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Ali SN, Tano Z, Landman J. The Changing Role of Renal Mass Biopsy. Urol Clin North Am 2023; 50:217-225. [PMID: 36948668 DOI: 10.1016/j.ucl.2023.01.002] [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: 02/22/2023]
Abstract
The incidence and prevalence of small renal masses (SRMs) continues to rise and with increased detection comes increases in surgical management, although the probability of an SRM being benign is upward of 30%. An extirpative treatment first diagnose-later strategy persists and clinical tools for risk stratification such as renal mass biopsy remain severely underutilized. The overtreatment of SRMs has multiple detrimental effects including surgical complications, psychosocial stress, financial loss, and reduced renal function leading to downstream effects such as the need for dialysis and cardiovascular disease.
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Affiliation(s)
| | - Zachary Tano
- Department of Urology, University of California, Irvine, CA, USA
| | - Jaime Landman
- Department of Urology, University of California, Irvine, CA, USA.
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Renal oncocytoma: a challenging diagnosis. Curr Opin Oncol 2022; 34:243-252. [DOI: 10.1097/cco.0000000000000829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Li C, Qiao G, Li J, Qi L, Wei X, Zhang T, Li X, Deng S, Wei X, Ma W. An Ultrasonic-Based Radiomics Nomogram for Distinguishing Between Benign and Malignant Solid Renal Masses. Front Oncol 2022; 12:847805. [PMID: 35311142 PMCID: PMC8931199 DOI: 10.3389/fonc.2022.847805] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Accepted: 02/11/2022] [Indexed: 12/11/2022] Open
Abstract
Objectives This study was conducted in order to develop and validate an ultrasonic-based radiomics nomogram for diagnosing solid renal masses. Methods Six hundred renal solid masses with benign renal lesions (n = 204) and malignant renal tumors (n = 396) were divided into a training set (n = 480) and a validation set (n = 120). Radiomics features were extracted from ultrasound (US) images preoperatively and then a radiomics score (RadScore) was calculated. By integrating the RadScore and independent clinical factors, a radiomics nomogram was constructed. The diagnostic performance of junior physician, senior physician, RadScore, and radiomics nomogram in identifying benign from malignant solid renal masses was evaluated based on the area under the receiver operating characteristic curve (ROC) in both the training and validation sets. The clinical usefulness of the nomogram was assessed using decision curve analysis (DCA). Results The radiomics signature model showed satisfactory discrimination in the training set [area under the ROC (AUC), 0.887; 95% confidence interval (CI), 0.860–0.915] and the validation set (AUC, 0.874; 95% CI, 0.816–0.932). The radiomics nomogram also demonstrated good calibration and discrimination in the training set (AUC, 0.911; 95% CI, 0.886–0.936) and the validation set (AUC, 0.861; 95% CI, 0.802–0.921). In addition, the radiomics nomogram model showed higher accuracy in discriminating benign and malignant renal masses compared with the evaluations by junior physician (DeLong p = 0.004), and the model also showed significantly higher specificity than the senior and junior physicians (0.93 vs. 0.57 vs. 0.46). Conclusions The ultrasonic-based radiomics nomogram shows favorable predictive efficacy in differentiating solid renal masses.
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Affiliation(s)
- Chunxiang Li
- Department of Diagnostic and Therapeutic Ultrasonography, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China
- National Clinical Research Center for Cancer, Tianjin, China
- Key Laboratory of Cancer Prevention and Therapy, Tianjin, China
- Tianjin’s Clinical Research Center for Cancer, Tianjin, China
| | - Ge Qiao
- National Clinical Research Center for Cancer, Tianjin, China
- Key Laboratory of Cancer Prevention and Therapy, Tianjin, China
- Tianjin’s Clinical Research Center for Cancer, Tianjin, China
- Department of Pathology, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China
| | - Jinghan Li
- Department of Diagnostic and Therapeutic Ultrasonography, Tianjin Ninghe Hospital, Tianjin, China
| | - Lisha Qi
- National Clinical Research Center for Cancer, Tianjin, China
- Key Laboratory of Cancer Prevention and Therapy, Tianjin, China
- Tianjin’s Clinical Research Center for Cancer, Tianjin, China
- Department of Pathology, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China
| | - Xueqing Wei
- Department of Diagnostic and Therapeutic Ultrasonography, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China
- National Clinical Research Center for Cancer, Tianjin, China
- Key Laboratory of Cancer Prevention and Therapy, Tianjin, China
- Tianjin’s Clinical Research Center for Cancer, Tianjin, China
| | - Tan Zhang
- Department of Diagnostic and Therapeutic Ultrasonography, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China
- National Clinical Research Center for Cancer, Tianjin, China
- Key Laboratory of Cancer Prevention and Therapy, Tianjin, China
- Tianjin’s Clinical Research Center for Cancer, Tianjin, China
| | - Xing Li
- Department of Diagnostic and Therapeutic Ultrasonography, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China
- National Clinical Research Center for Cancer, Tianjin, China
- Key Laboratory of Cancer Prevention and Therapy, Tianjin, China
- Tianjin’s Clinical Research Center for Cancer, Tianjin, China
| | - Shu Deng
- Second Hospital of Tianjin Medical University, Tianjin, China
| | - Xi Wei
- Department of Diagnostic and Therapeutic Ultrasonography, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China
- National Clinical Research Center for Cancer, Tianjin, China
- Key Laboratory of Cancer Prevention and Therapy, Tianjin, China
- Tianjin’s Clinical Research Center for Cancer, Tianjin, China
- *Correspondence: Xi Wei, ; Wenjuan Ma,
| | - Wenjuan Ma
- National Clinical Research Center for Cancer, Tianjin, China
- Key Laboratory of Cancer Prevention and Therapy, Tianjin, China
- Tianjin’s Clinical Research Center for Cancer, Tianjin, China
- Department of Breast Imaging, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China
- *Correspondence: Xi Wei, ; Wenjuan Ma,
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Abstract
PURPOSE OF REVIEW The use of renal tumor biopsy (RTB) for small renal masses (SRMs) in daily practice, although safe and accurate, is unusual. Considering the large number of benign tumors in patients with renal masses < 4 cm, some patients with benign tumors are directly referred for surgery instead. This study aimed to report the diagnostic rates of RTB, determine the concordance with surgical pathology, and assess the number of procedures that could have been avoided. We retrospectively studied 255 patients who underwent RTB at our institution in 2010-2019. Of them, 73 were excluded from the analysis (exclusion criteria: > 4 cm, cystic lesion, missing data). The remaining 182 with undetermined SRMs ≤ 4 cm underwent RTB under computed tomography guidance. RECENT FINDINGS Biopsies were diagnostic in 154/182 (84.6%) cases. Of the non-diagnostic biopsies, 11 were diagnostic when repeated. When RTB was performed of all undetermined SRMs, active treatment (surgery or cryotherapy) was avoided in 50/182 patients (27.5%) because of a benign diagnosis, while 9/182 patients (4.9%) underwent surveillance after a shared multidisciplinary decision. The overall diagnostic rate was 90.6%. All adverse events (approximately 4%) were Clavien-Dindo grade I and did not require active treatment. RTB histology results and nuclear grade were highly concordant with the final pathology (96% and 86.6%, respectively). On univariate logistic regression analysis, male sex was the only contributing factor of diagnostic biopsy. RTB of SRMs should be performed more frequently as part of a multidisciplinary decision-making process since it avoided unnecessary surgical treatment in 1 of 3 patients in our institution.
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Ding Y, Tan Q, Mao W, Dai C, Hu X, Hou J, Zeng M, Zhou J. Differentiating between malignant and benign renal tumors: do IVIM and diffusion kurtosis imaging perform better than DWI? Eur Radiol 2019; 29:6930-6939. [PMID: 31161315 DOI: 10.1007/s00330-019-06240-6] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Revised: 03/08/2019] [Accepted: 04/16/2019] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To quantitatively compare the diagnostic values of conventional diffusion-weighted imaging (DWI), intravoxel incoherent motion (IVIM), and diffusion kurtosis imaging (DKI) in differentiating between malignant and benign renal tumors. METHODS Multiple b value DWIs and DKIs were performed in 180 patients with renal tumors, which were divided into clear cell renal cell carcinoma (ccRCC), non-ccRCC, and benign renal tumor group. The apparent diffusion coefficient (ADC), true diffusivity (D), pseudo-diffusion coefficient (D*), perfusion fraction (f), mean kurtosis (MK), and mean diffusivity (MD) maps were calculated. The diagnostic efficacy of various diffusion parameters for predicting malignant renal tumors was compared. RESULTS The ADC, D, and MD values of ccRCCs were higher, while D*, f, and MK values were lower than those of benign renal tumors (all p < 0.025). The D* and f values of non-ccRCCs were lower than those of benign renal tumors (p = 0.002 and p < 0.001, respectively). The difference of ADC, D, MD, and MK values between non-ccRCCs and benign renal tumors was not statistically significant (p > 0.05). The ADC, D, MD, and f values of ccRCCs were higher, while MK values were lower than those of non-ccRCCs (all p < 0.001). The AUC values of ADC, D, D*, f, MK, and MD were 0.849, 0.891, 0.708, 0.656, 0.862, and 0.838 for differentiating ccRCCs from benign renal tumors, respectively. The AUC values of D* and f were 0.772 and 0.866 for discrimination between non-ccRCCs and benign renal tumors, respectively. CONCLUSION IVIM parameters are the best, while DWI and DKI parameters have similar performance in differentiating malignant and benign renal tumors. KEY POINTS • The D value is the best parameter for differentiating ccRCC from benign renal tumors. • The f value is the best parameter for differentiating non-ccRCC from benign renal tumors. • Conventional DWI and DKI have similar performance in differentiating malignant and benign renal tumors.
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Affiliation(s)
- Yuqin Ding
- Department of Radiology, Zhongshan Hospital, Fudan University; Shanghai Institute of Medical Imaging, 180 Fenglin Road, Shanghai, 200032, People's Republic of China
| | - Qinxuan Tan
- Department of Radiology, Zhongshan Hospital, Fudan University; Shanghai Institute of Medical Imaging, 180 Fenglin Road, Shanghai, 200032, People's Republic of China
| | - Wei Mao
- Department of Radiology, Zhongshan Hospital, Fudan University; Shanghai Institute of Medical Imaging, 180 Fenglin Road, Shanghai, 200032, People's Republic of China
| | - Chenchen Dai
- Department of Radiology, Zhongshan Hospital, Fudan University; Shanghai Institute of Medical Imaging, 180 Fenglin Road, Shanghai, 200032, People's Republic of China
| | - Xiaoyi Hu
- Department of Urology, Zhongshan Hospital, Fudan University, Shanghai, 200032, People's Republic of China
| | - Jun Hou
- Department of Pathology, Zhongshan Hospital, Fudan University, Shanghai, 200032, People's Republic of China
| | - Mengsu Zeng
- Department of Radiology, Zhongshan Hospital, Fudan University; Shanghai Institute of Medical Imaging, 180 Fenglin Road, Shanghai, 200032, People's Republic of China.
| | - Jianjun Zhou
- Department of Radiology, Zhongshan Hospital, Fudan University; Shanghai Institute of Medical Imaging, 180 Fenglin Road, Shanghai, 200032, People's Republic of China.
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Frequency of Angiomyolipomas Among Echogenic Nonshadowing Renal Masses (> 4 mm) Found at Ultrasound and the Utility of MRI for Diagnosis. AJR Am J Roentgenol 2017; 209:1074-1080. [DOI: 10.2214/ajr.16.17753] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Subtype Differentiation of Renal Tumors Using Voxel-Based Histogram Analysis of Intravoxel Incoherent Motion Parameters. Invest Radiol 2015; 50:144-52. [DOI: 10.1097/rli.0000000000000111] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Hwang EC, Yu HS, Kwon DD. Small renal masses: surgery or surveillance. Korean J Urol 2013; 54:283-8. [PMID: 23700492 PMCID: PMC3659220 DOI: 10.4111/kju.2013.54.5.283] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2013] [Accepted: 04/09/2013] [Indexed: 11/18/2022] Open
Abstract
The incidence of kidney cancer has been rising over the past two decades, especially in cases in which the disease is localized and small in size (<4 cm). This rise is mainly due to the widespread use of routine abdominal imaging such as ultrasonography, computed tomography, and magnetic resonance imaging. Early detection was initially heralded as an opportunity to cure an otherwise lethal disease. However, despite increasing rates of renal surgery in parallel to this trend, mortality rates from renal cell carcinoma have remained relatively unchanged. Moreover, data suggest that a substantial proportion of small renal masses are benign. As a result, the management of small renal masses has continued to evolve along two basic themes: it has become less radical and less invasive. These shifts are in part a reflection of an improved understanding that the biology of incidentally discovered renal cell carcinoma may be more indolent than previously thought. However, not all small renal masses are indolent, and de novo metastatic disease can develop at the initial presentation. Therefore, it is with this background of clinical uncertainty and biological heterogeneity that clinicians must interpret the benefits and disadvantages of various clinical approaches to small renal masses.
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Affiliation(s)
- Eu Chang Hwang
- Department of Urology, Chonnam National University Medical School, Gwangju, Korea
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Fujita T, Iwamura M, Wakatabe Y, Nishi M, Ishii D, Matsumoto K, Yoshida K, Baba S. Predictors of benign histology in clinical T1a renal cell carcinoma tumors undergoing partial nephrectomy. Int J Urol 2013; 21:100-2. [DOI: 10.1111/iju.12166] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2012] [Accepted: 03/13/2013] [Indexed: 01/20/2023]
Affiliation(s)
- Tetsuo Fujita
- Department of Urology; Kitasato University School of Medicine; Sagamihara Kanagawa Japan
| | - Masatsugu Iwamura
- Department of Urology; Kitasato University School of Medicine; Sagamihara Kanagawa Japan
| | - Yoji Wakatabe
- Department of Urology; Kitasato University School of Medicine; Sagamihara Kanagawa Japan
| | - Morihiro Nishi
- Department of Urology; Kitasato University School of Medicine; Sagamihara Kanagawa Japan
| | - Daisuke Ishii
- Department of Urology; Kitasato University School of Medicine; Sagamihara Kanagawa Japan
| | - Kazumasa Matsumoto
- Department of Urology; Kitasato University School of Medicine; Sagamihara Kanagawa Japan
| | - Kazunari Yoshida
- Department of Urology; Kitasato University School of Medicine; Sagamihara Kanagawa Japan
| | - Shiro Baba
- Department of Urology; Kitasato University School of Medicine; Sagamihara Kanagawa Japan
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Corcoran AT, Russo P, Lowrance WT, Asnis-Alibozek A, Libertino JA, Pryma DA, Divgi CR, Uzzo RG. A review of contemporary data on surgically resected renal masses--benign or malignant? Urology 2013; 81:707-13. [PMID: 23453080 DOI: 10.1016/j.urology.2013.01.009] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2012] [Revised: 12/31/2012] [Accepted: 01/04/2013] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To clearly define the proportions of benign vs malignant histologic findings in resected renal masses through an in-depth review of the contemporary medical data to assist in preoperative risk assessment. MATERIALS AND METHODS PubMed and select oncology congresses were searched for publications that identify the histologic classification of resected renal masses in a representative sample from the contemporary data: [search] incidence AND (renal cell carcinoma AND benign); incidence AND (renal tumor AND benign); percentage AND (renal cell carcinoma AND benign); limit 2003-2011. RESULTS We identified 26 representative studies meeting the inclusion criteria and incorporating 27,272 patients. The frequency of benign tumors ranged from 7% to 33%, with most studies within a few percentage points of the mean (14.5% ± 5.2%, median 13.9%). Clear cell renal cell carcinoma occurred in 46% to 83% of patients, with a mean of 68.3% (median 61.3; SD = 11.9%). An inverse relationship between tumor size and benign pathologic features was identified in 14 of 19 (74%) studies that examined an association between tumor size and pathologic characteristics. A statistically significant correlation between clear cell renal cell carcinoma and tumor size was identified in 13 of 19 studies (63%). The accuracy of preoperative cross-sectional imaging was low in the 2 studies examining computed tomography (17%). CONCLUSION Benign renal tumors represent ∼15% of detected surgically resected renal masses and are more prevalent among small clinical T1a lesions. Noninvasive preoperative differentiation between more and less aggressive renal masses would be an important clinical advance that could allow clinicians greater diagnostic confidence and guide patient management through improved risk stratification.
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Affiliation(s)
- Anthony T Corcoran
- Division of Urology, Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, PA 19111, USA
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Soga N, Nishikawa K, Takaki H, Yamada Y, Arima K, Hayashi N, Sugimura Y. Low incidence of benign lesions in resected suspicious renal masses greater than 2 cm: Single-center experience from Japan. Int J Urol 2012; 19:729-34. [DOI: 10.1111/j.1442-2042.2012.03030.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Current world literature. Curr Opin Urol 2011; 21:440-5. [PMID: 21814056 DOI: 10.1097/mou.0b013e32834a26cd] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Samplaski MK, Zhou M, Lane BR, Herts B, Campbell SC. Renal mass sampling: an enlightened perspective. Int J Urol 2010; 18:5-19. [PMID: 21039914 DOI: 10.1111/j.1442-2042.2010.02641.x] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Renal mass sampling (RMS) can be carried out by core biopsy or fine needle aspiration with each presenting potential advantages and limitations. The literature about RMS is confounded by a lack of standardized techniques, ambiguous terminology, imprecise definitions of accuracy, substantial rates of non-informative biopsies, and recurrent diagnostic challenges with respect to eosinophilic neoplasms. Despite these concerns, RMS has an expanding role in the evaluation and treatment of renal masses, in order to stratify biological aggressiveness and guide management that can range from surgery to active surveillance. Non-informative biopsies can be managed with surgical excision or repeat biopsy, with the latter showing encouraging results in recent studies. We propose a new classification in which all biopsies are categorized as non-informative versus informative, with the latter being subclassified as confirmed accurate, presumed accurate or confirmed inaccurate. This terminology will facilitate the comparison of results from various studies and stimulate progress. Incorporation of novel biomarkers and molecular fingerprinting into RMS protocols will likely allow for more rational management of patients with renal masses in the near future.
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Affiliation(s)
- Mary K Samplaski
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio 44195, USA
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