pathology John Radcliffe Hospital Oxford UK
- National Institute for Health Research (NIHR) Oxford Biomedical Research Centre (BRC) Oxford UK
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15
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Renshaw AA, Powell A, Caso J, Gould EW. Needle track seeding in renal mass biopsies. Cancer Cytopathol 2019; 127:358-361. [PMID: 31116493 DOI: 10.1002/cncy.22147] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Revised: 04/29/2019] [Accepted: 04/30/2019] [Indexed: 12/12/2022]
Abstract
A review and analysis of the literature demonstrates that needle track seeding in renal mass biopsy has been reported 16 times. This complication occurs almost exclusively among patients with papillary renal cell carcinoma. The incidence is associated with multiple punctures of the mass, the use of core needles of ≥20 gauge, and lack of a coaxial sheath. Needle tract seeding may be associated with tumor upstaging and a worse prognosis. Fine-needle aspiration has a significantly lower rate of needle track seeding compared with large core needle biopsy (>20-gauge needle). A more formalized risk-based system for interpreting renal mass fine-needle aspiration may be useful as clinicians choose among an increasing number of therapeutic options.
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Affiliation(s)
- Andrew A Renshaw
- Department of Pathology, Miami Cancer Institute, Baptist Hospital of Miami, Baptist Health of South Florida Healthcare System, Miami, Florida
| | - Alex Powell
- Interventional Radiology, Miami Cardiac and Vascular Institute, Miami, Florida
| | - Jorge Caso
- Department of Surgery, Miami Cancer Institute, Baptist Hospital of Miami, Baptist Health of South Florida Healthcare System, Miami, Florida
| | - Edwin W Gould
- Department of Pathology, Miami Cancer Institute, Baptist Hospital of Miami, Baptist Health of South Florida Healthcare System, Miami, Florida
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Tumour Seeding in the Tract of Percutaneous Renal Tumour Biopsy: A Report on Seven Cases from a UK Tertiary Referral Centre. Eur Urol 2019; 75:861-867. [DOI: 10.1016/j.eururo.2018.12.011] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Accepted: 12/07/2018] [Indexed: 12/31/2022]
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Abstract
OBJECTIVE. Renal masses comprise a heterogeneous group of pathologic conditions, including benign and indolent diseases and aggressive malignancies, complicating management. In this article, we explore the emerging role of imaging to provide a comprehensive noninvasive characterization of a renal mass-so-called "virtual biopsy"-and its potential use in the management of patients with renal tumors. CONCLUSION. Percutaneous renal mass biopsy (RMB) remains a valuable method to provide a presurgical histopathologic diagnosis of renal masses, but it is an invasive procedure and is not always feasible. Accumulating data support the use of imaging features to predict histopathology of renal masses. Imaging may help address some of the inherent limitations of RMB, and in certain settings, a multimodal clinical approach may allow decreasing the need for RMB.
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Macklin PS, Sullivan ME, Tapping CR, Webster GM, Roberts ISD, Verrill CL, Browning L. Reply to Maxine G. Tran, Ravi Barod, and Axel Bex's Letter to the Editor re: Philip S. Macklin, Mark E. Sullivan, Charles R. Tapping, et al. Tumour Seeding in the Tract of Percutaneous Renal Tumour Biopsy: A Report on Seven Cases from a UK Tertiary Referral Centre. Eur Urol 2019;75:861-7. Eur Urol 2019; 75:e177-e178. [PMID: 30827695 DOI: 10.1016/j.eururo.2019.02.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Accepted: 02/20/2019] [Indexed: 11/19/2022]
Affiliation(s)
- Philip S Macklin
- Department of Cellular Pathology, John Radcliffe Hospital, Oxford, UK.
| | | | | | - Guy M Webster
- Department of Urology, Churchill Hospital, Oxford, UK
| | - Ian S D Roberts
- Department of Cellular Pathology, John Radcliffe Hospital, Oxford, UK
| | - Clare L Verrill
- Department of Cellular Pathology, John Radcliffe Hospital, Oxford, UK; Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK; National Institute for Health Research, Oxford Biomedical Research Centre, Oxford, UK
| | - Lisa Browning
- Department of Cellular Pathology, John Radcliffe Hospital, Oxford, UK; National Institute for Health Research, Oxford Biomedical Research Centre, Oxford, UK
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