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Abdelsalam ME, Lu T, Baiomy A, Awad A, Odisio BC, Habibollahi P, Irwin D, Karam JA, Matin SF, Stafford J, Ahrar K. Magnetic resonance imaging-guided renal biopsy shows high safety and diagnostic yield: a tertiary cancer center experience. Eur Radiol 2024; 34:5551-5560. [PMID: 38400904 DOI: 10.1007/s00330-024-10656-0] [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: 09/25/2023] [Revised: 11/28/2023] [Accepted: 01/22/2024] [Indexed: 02/26/2024]
Abstract
OBJECTIVES To evaluate the technical success and outcomes of renal biopsies performed under magnetic resonance imaging (MRI) using a closed-bore, 1.5-Tesla MRI unit. MATERIALS AND METHODS We retrospectively reviewed our institutional biopsy database and included 150 consecutive MRI-guided biopsies for renal masses between November 2007 and March 2020. We recorded age, sex, BMI, tumor characteristics, RENAL nephrometry score, MRI scan sequence, biopsy technique, complications, diagnostic yield, pathologic outcome, and follow-up imaging. Univariate logistic regression was used to assess the association between different parameters and the development of complications. McNemar's test was used to assess the association between paired diagnostic yield measurements for fine-needle aspiration and core samples. RESULTS A total of 150 biopsies for 150 lesions were performed in 150 patients. The median tumor size was 2.7 cm. The median BMI was 28.3. The lesions were solid, partially necrotic/cystic, and predominantly cystic in 137, eight, and five patients, respectively. Image guidance using fat saturation steady-state free precession sequence was recorded in 95% of the biopsy procedures. Samples were obtained using both fine-needle aspiration (FNA) and cores in 99 patients (66%), cores only in 40 (26%), and FNA only in three (2%). Tissue sampling was diagnostic in 144 (96%) lesions. No major complication developed following any of the biopsy procedures. The median follow-up imaging duration was 8 years and none of the patients developed biopsy-related long-term complication or tumor seeding. CONCLUSIONS MRI-guided renal biopsy is safe and effective, with high diagnostic yield and no major complications. CLINICAL RELEVANCE STATEMENT Image-guided renal biopsy is safe and effective, and should be included in the management algorithm of patients with renal masses. Core biopsy is recommended. KEY POINTS • MRI-guided biopsy is a safe and effective technique for sampling of renal lesions. • MRI-guided biopsy has high diagnostic yield with no major complications. • Percutaneous image-guided biopsy plays a key role in the management of patients with renal masses.
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Affiliation(s)
- Mohamed E Abdelsalam
- Department of Interventional Radiology, Unit 1471, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, 77030-4009, USA.
| | - Thomas Lu
- Department of Interventional Radiology, Unit 1471, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, 77030-4009, USA
| | - Ali Baiomy
- Department of Radiology, The University of Texas Southwestern, Dallas, TX, 75390, USA
| | - Ahmed Awad
- Department of Interventional Radiology, Unit 1471, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, 77030-4009, USA
| | - Bruno C Odisio
- Department of Interventional Radiology, Unit 1471, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, 77030-4009, USA
| | - Peiman Habibollahi
- Department of Interventional Radiology, Unit 1471, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, 77030-4009, USA
| | - David Irwin
- Department of Interventional Radiology, Unit 1471, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, 77030-4009, USA
| | - Jose A Karam
- Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Surena F Matin
- Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Jason Stafford
- Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Kamran Ahrar
- Department of Interventional Radiology, Unit 1471, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, 77030-4009, USA
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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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Chen KY, Lange MJ, Qiu JX, Lambert D, Mithqal A, Krupski TL, Schenkman NS, Lobo JM. Cost-Effectiveness Analysis of the Clear Cell Likelihood Score Against Renal Mass Biopsy for Evaluating Small Renal Masses. Urology 2024; 188:111-117. [PMID: 38648945 PMCID: PMC11193637 DOI: 10.1016/j.urology.2024.04.007] [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: 12/11/2023] [Revised: 03/21/2024] [Accepted: 04/09/2024] [Indexed: 04/25/2024]
Abstract
OBJECTIVE To examine the cost-effectiveness of the clear cell likelihood score compared to renal mass biopsy (RMB) alone. METHODS The clear cell likelihood score, a new grading system based on multiparametric magnetic resonance imaging, has been proposed as a possible alternative to percutaneous RMB for identifying clear cell renal carcinoma in small renal masses and expediting treatment of high-risk patients. A decision analysis model was developed to compare a RMB strategy where all patients undergo biopsy and a clear cell likelihood score strategy where only patients that received an indeterminant score of 3 undergo biopsy. Effectiveness was assigned 1 for correct diagnoses and 0 for incorrect or indeterminant diagnoses. Costs were obtained from institutional fees and Medicare reimbursement rates. Probabilities were derived from literature estimates from radiologists trained in the clear cell likelihood score. RESULTS In the base case model, the clear cell likelihood score was both more effective (0.77 vs 0.70) and less expensive than RMB ($1629 vs $1966). Sensitivity analysis found that the nondiagnostic rate of RMB and the sensitivity of the clear cell likelihood score had the greatest impact on the model. In threshold analyses, the clear cell likelihood score was the preferred strategy when its sensitivity was greater than 62.7% and when an MRI cost less than $5332. CONCLUSION The clear cell likelihood score is a more cost-effective option than RMB alone for evaluating small renal masses for clear cell renal carcinoma.
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Affiliation(s)
- Katherina Y Chen
- Department of Urology, University of Virginia, Charlottesville, VA
| | - Moritz J Lange
- University of Virginia School of Medicine, Charlottesville, VA
| | - Jessica X Qiu
- University of Virginia School of Medicine, Charlottesville, VA
| | - Drew Lambert
- Department of Radiology and Medical Imaging, Charlottesville, VA
| | - Ayman Mithqal
- Department of Radiology and Medical Imaging, Charlottesville, VA
| | - Tracey L Krupski
- Department of Urology, University of Virginia, Charlottesville, VA
| | - Noah S Schenkman
- Department of Urology, University of Virginia, Charlottesville, VA
| | - Jennifer M Lobo
- Department of Urology, University of Virginia, Charlottesville, VA; Department of Public Health Sciences, School of Medicine, University of Virginia, Charlottesville, VA.
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Anari PY, Lay N, Zahergivar A, Firouzabadi FD, Chaurasia A, Golagha M, Singh S, Homayounieh F, Obiezu F, Harmon S, Turkbey E, Merino M, Jones EC, Ball MW, Linehan WM, Turkbey B, Malayeri AA. Deep learning algorithm (YOLOv7) for automated renal mass detection on contrast-enhanced MRI: a 2D and 2.5D evaluation of results. Abdom Radiol (NY) 2024; 49:1194-1201. [PMID: 38368481 DOI: 10.1007/s00261-023-04172-w] [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: 09/29/2023] [Revised: 12/17/2023] [Accepted: 12/19/2023] [Indexed: 02/19/2024]
Abstract
INTRODUCTION Accurate diagnosis and treatment of kidney tumors greatly benefit from automated solutions for detection and classification on MRI. In this study, we explore the application of a deep learning algorithm, YOLOv7, for detecting kidney tumors on contrast-enhanced MRI. MATERIAL AND METHODS We assessed the performance of YOLOv7 tumor detection on excretory phase MRIs in a large institutional cohort of patients with RCC. Tumors were segmented on MRI using ITK-SNAP and converted to bounding boxes. The cohort was randomly divided into ten benchmarks for training and testing the YOLOv7 algorithm. The model was evaluated using both 2-dimensional and a novel in-house developed 2.5-dimensional approach. Performance measures included F1, Positive Predictive Value (PPV), Sensitivity, F1 curve, PPV-Sensitivity curve, Intersection over Union (IoU), and mean average PPV (mAP). RESULTS A total of 326 patients with 1034 tumors with 7 different pathologies were analyzed across ten benchmarks. The average 2D evaluation results were as follows: Positive Predictive Value (PPV) of 0.69 ± 0.05, sensitivity of 0.39 ± 0.02, and F1 score of 0.43 ± 0.03. For the 2.5D evaluation, the average results included a PPV of 0.72 ± 0.06, sensitivity of 0.61 ± 0.06, and F1 score of 0.66 ± 0.04. The best model performance demonstrated a 2.5D PPV of 0.75, sensitivity of 0.69, and F1 score of 0.72. CONCLUSION Using computer vision for tumor identification is a cutting-edge and rapidly expanding subject. In this work, we showed that YOLOv7 can be utilized in the detection of kidney cancers.
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Affiliation(s)
- Pouria Yazdian Anari
- Radiology and Imaging Sciences, Clinical Center,, National Institutes of Health, 10 Center Drive, 1C352, Bethesda, MD, 20892, USA
| | - Nathan Lay
- Artificial Intelligence Resource, National Institutes of Health, Bethesda, USA
| | - Aryan Zahergivar
- Radiology and Imaging Sciences, Clinical Center,, National Institutes of Health, 10 Center Drive, 1C352, Bethesda, MD, 20892, USA
| | - Fatemeh Dehghani Firouzabadi
- Radiology and Imaging Sciences, Clinical Center,, National Institutes of Health, 10 Center Drive, 1C352, Bethesda, MD, 20892, USA
| | - Aditi Chaurasia
- Urology Oncology Branch, National Cancer Institutes, National Institutes of Health, Bethesda, USA
| | - Mahshid Golagha
- Radiology and Imaging Sciences, Clinical Center,, National Institutes of Health, 10 Center Drive, 1C352, Bethesda, MD, 20892, USA
| | - Shiva Singh
- Radiology and Imaging Sciences, Clinical Center,, National Institutes of Health, 10 Center Drive, 1C352, Bethesda, MD, 20892, USA
| | | | - Fiona Obiezu
- Radiology and Imaging Sciences, Clinical Center,, National Institutes of Health, 10 Center Drive, 1C352, Bethesda, MD, 20892, USA
| | - Stephanie Harmon
- Artificial Intelligence Resource, National Institutes of Health, Bethesda, USA
| | - Evrim Turkbey
- Radiology and Imaging Sciences, Clinical Center,, National Institutes of Health, 10 Center Drive, 1C352, Bethesda, MD, 20892, USA
| | - Maria Merino
- Pathology Department, National Cancer Institutes, National Institutes of Health, Bethesda, USA
| | - Elizabeth C Jones
- Radiology and Imaging Sciences, Clinical Center,, National Institutes of Health, 10 Center Drive, 1C352, Bethesda, MD, 20892, USA
| | - Mark W Ball
- Urology Oncology Branch, National Cancer Institutes, National Institutes of Health, Bethesda, USA
| | - W Marston Linehan
- Urology Oncology Branch, National Cancer Institutes, National Institutes of Health, Bethesda, USA
| | - Baris Turkbey
- Artificial Intelligence Resource, National Institutes of Health, Bethesda, USA
| | - Ashkan A Malayeri
- Radiology and Imaging Sciences, Clinical Center,, National Institutes of Health, 10 Center Drive, 1C352, Bethesda, MD, 20892, USA.
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Iguchi T, Matsui Y, Toji T, Sakurai J, Tomita K, Uka M, Umakoshi N, Kawabata T, Munetomo K, Mitsuhashi T, Hiraki T. Prospective evaluation of core number of biopsy for renal tumor: are multiple cores preferable? Jpn J Radiol 2024; 42:319-325. [PMID: 37833443 PMCID: PMC10899300 DOI: 10.1007/s11604-023-01496-x] [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: 07/04/2023] [Accepted: 09/24/2023] [Indexed: 10/15/2023]
Abstract
PURPOSE This single-center, single-arm, prospective, open-label study was conducted to evaluate the optimal number of cores (single or multiple) in renal tumor biopsy. MATERIALS AND METHODS Forty-four biopsies of 44 tumors (mean diameter, 2.7 ± 1.0 cm; range, 1.6-5.0 cm) were included. Biopsy was performed under ultrasound or computed tomography fluoroscopy guidance using an 18-gauge cutting needle and the co-axial method. Two or more specimens were obtained, which were divided into first and subsequent specimens. "First specimen" and "all specimens" were histologically evaluated (i.e., appropriateness of specimen, histological diagnosis, subtype, and Fuhrman grade of renal cell carcinoma [RCC]) blindly and independently by two board-certified pathologists. RESULTS Multiple specimens were successfully and safely obtained in all the biopsies. All tumors were histologically diagnosed; 40 malignancies included 39 RCCs and 1 solitary fibrous tumor, and 4 benign lesions included 2 angiomyolipomas, 1 oncocytoma, and 1 capillary hemangioma. In all RCCs, the subtype could be determined (32 clear cell RCCs, 4 chromophobe RCCs, and 3 papillary RCCs), and the Furman grade was determined in 38 RCCs. When only the first specimen was evaluated, 22.7% of the specimens were inappropriate for diagnosis, and 34 (77.3%) were histologically diagnosed. The diagnostic yield was significantly lower than that of all specimens (P = 0.0044). Univariate analysis revealed that smaller lesions were a significant predictor of diagnostic failure (P = 0.020). CONCLUSION Biopsy with multiple cores significantly improved diagnostic yield. Thus, operators should obtain multiple cores during renal tumor biopsy.
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Affiliation(s)
- Toshihiro Iguchi
- Department of Radiology, Okayama University Hospital, 2-5-1 Shikata-cho Kita-ku, Okayama, 700-8558, Japan.
- Department of Radiological Technology, Faculty of Health Sciences, Okayama University, 2-5-1 Shikata-cho Kita-ku, Okayama, 700-8558, Japan.
| | - Yusuke Matsui
- Department of Radiology, Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan
| | - Tomohiro Toji
- Department of Pathology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, 2-5-1 Shikata-cho Kita-ku, Okayama, 700-8558, Japan
| | - Jun Sakurai
- Center for Innovative Clinical Medicine, Okayama University Hospital, 2-5-1 Shikata-cho Kita-ku, Okayama, 700-8558, Japan
| | - Koji Tomita
- Department of Radiology, Okayama University Hospital, 2-5-1 Shikata-cho Kita-ku, Okayama, 700-8558, Japan
| | - Mayu Uka
- Department of Radiology, Okayama University Hospital, 2-5-1 Shikata-cho Kita-ku, Okayama, 700-8558, Japan
| | - Noriyuki Umakoshi
- Department of Radiology, Okayama University Hospital, 2-5-1 Shikata-cho Kita-ku, Okayama, 700-8558, Japan
| | - Takahiro Kawabata
- Department of Radiology, Okayama University Hospital, 2-5-1 Shikata-cho Kita-ku, Okayama, 700-8558, Japan
| | - Kazuaki Munetomo
- Department of Radiology, Okayama University Hospital, 2-5-1 Shikata-cho Kita-ku, Okayama, 700-8558, Japan
| | - Toshiharu Mitsuhashi
- Center for Innovative Clinical Medicine, Okayama University Hospital, 2-5-1 Shikata-cho Kita-ku, Okayama, 700-8558, Japan
| | - Takao Hiraki
- Department of Radiology, Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan
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Trovato P, Simonetti I, Morrone A, Fusco R, Setola SV, Giacobbe G, Brunese MC, Pecchi A, Triggiani S, Pellegrino G, Petralia G, Sica G, Petrillo A, Granata V. Scientific Status Quo of Small Renal Lesions: Diagnostic Assessment and Radiomics. J Clin Med 2024; 13:547. [PMID: 38256682 PMCID: PMC10816509 DOI: 10.3390/jcm13020547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Revised: 01/05/2024] [Accepted: 01/16/2024] [Indexed: 01/24/2024] Open
Abstract
Background: Small renal masses (SRMs) are defined as contrast-enhanced renal lesions less than or equal to 4 cm in maximal diameter, which can be compatible with stage T1a renal cell carcinomas (RCCs). Currently, 50-61% of all renal tumors are found incidentally. Methods: The characteristics of the lesion influence the choice of the type of management, which include several methods SRM of management, including nephrectomy, partial nephrectomy, ablation, observation, and also stereotactic body radiotherapy. Typical imaging methods available for differentiating benign from malignant renal lesions include ultrasound (US), contrast-enhanced ultrasound (CEUS), computed tomography (CT), and magnetic resonance imaging (MRI). Results: Although ultrasound is the first imaging technique used to detect small renal lesions, it has several limitations. CT is the main and most widely used imaging technique for SRM characterization. The main advantages of MRI compared to CT are the better contrast resolution and tissue characterization, the use of functional imaging sequences, the possibility of performing the examination in patients allergic to iodine-containing contrast medium, and the absence of exposure to ionizing radiation. For a correct evaluation during imaging follow-up, it is necessary to use a reliable method for the assessment of renal lesions, represented by the Bosniak classification system. This classification was initially developed based on contrast-enhanced CT imaging findings, and the 2019 revision proposed the inclusion of MRI features; however, the latest classification has not yet received widespread validation. Conclusions: The use of radiomics in the evaluation of renal masses is an emerging and increasingly central field with several applications such as characterizing renal masses, distinguishing RCC subtypes, monitoring response to targeted therapeutic agents, and prognosis in a metastatic context.
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Affiliation(s)
- Piero Trovato
- Radiology Division, Istituto Nazionale Tumori-IRCCS-Fondazione G. Pascale, 80131 Naples, Italy; (P.T.); (I.S.); (S.V.S.); (A.P.); (V.G.)
| | - Igino Simonetti
- Radiology Division, Istituto Nazionale Tumori-IRCCS-Fondazione G. Pascale, 80131 Naples, Italy; (P.T.); (I.S.); (S.V.S.); (A.P.); (V.G.)
| | - Alessio Morrone
- Division of Radiology, Università degli Studi della Campania Luigi Vanvitelli, 80138 Naples, Italy;
| | - Roberta Fusco
- Medical Oncology Division, Igea SpA, 80013 Naples, Italy
- Italian Society of Medical and Interventional Radiology (SIRM), SIRM Foundation, Via della Signora 2, 20122 Milan, Italy
| | - Sergio Venanzio Setola
- Radiology Division, Istituto Nazionale Tumori-IRCCS-Fondazione G. Pascale, 80131 Naples, Italy; (P.T.); (I.S.); (S.V.S.); (A.P.); (V.G.)
| | - Giuliana Giacobbe
- General and Emergency Radiology Department, “Antonio Cardarelli” Hospital, 80131 Naples, Italy;
| | - Maria Chiara Brunese
- Diagnostic Imaging Section, Department of Medical and Surgical Sciences & Neurosciences, University of Molise, 86100 Campobasso, Italy;
| | - Annarita Pecchi
- Department of Radiology, University of Modena and Reggio Emilia, 41121 Modena, Italy;
| | - Sonia Triggiani
- Postgraduate School of Radiodiagnostics, University of Milan, 20122 Milan, Italy; (S.T.); (G.P.)
| | - Giuseppe Pellegrino
- Postgraduate School of Radiodiagnostics, University of Milan, 20122 Milan, Italy; (S.T.); (G.P.)
| | - Giuseppe Petralia
- Department of Medical Imaging and Radiation Sciences, IEO European Institute of Oncology IRCCS, Via Ripamonti 435, 20141 Milan, Italy;
| | - Giacomo Sica
- Radiology Unit, Monaldi Hospital, Azienda Ospedaliera dei Colli, 80131 Naples, Italy;
| | - Antonella Petrillo
- Radiology Division, Istituto Nazionale Tumori-IRCCS-Fondazione G. Pascale, 80131 Naples, Italy; (P.T.); (I.S.); (S.V.S.); (A.P.); (V.G.)
| | - Vincenza Granata
- Radiology Division, Istituto Nazionale Tumori-IRCCS-Fondazione G. Pascale, 80131 Naples, Italy; (P.T.); (I.S.); (S.V.S.); (A.P.); (V.G.)
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Toffoli T, Saut O, Etchegaray C, Jambon E, Le Bras Y, Grenier N, Marcelin C. Differentiation of Small Clear Renal Cell Carcinoma and Oncocytoma through Magnetic Resonance Imaging-Based Radiomics Analysis: Toward the End of Percutaneous Biopsy. J Pers Med 2023; 13:1444. [PMID: 37888055 PMCID: PMC10608459 DOI: 10.3390/jpm13101444] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 09/13/2023] [Accepted: 09/21/2023] [Indexed: 10/28/2023] Open
Abstract
PURPOSE The aim of this study was to ascertain whether radiomics data can assist in differentiating small (<4 cm) clear cell renal cell carcinomas (ccRCCs) from small oncocytomas using T2-weighted magnetic resonance imaging (MRI). MATERIAL AND METHODS This retrospective study incorporated 48 tumors, 28 of which were ccRCCs and 20 were oncocytomas. All tumors were less than 4 cm in size and had undergone pre-biopsy or pre-surgery MRI. Following image pre-processing, 102 radiomics features were evaluated. A univariate analysis was performed using the Wilcoxon rank-sum test with Bonferroni correction. We compared multiple radiomics pipelines of normalization, feature selection, and machine learning (ML) algorithms, including random forest (RF), logistic regression (LR), AdaBoost, K-nearest neighbor, and support vector machine, using a supervised ML approach. RESULTS No statistically significant features were identified via the univariate analysis with Bonferroni correction. The most effective algorithm was identified using a pipeline incorporating standard normalization, RF-based feature selection, and LR, which achieved an area under the curve (AUC) of 83%, accuracy of 73%, sensitivity of 79%, and specificity of 65%. Subsequently, the most significant features were identified from this algorithm, and two groups of uncorrelated features were established based on Pearson correlation scores. Using these features, an algorithm was established after a pipeline of standard normalization and LR, achieving an AUC of 90%, an accuracy of 77%, sensitivity of 83%, and specificity of 69% for distinguishing ccRCCs from oncocytomas. CONCLUSIONS Radiomics analysis based on T2-weighted MRI can aid in distinguishing small ccRCCs from small oncocytomas. However, it is not superior to standard multiparameter renal MRI and does not yet allow us to dispense with percutaneous biopsy.
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Affiliation(s)
- Thibault Toffoli
- Centre Hospitalier Universitaire (CHU) de Bordeaux, Imaging and Interventional Radiology, Hôpital Pellegrin, 33000 Bordeaux, France; (T.T.); (E.J.); (Y.L.B.)
| | - Olivier Saut
- University of Bordeaux, IMB, UMR CNRS 5251, INRIA Project Team Monc, F-33400 Talence, France; (O.S.); (C.E.); (N.G.)
| | - Christele Etchegaray
- University of Bordeaux, IMB, UMR CNRS 5251, INRIA Project Team Monc, F-33400 Talence, France; (O.S.); (C.E.); (N.G.)
| | - Eva Jambon
- Centre Hospitalier Universitaire (CHU) de Bordeaux, Imaging and Interventional Radiology, Hôpital Pellegrin, 33000 Bordeaux, France; (T.T.); (E.J.); (Y.L.B.)
| | - Yann Le Bras
- Centre Hospitalier Universitaire (CHU) de Bordeaux, Imaging and Interventional Radiology, Hôpital Pellegrin, 33000 Bordeaux, France; (T.T.); (E.J.); (Y.L.B.)
| | - Nicolas Grenier
- University of Bordeaux, IMB, UMR CNRS 5251, INRIA Project Team Monc, F-33400 Talence, France; (O.S.); (C.E.); (N.G.)
| | - Clément Marcelin
- Centre Hospitalier Universitaire (CHU) de Bordeaux, Imaging and Interventional Radiology, Hôpital Pellegrin, 33000 Bordeaux, France; (T.T.); (E.J.); (Y.L.B.)
- Bordeaux Institute of Oncology, BRIC U1312, INSERM, Bordeaux University, 33000 Bordeaux, France
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Abstract
Kidney cancer accounts for 2% of cancer related deaths. Historically, a patient with a solid renal mass would undergo surgery without biopsy given the previously low diagnostic yield of biopsy and the fear of tumor seeding. This led to a high rate of resection for benign masses. With the rising incidence of renal masses discovered on imaging, improvements in biopsy technique and advancements in pathologic evaluation of biopsy samples of renal masses, renal mass biopsy now plays an important role in selected patients with renal masses. Coaxial core needle biopsy is the preferred technique with a low rate of complications and a high diagnostic yield. This article will discuss indications, methods, utility, limitations and complications of renal mass biopsy.
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Affiliation(s)
- Keith B Quencer
- Department of Radiology, University of Utah, Salt Lake City, UT.
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9
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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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A Radiomic-based Machine Learning Algorithm to Reliably Differentiate Benign Renal Masses from Renal Cell Carcinoma. Eur Urol Focus 2021; 8:988-994. [PMID: 34538748 DOI: 10.1016/j.euf.2021.09.004] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 08/17/2021] [Accepted: 09/07/2021] [Indexed: 01/20/2023]
Abstract
BACKGROUND A substantial proportion of patients undergo treatment for renal masses where active surveillance or observation may be more appropriate. OBJECTIVE To determine whether radiomic-based machine learning platforms can distinguish benign from malignant renal masses. DESIGN, SETTING, AND PARTICIPANTS A prospectively maintained single-institutional renal mass registry was queried to identify patients with a computed tomography-proven clinically localized renal mass who underwent partial or radical nephrectomy. INTERVENTION Radiomic analysis of preoperative scans was performed. Clinical and radiomic variables of importance were identified through decision tree analysis, which were incorporated into Random Forest and REAL Adaboost predictive models. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS The primary outcome was the degree of congruity between the virtual diagnosis and final pathology. Subanalyses were performed for small renal masses and patients who had percutaneous renal mass biopsies as part of their workup. Receiver operating characteristic curves were used to evaluate each model's discriminatory function. RESULTS AND LIMITATIONS A total of 684 patients met the selection criteria. Of them, 76% had renal cell carcinoma; 57% had small renal masses, of which 73% were malignant. Predictive modeling differentiated benign pathology from malignant with an area under the curve (AUC) of 0.84 (95% confidence interval [CI] 0.79-0.9). In small renal masses, radiomic analysis yielded a discriminatory AUC of 0.77 (95% CI 0.69-0.85). When negative and nondiagnostic biopsies were supplemented with radiomic analysis, accuracy increased from 83.3% to 93.4%. CONCLUSIONS Radiomic-based predictive modeling may distinguish benign from malignant renal masses. Clinical factors did not substantially improve the diagnostic accuracy of predictive models. Enhanced diagnostic predictability may improve patient selection before surgery and increase the utilization of active surveillance protocols. PATIENT SUMMARY Not all kidney tumors are cancerous, and some can be watched. We evaluated a new method that uses radiographic features invisible to the naked eye to distinguish benign masses from true cancers and found that it can do so with acceptable accuracy.
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Value of Quantitative CTTA in Differentiating Malignant From Benign Bosniak III Renal Lesions on CT Images. J Comput Assist Tomogr 2021; 45:528-536. [PMID: 34176873 DOI: 10.1097/rct.0000000000001181] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
OBJECTIVE The aim of this study was to investigate whether computed tomography texture analysis can differentiate malignant from benign Bosniak III renal lesions on computed tomography (CT) images. METHODS This retrospective case-control study included 45 patients/lesions (22 benign and 23 malignant lesions) with Bosniak III renal lesions who underwent CT examination. Axial image slices in the unenhanced phase, corticomedullary phase, and nephrographic phase were selected and delineated manually. Computed tomography texture analysis was performed on each lesion during these 3 phases. Histogram-based, gray-level co-occurrence matrix, and gray-level run-length matrix features were extracted using open-source software and analyzed. In addition, receiver operating characteristic curve was constructed, and the area under the receiver operating characteristic curve (AUC) of each feature was constructed. RESULTS Of the 33 extracted features, 16 features showed significant differences (P < 0.05). Eight features were significantly different between the 2 groups after Holm-Bonferroni correction, including 3 histogram-based, 4 gray-level co-occurrence matrix, and 1 gray-level run-length matrix features (P < 0.01). The texture features resulted in the highest AUC of 0.769 ± 0.074. Renal cell carcinomas were labeled with a higher degree of lesion gray-level disorder and lower lesion homogeneity, and a model incorporating the 3 most discriminative features resulted in an AUC of 0.846 ± 0.058. CONCLUSIONS The results of this study showed that CT texture features were related to malignancy in Bosniak III renal lesions. Computed tomography texture analysis might help in differentiating malignant from benign Bosniak III renal lesions on CT images.
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A 25 year perspective on the evolution and advances in an understanding of the biology, evaluation and treatment of kidney cancer. Urol Oncol 2021; 39:548-560. [PMID: 34092483 DOI: 10.1016/j.urolonc.2021.04.038] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 04/20/2021] [Accepted: 04/25/2021] [Indexed: 01/20/2023]
Abstract
The diagnosis, evaluation and management of patients with renal cell carcinoma has transformed in the 21st century. Utilizing biological discoveries and technological advances, the field has moved from blunt surgical and largely ineffective medical treatments, to nuanced and fine-tuned approaches based on biology, extent of disease and patient preferences. In this review we will summarize the last 25 years of progress in kidney cancer.
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Classification of renal tumour using convolutional neural networks to detect oncocytoma. Eur J Radiol 2020; 133:109343. [DOI: 10.1016/j.ejrad.2020.109343] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 09/29/2020] [Accepted: 10/05/2020] [Indexed: 01/10/2023]
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Sheth RA, Baerlocher MO, Connolly BL, Dariushnia SR, Shyn PB, Vatsky S, Tam AL, Gupta S. Society of Interventional Radiology Quality Improvement Standards on Percutaneous Needle Biopsy in Adult and Pediatric Patients. J Vasc Interv Radiol 2020; 31:1840-1848. [DOI: 10.1016/j.jvir.2020.07.012] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Accepted: 07/10/2020] [Indexed: 12/13/2022] Open
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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: 8] [Impact Index Per Article: 2.0] [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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Jin H, He X, Zhou H, Zhang M, Tang Q, Lin L, Hao J, Zeng R. Efficacy of raman spectroscopy in the diagnosis of kidney cancer: A systematic review and meta-analysis. Medicine (Baltimore) 2020; 99:e20933. [PMID: 32629694 PMCID: PMC7337610 DOI: 10.1097/md.0000000000020933] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2019] [Revised: 05/03/2020] [Accepted: 05/25/2020] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVE To comprehensively analyze the relative effectiveness of Raman spectroscopy (RS) in the diagnosis of suspected kidney cancer. PATIENTS AND METHODS We performed a complete systematic review based on studies from PubMed/Medline, EMBASE, Web of Science, Ovid, Web of Knowledge, Cochrane Library and China National Knowledge Infrastructure. We identified 2413 spectra with strict criteria in 6 individual studies published between January 2008 and November 2018 in accordance to Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. We summarized the test performance using random effects models. RESULTS General pooled diagnostic sensitivity and specificity of RS to kidney cancer were 0.96 (95% confidence interval [CI] 0.95-0.97) and 0.91 (95% CI 0.89-0.92). The pooled positive likelihood ratio (LR) was 9.57 (95% CI 5.73-15.46) while the negative LR was 0.04 (95% CI 0.02-0.11). The pooled diagnostic odds ratio was 238.06 (95% CI 77.79-728.54). The area under curve of summary receiver operator characteristics was 0.9466. CONCLUSION Through this meta-analysis, we found a promisingly high sensitivity and specificity of RS in the diagnosis of suspected kidney masses and tumors. Other parameters like positive LR, negative LR, diagnostic odds ratio and area under curve of the summary receiver operator characteristics curve all helped to illustrate the high efficacy of RS in the diagnosis of kidney cancer.
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Affiliation(s)
- Hongyu Jin
- Department of Liver Surgery and Liver Transplantation Center, West China Hospital
| | - Xiao He
- West China Clinical Skills Training Center, West China School of Medicine, Sichuan University
| | - Hui Zhou
- Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology
| | | | | | | | | | - Rui Zeng
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
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Martínez Rodríguez C, Tardáguila de la Fuente G, Villanueva Campos A. Current management of small renal masses. RADIOLOGIA 2020. [DOI: 10.1016/j.rxeng.2020.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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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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Martínez Rodríguez C, Tardáguila de la Fuente G, Villanueva Campos AM. Current management of small renal masses. RADIOLOGIA 2019; 62:167-179. [PMID: 31882171 DOI: 10.1016/j.rx.2019.11.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Revised: 11/18/2019] [Accepted: 11/22/2019] [Indexed: 12/12/2022]
Abstract
One of the consequences of the growing use of diagnostic imaging techniques is the notable growth in the detection of small renal masses presumably corresponding to localized tumors that are potentially curable with surgical treatment. When faced with the finding of a small renal mass, radiologists must determine whether it is benign or malignant, and if it is malignant, what subtype it belong to, and whether it should be managed with surgical treatment, with ablative techniques, or with watchful waiting with active surveillance. Small renal masses are now a clinical entity that require management different from the approaches used for classical renal cell carcinomas. In this scenario, radiologists are key because they are involved in all aspects of the management of these tumors, including in their diagnosis, treatment, and follow-up.
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Update on Indications for Percutaneous Renal Mass Biopsy in the Era of Advanced CT and MRI. AJR Am J Roentgenol 2019; 212:1187-1196. [PMID: 30917018 DOI: 10.2214/ajr.19.21093] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVE. The objective of this article is to review the burgeoning role of percutaneous renal mass biopsy (RMB). CONCLUSION. Percutaneous RMB is safe, accurate, and indicated for an expanded list of clinical scenarios. The chief scenarios among them are to prevent treatment of benign masses and help select patients for active surveillance (AS). Imaging characterization of renal masses has improved; however, management decisions often depend on a histologic diagnosis and an assessment of biologic behavior of renal cancers, both of which are currently best achieved with RMB.
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Hoang UN, Mojdeh Mirmomen S, Meirelles O, Yao J, Merino M, Metwalli A, Marston Linehan W, Malayeri AA. Assessment of multiphasic contrast-enhanced MR textures in differentiating small renal mass subtypes. Abdom Radiol (NY) 2018; 43:3400-3409. [PMID: 29858935 PMCID: PMC8080867 DOI: 10.1007/s00261-018-1625-x] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
PURPOSE This study seeks to evaluate the use of quantitative texture parameters extracted from multiphasic contrast-enhanced magnetic resonance (MR) imaging in differentiating between benign and malignant masses (oncocytoma vs. clear cell and papillary RCC) and between common subtypes of renal cell carcinoma (clear cell vs. papillary RCC) in small renal masses (< 4 cm). METHOD One-hundred and forty-two renal lesions (90 clear cell and 22 papillary RCCs; 30 oncocytomas) were identified in a cohort of 41 patients (18 men, 23 women: mean age, 52.8 ± 14.4 years) who underwent preoperative multiphasic contrast-enhanced MR with four phases (unenhanced, arterial, venous, and delayed) between 2015 and 2016. In this study, texture features were extracted from entire cross-sectional tumoral region in three consecutive slices containing the largest cross-sectional area from each of the four phases. The change in imaging feature between precontrast imaging and each postcontrast phase was calculated. Data dimension reduction and feature selection were performed by conducting (1) pairwise Wilcoxon rank test followed by modified false discovery rate adjustment, and (2) Lasso regression. Multivariate modeling incorporating the selected features was performed using random forest classification method. RESULTS Histogram imaging features were informative variables in differentiating between benign and malignant masses, while textures imaging features were of added value in differentiating between subtypes of RCCs. Papillary RCCs were distinguished from clear cell RCCs (sensitivity 65.5%, specificity 88%, and accuracy 77.9%), oncocytomas from clear cell RCCs (sensitivity 67.3%, specificity 88.9%, and accuracy 79.3%), and oncocytomas from papillary and clear cell RCCs (sensitivity 64.7%, specificity 85.9%, and accuracy 77.9%). CONCLUSIONS A combination of histogram and texture imaging features on multiphasic MR can help differentiate histologic cell types in common small renal masses (< 4 cm).
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Affiliation(s)
- Uyen N Hoang
- Clinical Center, National Institutes of Health, Bethesda, MD, 20892, USA.
- Urologic Oncology Branch, National Cancer Institute, Bethesda, MD, 20892, USA.
- , 10 Center Dr, Bethesda, MD, 20814, USA.
| | - S Mojdeh Mirmomen
- Clinical Center, National Institutes of Health, Bethesda, MD, 20892, USA
| | - Osorio Meirelles
- Neuroepidemiology Section, National Institute of Aging, Bethesda, MD, 20892, USA
| | - Jianhua Yao
- Clinical Center, National Institutes of Health, Bethesda, MD, 20892, USA
| | - Maria Merino
- Urologic Oncology Branch, National Cancer Institute, Bethesda, MD, 20892, USA
| | - Adam Metwalli
- Urologic Oncology Branch, National Cancer Institute, Bethesda, MD, 20892, USA
| | - W Marston Linehan
- Neuroepidemiology Section, National Institute of Aging, Bethesda, MD, 20892, USA
| | - Ashkan A Malayeri
- Clinical Center, National Institutes of Health, Bethesda, MD, 20892, USA
- Urologic Oncology Branch, National Cancer Institute, Bethesda, MD, 20892, USA
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Li Y, Wang Y, Qin J, Wu J, Dai X, Xu J. Meta-analysis of diffusion-weighted imaging in the differential diagnosis of renal lesions. Clin Imaging 2018; 52:264-272. [PMID: 30172176 DOI: 10.1016/j.clinimag.2018.08.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2018] [Revised: 07/15/2018] [Accepted: 08/13/2018] [Indexed: 01/30/2023]
Abstract
PURPOSE To assess the diagnostic value of diffusion-weighted imaging (DWI) in distinguishing between renal malignant and benign lesions. MATERIALS AND METHODS Electronic databases were systematically searched to identify original studies evaluating DWI findings on renal lesions from January 2000 through January 2018. Pooled weighted estimates of sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), and diagnostic odds ratio (DOR) were calculated. A summary receiver operator characteristic (sROC) curve was constructed to calculate the area under the sROC curve (AUC). Publication bias was assessed by using Deeks' asymmetry test. RESULTS A total of 15 studies including 1386 renal lesions were eligible in the meta-analysis. The pooled sensitivity and specificity with a corresponding 95% confidence interval (CI) were 0.83 (95% CI: 0.80-0.86) and 0.74 (95% CI: 0.71-0.78), respectively. The PLR, NLR, and DOR were 3.21 (95% CI: 2.39-4.32), 0.24 (95% CI: 0.18-0.30), and 15.95 (95% CI: 11.19-22.71), respectively. The AUC was 0.87 (95% CI: 0.84-0.90). Significant heterogeneity was observed between the included studies. Reference standard, country, and gradient factor were identified as the most important variable sources. No evidence of notable publication bias was reported. CONCLUSIONS DWI is an informative MRI modality in discriminating benign and malignant lesions and exhibits moderately high diagnostic accuracy. However, it remains inconclusive and limited in the absence of an optimal b value and ADC cutoff value. High-quality prospective studies regarding DWI have yet to be conducted to explore optimal imaging parameters and diagnostic thresholds.
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Affiliation(s)
- Yang Li
- Department of General Surgery, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200080, China
| | - Ye Wang
- Department of General Surgery, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200080, China
| | - Jun Qin
- Department of General Surgery, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200080, China
| | - Junyi Wu
- Department of General Surgery, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200080, China
| | - Xueming Dai
- Department of General Surgery, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200080, China
| | - Junming Xu
- Department of General Surgery, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200080, China.
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Abstract
Image-guided renal biopsies have an increasing role in clinical practice. Renal mass and renal parenchymal biopsy indications, techniques, and other clinical considerations are reviewed in this article. Image-guided renal mass ablation shows significant promise and increasing clinical usefulness as more studies demonstrate its safety and efficacy. Renal mass ablation indications, techniques, and other considerations are also reviewed.
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Affiliation(s)
- Sharath K Bhagavatula
- Department of Radiology, Harvard Medical School, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA.
| | - Paul B Shyn
- Department of Radiology, Harvard Medical School, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA
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Alle N, Tan N, Huss J, Huang J, Pantuck A, Raman SS. Percutaneous image-guided core biopsy of solid renal masses: analysis of safety, efficacy, pathologic interpretation, and clinical significance. Abdom Radiol (NY) 2018; 43:1813-1819. [PMID: 29079986 DOI: 10.1007/s00261-017-1337-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
PURPOSE To determine the efficacy, safety and clinical utility of CT and US-guided percutaneous renal mass biopsy. MATERIALS AND METHODS A retrospective IRB-approved, HIPAA-compliant study of a cohort of 183 consecutive patients who underwent percutaneous, CT or US-guided renal mass biopsy (RMB) from March 2002 through December 2012 was performed. RMB was performed in 183 consecutive patients for suspected solid renal mass of whom 14/183 (7.7%) were excluded because biopsies were performed at an outside institution, medical records were incomplete, or lesions were poorly visualized. Ten patients had multiple biopsies for new growing masses. Using US, CT or CT/US fusion-guidance, a 17G or 19G cannula needle was placed at the margin of the mass and an 18G or 20G core biopsy gun was used to obtain several tissue cores. Renal parenchymal biopsies for medical renal diseases were excluded. Imaging variables (including size, location, and extent of disease), number of core biopsies, patient demographics (age, gender), clinical indication, final pathologic diagnosis, immunohistochemical (IHC) studies, and subsequent final pathological diagnosis on nephrectomy were evaluated. RESULTS Of the 169 patients with 184 RMB, 121/169 (71.6%) were male with a mean age of 67.5 years. Of 184 RMB, 126 were malignant [126/184 (68.5%)], 37 [37/184 (20.1%)], were benign, and 21 (21/184 (11.4%) were nondiagnostic. IHC was performed in 131 biopsies (71.1%) and was diagnostic in 88.5% of those cases. Twenty-eight patients underwent subsequent partial nephrectomy; in 27/27 (100%) cases, RMB was concordant with nephrectomy for malignancy and in 21/27 (77.8%) RMB was concordant for subtype of RCC. Overall, the RMB sensitivity for detection of malignancy, specificity, and positive predictive value were 100%. The negative predictive value of benign RMB diagnosis was also 100%. There was a total of 14 (7.6%) complications, 13 minor (7.1%) and 1 major (0.5%). Of the minor complications, ten (5.5%) were postprocedural minor hematomas that resolved conservatively; one (0.5%) postprocedural vasovagal reaction; one (0.5%) episode of hematuria; and one (0.5%) episode of nausea and abdominal discomfort. No cases of renal pseudoaneurysm or tumor seeding attributed to biopsy were identified. CONCLUSION Percutaneous image-guided RMB is safe and highly diagnostic when combined with IHC and supports a greater role of RMB and imaging in evaluating renal masses when rendering appropriate treatments.
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Affiliation(s)
- Nisha Alle
- The Department of Radiology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.
- Department of Radiology, Ronald Reagan-UCLA Medical Center, 757 Westwood Plaza, Suite 1638, Los Angeles, CA, 90095-7437, USA.
| | - Nelly Tan
- The Department of Radiology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Julie Huss
- The Department of Pathology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Jiatoi Huang
- The Department of Pathology, Duke University School of Medicine, Durham, NC, USA
| | - Allan Pantuck
- The Department of Urology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Steven S Raman
- The Department of Radiology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
- The Department of Urology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
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Karaosmanoglu AD, Onur MR, Karcaaltincaba M, Akata D, Ozmen MN. Secondary Tumors of the Urinary System: An Imaging Conundrum. Korean J Radiol 2018; 19:742-751. [PMID: 29962880 PMCID: PMC6005933 DOI: 10.3348/kjr.2018.19.4.742] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Accepted: 12/29/2017] [Indexed: 01/20/2023] Open
Abstract
Imaging features of metastases to the urinary system may closely mimic primary urinary tract tumors, and differential diagnosis by imaging alone may be problematic or even impossible in some cases. The main purpose of this article was to familiarize radiologists with imaging findings of metastasis to the urinary system on cross-sectional imaging, with an emphasis on abdominal and pelvic computed tomography and magnetic resonance imaging. In addition, we review the clinical importance and implications of metastases to the urinary tract and provide information on diagnostic work-ups.
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Affiliation(s)
| | - Mehmet Ruhi Onur
- Department of Radiology, Hacettepe University, School of Medicine, Ankara 06230, Turkey
| | | | - Deniz Akata
- Department of Radiology, Hacettepe University, School of Medicine, Ankara 06230, Turkey
| | - Mustafa Nasuh Ozmen
- Department of Radiology, Hacettepe University, School of Medicine, Ankara 06230, Turkey
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Azawi NH, Tolouee SA, Madsen M, Berg KD, Dahl C, Fode M. Core needle biopsy clarify the histology of the small renal masses and may prevent overtreatment. Int Urol Nephrol 2018; 50:1205-1209. [DOI: 10.1007/s11255-018-1885-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Accepted: 04/30/2018] [Indexed: 10/16/2022]
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Hélénon O, Crosnier A, Verkarre V, Merran S, Méjean A, Correas JM. Simple and complex renal cysts in adults: Classification system for renal cystic masses. Diagn Interv Imaging 2018; 99:189-218. [DOI: 10.1016/j.diii.2017.10.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Accepted: 09/26/2017] [Indexed: 02/08/2023]
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Liu Y, Du Z, Zhang J, Jiang H. Renal mass biopsy using Raman spectroscopy identifies malignant and benign renal tumors: potential for pre-operative diagnosis. Oncotarget 2018; 8:36012-36019. [PMID: 28415596 PMCID: PMC5482634 DOI: 10.18632/oncotarget.16419] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2016] [Accepted: 03/10/2017] [Indexed: 12/26/2022] Open
Abstract
The accuracy of renal mass biopsy to diagnose malignancy can be affected by multiple factors. Here, we investigated the feasibility of Raman spectroscopy to distinguish malignant and benign renal tumors using biopsy specimens. Samples were collected from 63 patients who received radical or partial nephrectomy, mass suspicious of cancer and distal parenchyma were obtained from resected kidney using an 18-gauge biopsy needle. Four Raman spectra were obtained for each sample, and Discriminant Analysis was applied for data analysis. A total of 383 Raman spectra were eventually gathered and each type of tumor had its characteristic spectrum. Raman could separate tumoral and normal tissues with an accuracy of 82.53%, and distinguish malignant and benign tumors with a sensitivity of 91.79% and specificity of 71.15%. It could classify low-grade and high-grade tumors with an accuracy of 86.98%. Besides, clear cell renal carcinoma was differentiated with oncocytoma and angiomyolipoma with accuracy of 100% and 89.25%, respectively. And histological subtypes of cell carcinoma were distinguished with an accuracy of 93.48%. When compared with final pathology and biopsy, Raman spectroscopy was able to correctly identify 7 of 11 “missed” biopsy diagnoses. These results suggested that Raman may serve as a promising non-invasive approach in the future for pre-operative diagnosis.
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Affiliation(s)
- Yufei Liu
- Department of Urology, Huashan Hospital, Fudan University, Shanghai, China.,Fudan Institute of Urology, Huashan Hospital, Fudan University, Shanghai, China
| | - Zhebin Du
- Department of Urology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Jin Zhang
- Department of Urology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Haowen Jiang
- Department of Urology, Huashan Hospital, Fudan University, Shanghai, China.,Fudan Institute of Urology, Huashan Hospital, Fudan University, Shanghai, China
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Wei SP, Xu CL, Zhang Q, Zhang QR, Zhao YE, Huang PF, Xie YD, Zhou CS, Tian FL, Yang B. Contrast-enhanced ultrasound for differentiating benign from malignant solid small renal masses: comparison with contrast-enhanced CT. Abdom Radiol (NY) 2017; 42:2135-2145. [PMID: 28331942 DOI: 10.1007/s00261-017-1111-x] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
PURPOSE The study aimed to compare the diagnostic efficiency of contrast-enhanced ultrasound (CEUS) with that of contrast-enhanced computed tomography (CECT) in the evaluation of benign and malignant small renal masses (SRMs) (<4 cm) confirmed by pathology. METHODS A total of 118 patients with 118 renal masses smaller than 4 cm diagnosed by both CEUS and CECT were enrolled in this study, including 25 benign lesions and 93 malignant lesions. All lesions were confirmed by histopathologic diagnosis after surgical resection. The diagnostic imaging studies of the patients were retrospectively reviewed by two independent ultrasonologists and two independent radiologists blinded to the CT or ultrasound findings and final histological results. All lesions on both CEUS and CECT were independently scored on a 3-point scale (1: benign, 2: equivocal, and 3: malignant). The concordance between interobserver agreement was interpreted using a weighted kappa statistic. The diagnostic efficiency of the evaluation of benign and malignant lesions was compared between CEUS and CECT. RESULTS All the 118 included lesions were detected by both CEUS and CECT. In CEUS and CECT imaging evaluation of the 118 lesions, the weighted kappa value interpreting the concordance between interobserver agreement was 0.89 (95% CI 0.79-0.98) and 0.93 (95% CI 0.87-0.99), respectively. Both CEUS and CECT demonstrated good diagnostic performance in differential diagnosis of benign and malignant SRMs with sensitivity of 93.5% and 89.2%, specificity of 68% and 76%, PPV of 91.6% and 93.3%, NPV of 73.9% and 65.5%, and AUC of 0.808 and 0.826, respectively. There was no statistically significant difference in any of the diagnostic performance indices between these two methods (P > 0.05). However, the qualitative diagnosis of small papillary renal cell carcinoma (RCC) by CEUS was significantly better than that by CECT (P < 0.05), while there was no significant difference in qualitative diagnostic accuracy on other histotypes of SRMs between CEUS and CECT (P > 0.05). CONCLUSIONS Both CEUS and CECT imaging modalities are effective for the differential diagnosis of benign and malignant SRMs. Furthermore, CEUS may be more effective than CECT for the qualitative diagnosis of small papillary RCC.
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Wells SA, Wong VK, Wittmann TA, Lubner MG, Best SL, Ziemlewicz TJ, Hinshaw JL, Lee FT, Abel EJ. Renal mass biopsy and thermal ablation: should biopsy be performed before or during the ablation procedure? Abdom Radiol (NY) 2017; 42:1773-1780. [PMID: 28184961 DOI: 10.1007/s00261-016-1037-8] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
PURPOSE To determine if renal mass biopsy should be performed before or during the ablation procedure with emphasis on complications and rate of ablation for renal cell carcinomas (RCC), benign tumors, and small renal masses without a histologic diagnosis. METHODS This HIPAA-compliant, single-center retrospective study was performed under a waiver of informed consent from the institutional review board. Two hundred eighty-four consecutive patients with a small renal mass (≤4.0 cm) treated with percutaneous thermal ablation between January 2001 and January 2015 were included. Two cohorts were identified based upon the timing of renal mass biopsy: separate session two weeks prior to ablation and same session obtained immediately preceding ablation. Clinical and pathologic data were collected including risk factors for non-diagnostic biopsy. Two-sided t test, χ 2 test or Fischer's exact tests were used to evaluate differences between cohorts. Univariate and multivariate logistic regression models were constructed. RESULTS A histologic diagnostic was achieved more frequently in the separate session cohort [210/213 (98.6%) vs. 60/71 (84.3%), p < 0.0001]. The rate of ablation of RCC was higher in the separate session group [201/213 (94.4%) vs. 46/61 (64.7%), p = 0.001]. The rate of ablation for benign tumors [14/71 (19.7%) vs. 6/213 (2.8%), p < 0.0001] and small renal masses without a histologic diagnosis [3/213 (1.4%) vs. 11/71 (15.5%), p < 0.0001] was higher in the same session cohort. There were no high-grade complications in either cohort. CONCLUSION Performing renal mass biopsy prior to the day of ablation is safe, increases the rate of histologic diagnosis, and reduces the rate of ablation for benign tumors and small renal masses without a histologic diagnosis.
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Affiliation(s)
- Shane A Wells
- Department of Radiology, E3/366 Clinical Science Center, University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue, Madison, WI, 53792, USA.
| | - Vincenzo K Wong
- Department of Radiology, E3/366 Clinical Science Center, University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue, Madison, WI, 53792, USA
| | - Tyler A Wittmann
- Health Sciences Learning Center, University of Wisconsin School of Medicine and Public Health, 750 Highland Avenue, Madison, WI, 53705, USA
| | - Meghan G Lubner
- Department of Radiology, E3/366 Clinical Science Center, University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue, Madison, WI, 53792, USA
| | - Sara L Best
- Department of Urology, University of Wisconsin Medical Foundation Centennial Building, Third Floor, 1685 Highland Avenue, Madison, WI, 53705, USA
| | - Timothy J Ziemlewicz
- Department of Radiology, E3/366 Clinical Science Center, University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue, Madison, WI, 53792, USA
| | - J Louis Hinshaw
- Department of Radiology, E3/366 Clinical Science Center, University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue, Madison, WI, 53792, USA
- Department of Urology, University of Wisconsin Medical Foundation Centennial Building, Third Floor, 1685 Highland Avenue, Madison, WI, 53705, USA
| | - Fred T Lee
- Department of Radiology, E3/366 Clinical Science Center, University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue, Madison, WI, 53792, USA
- Department of Urology, University of Wisconsin Medical Foundation Centennial Building, Third Floor, 1685 Highland Avenue, Madison, WI, 53705, USA
| | - E Jason Abel
- Department of Radiology, E3/366 Clinical Science Center, University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue, Madison, WI, 53792, USA
- Department of Urology, University of Wisconsin Medical Foundation Centennial Building, Third Floor, 1685 Highland Avenue, Madison, WI, 53705, USA
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Abstract
Objective: To review hot issues and future direction of renal tumor biopsy (RTB) technique. Data Sources: The literature concerning or including RTB technique in English was collected from PubMed published from 1990 to 2015. Study Selection: We included all the relevant articles on RTB technique in English, with no limitation of study design. Results: Computed tomography and ultrasound were usually used for guiding RTB with respective advantages. Core biopsy is more preferred over fine needle aspiration because of superior accuracy. A minimum of two good-quality cores for a single renal tumor is generally accepted. The use of coaxial guide is recommended. For biopsy location, sampling different regions including central and peripheral biopsies are recommended. Conclusion: In spite of some limitations, RTB technique is relatively mature to help optimize the treatment of renal tumors.
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Affiliation(s)
- Lei Zhang
- Department of Urology, Peking University First Hospital, Beijing 100034, China
| | - Xue-Song Li
- Department of Urology, Peking University First Hospital, Beijing 100034, China
| | - Li-Qun Zhou
- Department of Urology, Peking University First Hospital, Beijing 100034, China
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34
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Curci N, Caoili EM. The Current Role of Biopsy in the Diagnosis of Renal Tumors. Semin Ultrasound CT MR 2017; 38:72-77. [DOI: 10.1053/j.sult.2016.09.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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Leão RR, Richard PO, Jewett MA. The role of biopsy for small renal masses. Int J Surg 2016; 36:513-517. [DOI: 10.1016/j.ijsu.2016.02.097] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2015] [Revised: 01/13/2016] [Accepted: 02/29/2016] [Indexed: 01/15/2023]
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36
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Elstob A, Gonsalves M, Patel U. Diagnostic modalities. Int J Surg 2016; 36:504-512. [PMID: 27321380 DOI: 10.1016/j.ijsu.2016.06.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2016] [Revised: 05/23/2016] [Accepted: 06/04/2016] [Indexed: 01/17/2023]
Abstract
The incidental detection of small renal masses on imaging undertaken to evaluate unrelated symptoms or conditions is an increasingly common occurrence. Accurate imaging characterisation is fundamental to determining optimum patient management. The goals of imaging small renal masses include determining whether a lesion is solid or cystic, if there are signs of biological aggressiveness and whether the lesion is likely benign or malignant. The current imaging practices and the evidence supporting the use of different imaging modalities for the characterisation of small renal masses are discussed. CT remains the primary imaging modality and is able to classify most masses into surgical or non-surgical lesions. MRI and contrast enhanced ultrasound are most often employed to problem solve in lesions deemed indeterminate on contrast enhanced CT or for patients in which CECT is contraindicated. Percutaneous biopsy should be considered in lesions that remain indeterminate after initial imaging investigations. Given the central role of imaging in the management of small renal masses, all multidisciplinary team members involved in renal cancer care should have an understanding of the performance of the different imaging modalities.
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Affiliation(s)
- Alison Elstob
- Radiology Department, St George's University Hospitals NHS Foundation Trust, Blackshaw Road, London, SW17 0QT, UK.
| | - Michael Gonsalves
- Radiology Department, St George's University Hospitals NHS Foundation Trust, Blackshaw Road, London, SW17 0QT, UK
| | - Uday Patel
- Radiology Department, St George's University Hospitals NHS Foundation Trust, Blackshaw Road, London, SW17 0QT, UK
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Abstract
Objective: To review the natural history and growth kinetics of small renal masses (SRMs). Data Sources: The literature concerning natural history and growth kinetics of SRMs was collected from PubMed published from 1990 to 2014. Study Selection: We included all the relevant articles on the active surveillance (AS) or delayed treatment for SRMs in English, with no limitation of study design. Results: SRMs under AS have a slow growth potential in general. The mean linear growth rate is 0.33 cm/year, the mean volumetric growth rate is 9.48 cm3/year. The rate of metastasis during AS is below 2%. Some factors are associated with the growth rate of SRMs, including tumor grade, histological subtype, initial tumor size, age, radiographic characteristics, and molecular markers. No definite predictor of growth rate of SRMs is defined at present. SRMs with high tumor grade and the subtype of clear cell renal cell carcinoma may have aggressive growth potential. Conclusions: AS is a reasonable choice for elderly patients with SRMs, who are at high risk from surgery. Progression during observation is the biggest concern while performing AS. There is no definite predictor of progression for SRMs under AS. Percutaneous renal biopsy providing immunohistological and genic biomarkers may improve the understanding of natural history of SRMs.
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Affiliation(s)
| | - Xue-Song Li
- Department of Urology, Peking University First Hospital, Beijing 100034, China
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Heilbrun ME, Remer EM, Casalino DD, Beland MD, Bishoff JT, Blaufox MD, Coursey CA, Goldfarb S, Harvin HJ, Nikolaidis P, Preminger GM, Raman SS, Sahni A, Vikram R, Weinfeld RM. ACR Appropriateness Criteria indeterminate renal mass. J Am Coll Radiol 2015; 12:333-41. [PMID: 25842014 DOI: 10.1016/j.jacr.2014.12.012] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2014] [Accepted: 12/30/2014] [Indexed: 11/29/2022]
Abstract
Renal masses are increasingly detected in asymptomatic individuals as incidental findings. An indeterminate renal mass is one that cannot be diagnosed confidently as benign or malignant at the time it is discovered. CT, ultrasonography, and MRI of renal masses with fast-scan techniques and intravenous (IV) contrast are the mainstays of evaluation. Dual-energy CT, contrast-enhanced ultrasonography, PET/CT, and percutaneous biopsy are all technologies that are gaining traction in the characterization of the indeterminate renal mass. In cases in which IV contrast cannot be used, whether because of IV contrast allergy or renal insufficiency, renal mass classification with CT is markedly limited. In the absence of IV contrast, ultrasonography, MRI, and biopsy have some advantages. Owing to the low malignant and metastatic potential of small renal cell carcinomas (≤4 cm in diameter), active surveillance is additionally emerging as a diagnostic strategy for patients who have high surgical risk or limited life expectancy. The ACR Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed every 3 years by a multidisciplinary expert panel. The guideline development and review include an extensive analysis of current medical literature from peer-reviewed journals and application by the panel of a well-established consensus methodology (modified Delphi) to rate the appropriateness of imaging and treatment procedures. In those instances in which evidence is lacking or not definitive, expert opinion may be used to recommend imaging or treatment.
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Affiliation(s)
| | | | | | | | | | | | | | - Stanley Goldfarb
- University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
| | | | | | | | - Steven S Raman
- Universty of California Los Angeles Medical Center, Los Angeles, California
| | - Anik Sahni
- Brigham & Women's Hospital, Boston, Massachusetts
| | | | - Robert M Weinfeld
- Oakland University William Beaumont School of Medicine, Troy, Michigan
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Chang EH, Chong WK, Kasoji SK, Dayton PA, Rathmell WK. Management of Indeterminate Cystic Kidney Lesions: Review of Contrast-enhanced Ultrasound as a Diagnostic Tool. Urology 2015; 87:1-10. [PMID: 26483268 DOI: 10.1016/j.urology.2015.10.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2015] [Revised: 09/24/2015] [Accepted: 10/01/2015] [Indexed: 01/29/2023]
Abstract
Indeterminate cystic kidney lesions found incidentally are an increasingly prevalent diagnostic challenge. Standard workup includes Bosniak classification with contrast-enhanced computed tomography (CT) or magnetic resonance imaging (MRI). However, these tests are costly and not without risks. Contrast-enhanced ultrasound (CEUS) is a relatively new technique with lower risk of adverse events than iodine-containing contrast or gadolinium. In our review of the evidence for characterization of cystic kidney lesions with CEUS, CEUS displayed sensitivity (89%-100%) and negative predictive value (86%-100%) comparable to contrast-enhanced CT or MRI, with no decrease in specificity compared with CT and only a slight decrease compared with MRI.
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Affiliation(s)
- Emily H Chang
- Department of Medicine, Division of Nephrology and Hypertension, UNC Kidney Center, University of North Carolina at Chapel Hill, Chapel Hill, NC.
| | - Wui K Chong
- Department of Radiology, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Sandeep K Kasoji
- Biomedical Engineering, University of North Carolina at Chapel Hill, Chapel Hill, NC and North Carolina State at Raleigh, Raleigh, NC
| | - Paul A Dayton
- Biomedical Engineering, University of North Carolina at Chapel Hill, Chapel Hill, NC and North Carolina State at Raleigh, Raleigh, NC
| | - W Kimryn Rathmell
- Department of Medicine, Division of Hematology and Oncology, Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC
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Blute ML, Drewry A, Abel EJ. Percutaneous biopsy for risk stratification of renal masses. Ther Adv Urol 2015; 7:265-74. [PMID: 26425141 DOI: 10.1177/1756287215585273] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
The increased use of abdominal imaging has led to identification of more patients with incidental renal masses, and renal mass biopsy (RMB) has become a popular method to evaluate unknown renal masses prior to definitive treatment. Pathologic data obtained from biopsy may be used to guide decisions for treatment and may include the presence or absence of malignant tumor, renal cell cancer subtype, tumor grade and the presence of other aggressive pathologic features. However, prior to using RMB for risk stratification, it is important to understand whether RMB findings are equivalent to pathologic analysis of surgical specimens and to identify any potential limitations of this approach. This review outlines the advantages and limitations of the current studies that evaluate RMB as a guide for treatment decision in patients with unknown renal masses. In multiple series, RMB has demonstrated low morbidity and a theoretical reduction in cost, if patients with benign tumors are identified from biopsy and can avoid subsequent treatment. However, when considering the routine use of RMB for risk stratification, it is important to note that biopsy may underestimate risk in some patients by undergrading, understaging or failing to identify aggressive tumor features. Future studies should focus on developing treatment algorithms that integrate RMB to identify the optimal use in risk stratification of patients with unknown renal masses.
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Affiliation(s)
- Michael L Blute
- Department of Urology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Anna Drewry
- Department of Urology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Edwin Jason Abel
- Assistant Professor, Department of Urology, University of Wisconsin School of Medicine and Public Health, 1685 Highland Avenue, Madison, WI 53705-2281, USA
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Marconi L, Dabestani S, Lam TB, Hofmann F, Stewart F, Norrie J, Bex A, Bensalah K, Canfield SE, Hora M, Kuczyk MA, Merseburger AS, Mulders PFA, Powles T, Staehler M, Ljungberg B, Volpe A. Systematic Review and Meta-analysis of Diagnostic Accuracy of Percutaneous Renal Tumour Biopsy. Eur Urol 2015; 69:660-673. [PMID: 26323946 DOI: 10.1016/j.eururo.2015.07.072] [Citation(s) in RCA: 358] [Impact Index Per Article: 39.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2015] [Accepted: 07/31/2015] [Indexed: 01/09/2023]
Abstract
CONTEXT The role of percutaneous renal tumour biopsy (RTB) remains controversial due to uncertainties regarding its diagnostic accuracy and safety. OBJECTIVE We performed a systematic review and meta-analysis to determine the safety and accuracy of percutaneous RTB for the diagnosis of malignancy, histologic tumour subtype, and grade. EVIDENCE ACQUISITION Medline, Embase, and Cochrane Library were searched for studies providing data on diagnostic accuracy and complications of percutaneous core biopsy (CB) or fine-needle aspiration (FNA) of renal tumours. A meta-analysis was performed to obtain pooled estimates of sensitivity and specificity for diagnosis of malignancy. The Cohen kappa coefficient (κ) was estimated for the analysis of histotype/grade concordance between diagnosis on RTB and surgical specimen. Risk of bias assessment was performed (QUADAS-2). EVIDENCE SYNTHESIS A total of 57 studies recruiting 5228 patients were included. The overall median diagnostic rate of RTB was 92%. The sensitivity and specificity of diagnostic CBs and FNAs were 99.1% and 99.7%, and 93.2% and 89.8%, respectively. A good (κ = 0.683) and a fair (κ = 0.34) agreement were observed between histologic subtype and Fuhrman grade on RTB and surgical specimen, respectively. A very low rate of Clavien ≥ 2 complications was reported. Study limitations included selection and differential-verification bias. CONCLUSIONS RTB is safe and has a high diagnostic yield in experienced centres. Both CB and FNA have good accuracy for the diagnosis of malignancy and histologic subtype, with better performance for CB. The accuracy for Fuhrman grade is fair. Overall, the quality of the evidence was moderate. Prospective cohort studies recruiting consecutive patients and using homogeneous reference standards are required. PATIENT SUMMARY We systematically reviewed the literature to assess the safety and diagnostic performance of renal tumour biopsy (RTB). The results suggest that RTB has good accuracy in diagnosing renal cancer and its subtypes, and it appears to be safe. However, the quality of evidence was moderate, and better quality studies are required to provide a more definitive answer.
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Affiliation(s)
- Lorenzo Marconi
- Department of Urology, Coimbra University Hospital, Coimbra, Portugal
| | - Saeed Dabestani
- Department of Urology, Skåne University Hospital, Malmö, Sweden
| | - Thomas B Lam
- Academic Urology Unit, University of Aberdeen, Aberdeen, UK
| | - Fabian Hofmann
- Department of Urology, Sunderby Hospital, Sunderby, Sweden
| | - Fiona Stewart
- Academic Urology Unit, University of Aberdeen, Aberdeen, UK
| | - John Norrie
- Health Services Research Unit, University of Aberdeen, UK
| | - Axel Bex
- Department of Urology, The Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Karim Bensalah
- Department of Urology, University of Rennes, Rennes, France
| | - Steven E Canfield
- Division of Urology, University of Texas Medical School at Houston, Houston, TX, USA
| | - Milan Hora
- Department of Urology, Faculty Hospital and Faculty of Medicine in Pilsen, Charles University in Prague, Prague, Czech Republic
| | - Markus A Kuczyk
- Department of Urology and Urologic Oncology, Hannover Medical School, Hannover, Germany
| | - Axel S Merseburger
- Department of Urology, University Hospital Schleswig-Holstein, Lübeck, Germany
| | - Peter F A Mulders
- Department of Urology, Radboud University, Nijmegen, The Netherlands
| | - Thomas Powles
- Barts Cancer Institute, Queen Mary University of London, St. Bartholomew's Hospital, London, UK
| | - Michael Staehler
- Department of Urology, Ludwig-Maximilians University, Munich, Germany
| | - Borje Ljungberg
- Department of Surgical and Perioperative Sciences, Urology and Andrology, Umeå University, Umeå, Sweden
| | - Alessandro Volpe
- Division of Urology, Maggiore della Carità Hospital, University of Eastern Piedmont, Novara, Italy.
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He Q, Wang H, Kenyon J, Liu G, Yang L, Tian J, Yue Z, Wang Z. Accuracy of Percutaneous Core Biopsy in the Diagnosis of Small Renal Masses (≤ 4.0 cm): A Meta-analysis. Int Braz J Urol 2015; 41:15-25. [PMID: 25928506 PMCID: PMC4752052 DOI: 10.1590/s1677-5538.ibju.2015.01.04] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2013] [Accepted: 02/07/2014] [Indexed: 11/22/2022] Open
Abstract
Objective To use meta-analysis to determine the accuracy of percutaneous core needle biopsy in the diagnosis of small renal masses (SMRs≤4.0 cm). Materials and Methods Studies were identified by searching PubMed, Embase, and the Cochrane Library database up to March 2013. Two of the authors independently assessed the study quality using QUADAS-2 tool and extracted data that met the inclusion criteria. The sensitivity, specificity, likelihood ratios, diagnostic odds ratio (DOR) and also summary receiver operating characteristic (SROC) curve were investigated and draw. Deek’s funnel plot was used to evaluate the publication bias. Result A total of 9 studies with 788 patients (803 biopsies) were included. Failed biopsies without repeated or aborted from follow-up/surgery result were excluded (232 patients and 353 biopsies). For all cases, the pooled sensitivity was 94.0% (95% CI: 91.0%, 95.0%), the pooled positive likelihood was 22.57 (95% CI: 9.20-55.34), the pooled negative likelihood was 0.09 (95% CI: 0.06-0.13), the pooled DOR was 296.52(95% CI: 99. 42-884.38). The area under the curve of SROC analysis was 0.959±0.0254. Conclusion Imaging-guided percutaneous core needle biopsy of small renal masses (SMRs≤4.0 cm) is highly accurate to malignant tumor diagnosis with unknown metastatic status and could be offered to some patients after clinic judgment prior to surgical intervention consideration.
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Affiliation(s)
- Qiqi He
- Department of Urology, Key laboratory of disease of Urological systems, Gansu Nepho-Urological clinical Center, Second hospital of Lanzhou University, Lanzhou, Gansu, China.,Department of Urology, University Hospitals Case Medicine Center, Case Western Reserve University, Cleveland, OH, USA
| | - Hanzhang Wang
- Tulane School of Public Health and Tropical Medicine, New Orleans, USA
| | - Jonathan Kenyon
- Department of Urology, University Hospitals Case Medicine Center, Case Western Reserve University, Cleveland, OH, USA
| | - Guiming Liu
- Department of Urology, University Hospitals Case Medicine Center, Case Western Reserve University, Cleveland, OH, USA
| | - Li Yang
- Department of Urology, Key laboratory of disease of Urological systems, Gansu Nepho-Urological clinical Center, Second hospital of Lanzhou University, Lanzhou, Gansu, China
| | - Junqiang Tian
- Department of Urology, Key laboratory of disease of Urological systems, Gansu Nepho-Urological clinical Center, Second hospital of Lanzhou University, Lanzhou, Gansu, China
| | - Zhongjin Yue
- Department of Urology, Key laboratory of disease of Urological systems, Gansu Nepho-Urological clinical Center, Second hospital of Lanzhou University, Lanzhou, Gansu, China
| | - Zhiping Wang
- Department of Urology, Key laboratory of disease of Urological systems, Gansu Nepho-Urological clinical Center, Second hospital of Lanzhou University, Lanzhou, Gansu, China
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Delahunt B, Samaratunga H, Martignoni G, Srigley JR, Evans AJ, Brunelli M. Percutaneous renal tumour biopsy. Histopathology 2015; 65:295-308. [PMID: 25041600 DOI: 10.1111/his.12495] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
The use of percutaneous renal tumour biopsy (RTB) as a diagnostic tool for the histological characterization of renal masses has increased dramatically within the last 30 years. This increased utilization has paralleled advances in imaging techniques and an evolving knowledge of the clinical value of nephron sparing surgery. Improved biopsy techniques using image guidance, coupled with the use of smaller gauge needles has led to a decrease in complication rates. Reports from series containing a large number of cases have shown the non-diagnostic rate of RTB to range from 4% to 21%. Re-biopsy has been shown to reduce this rate, while the use of molecular markers further improves diagnostic sensitivity. In parallel with refinements of the biopsy procedure, there has been a rapid expansion in our understanding of the complexity of renal cell neoplasia. The 2013 Vancouver Classification is the current classification for renal tumours, and contains five additional entities recognized as novel forms of renal malignancy. The diagnosis of tumour morphotype on RTB is usually achievable on routine histology; however, immunohistochemical studies may be of assistance in difficult cases. The morphology of the main tumour subtypes, based upon the Vancouver Classification, is described and differentiating features are discussed.
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Affiliation(s)
- Brett Delahunt
- Department of Pathology and Molecular Medicine, Wellington School of Medicine and Health Sciences, Wellington, New Zealand
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45
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Renal Mass Biopsy in the Era of Surgical Alternatives. CURRENT RADIOLOGY REPORTS 2015. [DOI: 10.1007/s40134-015-0102-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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46
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Leão RRN, Richard PO, Jewett MAS. Indications for biopsy and the current status of focal therapy for renal tumours. Transl Androl Urol 2015; 4:283-93. [PMID: 26816831 PMCID: PMC4708239 DOI: 10.3978/j.issn.2223-4683.2015.06.01] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2015] [Accepted: 06/02/2015] [Indexed: 12/18/2022] Open
Abstract
The increased detection of small renal masses (SRMs) has focused attention on their uncertain natural history. The development of treatment alternatives and the discovery of biologically targeted drugs have also raised interest. Renal mass biopsies (RMBs) have a crucial role as they provide the pathological, molecular and genetic information needed to classify these lesions and guide clinical management. The improved accuracy has improved our knowledge of the behaviour of different tumour histologies and opened the potential for risk-adapted individualized treatment approaches. To date, studies have demonstrated that percutaneous ablation is an effective therapy with acceptable outcomes and low risk in the appropriate clinical setting. Although partial nephrectomy (PN) is still considered the standard treatment for SRM, percutaneous ablation is increasingly being performed and if long-term efficacy is sustained, it may have a wider application for SRMs after biopsy characterization.
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Affiliation(s)
- Ricardo R N Leão
- Department of Surgery (Urology) and Surgical Oncology, Princess Margaret Cancer Centre, University Health Network and the University of Toronto, Toronto, Ontario, Canada
| | - Patrick O Richard
- Department of Surgery (Urology) and Surgical Oncology, Princess Margaret Cancer Centre, University Health Network and the University of Toronto, Toronto, Ontario, Canada
| | - Michael A S Jewett
- Department of Surgery (Urology) and Surgical Oncology, Princess Margaret Cancer Centre, University Health Network and the University of Toronto, Toronto, Ontario, Canada
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47
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Diagnostic potential of multidetector computed tomography for characterizing small renal masses. ScientificWorldJournal 2015; 2015:476750. [PMID: 25950017 PMCID: PMC4407528 DOI: 10.1155/2015/476750] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2015] [Revised: 03/11/2015] [Accepted: 03/11/2015] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES To assess the potential of CT for characterizing small renal tumors. METHODS 76 patients with <4 cm renal tumors underwent CT examination. The following parameters were assessed: presence of calcifications, densitometry on unenhanced and enhanced scans, washout percentage, urinary tract infiltration, star-shaped scar, and paradoxical effect. RESULTS Calcifications were found in 7/56 (12.5%) carcinomas. Clear cell carcinomas were as follows: mean density 183.5 HU (arterial phase), 136 HU (portal phase), and 94 HU (delayed phase), washout 34.3%; chromophobe carcinomas were as follows: mean density 135 HU (arterial phase), 161 HU (portal phase), and 148 HU (delayed phase), washout 28%; papillary carcinomas were as follows: mean density 50.3 HU (arterial phase), 60 HU (portal phase), and 58.1 HU (delayed phase), washout 2.7%. In 2/56 (3.6%) cases urinary tract infiltration was found. Oncocytomas were as follows: mean density 126.5 HU (arterial phase), 147.5 HU (portal phase), and 115.5 HU (delayed phase), washout 28.6%. On unenhanced scans, angiomyolipomas were as follows: density values <30 HU in 12/12 (100%) of cases and on enhanced scans: mean density 78 HU (arterial phase), 128 HU (portal phase), and 80 HU (delayed phase), washout 50%. CONCLUSIONS Intralesional calcifications and urinary tract infiltration are suggestive for malignancy, with the evidence of adipose tissue for angiomyolipomas and a modest increase in density with a reduced washout for papillary carcinomas. The intralesional density on enhanced scans, peak enhancement, and washout do not seem significant for differentiating clear cell, chromophobe carcinomas, angiomyolipomas, and oncocytomas.
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Atri M, Tabatabaeifar L, Jang HJ, Finelli A, Moshonov H, Jewett M. Accuracy of Contrast-enhanced US for Differentiating Benign from Malignant Solid Small Renal Masses. Radiology 2015; 276:900-8. [PMID: 25919803 DOI: 10.1148/radiol.2015140907] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
PURPOSE To test the hypothesis that qualitative and quantitative features of contrast material-enhanced ultrasonography (US) can be used to differentiate benign from malignant small renal masses. MATERIALS AND METHODS This is an institutional review board approved, HIPAA-compliant prospective study with written informed consent. Patients with histologically characterized solid small renal masses, excluding lipid-rich angiomyolipomas, underwent qualitative contrast-enhanced US with a combination of three different US machines. A subgroup of patients underwent quantitative contrast-enhanced US. Patients received a bolus injection of 0.2 mL of contrast material for qualitative and quantitative evaluations and were followed for 3 minutes. Two radiologists independently reviewed videotaped qualitative contrast-enhanced US examinations and were blinded to the final diagnoses. Features that were evaluated included lesion vascularity relative to the adjacent cortex in the arterial phase, the presence of a capsule, homogeneity, the pattern of vascularity, and washout. One radiologist separately reviewed a subset of contrast-enhanced US examinations that were performed with all three machines. Parameters of a first-pass time intensity curve were calculated for quantitative analysis. The Mann-Whitney test was used for quantitative parameters, the χ(2) or Fisher exact test was used for qualitative parameters, and κ statistics and Fleiss methodology were used to determine interobserver and intermachine agreement. RESULTS The study population consisted of 91 patients (35 women and 56 men) with 94 lesions. The mean age was 62 years ± 14 (range, 21-91). Three patients had two lesions each, which were evaluated at two different sessions. There were 26 benign small renal masses (including 18 oncocytomas, seven lipid-poor angiomyolipomas, and one hemangioblastoma) and 68 malignant masses (including 41 clear cell, 20 papillary, and seven chromophobe renal cell carcinomas [RCCs[) that were 1.1-4.0 cm in diameter (mean, 2.7 cm ± 0.9). All patients underwent contrast-enhanced US on the same one machine, and 68 patients were imaged on all three machines. Vascularity was present in all lesions (n = 94) at contrast-enhanced US. Lesion hypovascularity relative to the adjacent cortex in the arterial phase was seen in only malignant lesions by both reviewers; reviewer 1 saw hypovascularity in 24 of 94 lesions (P = .0001), and reviewer 2 saw hypovascularity in 21 of 94 lesions (P = .0006), for a specificity of 100% (95% confidence interval [CI]: 84, 100). This feature had κ values of 0.91 (95%CI: 0.82, 1.00) between the two reviewers and 0.85 (95% CI: 0.72, 0.99) between the three machines. Eighteen of 20 papillary RCCs were hypovascular. Quantitative parameters of area under the receiver operating characteristics curve, peak intensity, wash-in slope of 10%-90% and 5%-45%, and washout slope of 100%-10% and 50%-10% were significantly higher in malignant renal masses (P = .018, P = .002, P = .036, P = .016, P = .001, and P = .005, respectively) than in benign lesions. CONCLUSION Excluding lipid-rich angiomyolipoma, hypovascularity-which has high interobserver and intermachine agreement-of solid small renal masses relative to the cortex in the arterial phase has 100% specificity (95% CI: 84, 100) for detecting malignancy, most often papillary RCC.
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Affiliation(s)
- Mostafa Atri
- From the Departments of Medical Imaging (M.A., L.T., H.J.J.), Urology (A.F., M.J.), and Statistics (H.M.), University Health Network, Toronto General Hospital, 585 University Ave, Toronto, ON, Canada M5G 2N2
| | - Leila Tabatabaeifar
- From the Departments of Medical Imaging (M.A., L.T., H.J.J.), Urology (A.F., M.J.), and Statistics (H.M.), University Health Network, Toronto General Hospital, 585 University Ave, Toronto, ON, Canada M5G 2N2
| | - Hyun-Jung Jang
- From the Departments of Medical Imaging (M.A., L.T., H.J.J.), Urology (A.F., M.J.), and Statistics (H.M.), University Health Network, Toronto General Hospital, 585 University Ave, Toronto, ON, Canada M5G 2N2
| | - Anthony Finelli
- From the Departments of Medical Imaging (M.A., L.T., H.J.J.), Urology (A.F., M.J.), and Statistics (H.M.), University Health Network, Toronto General Hospital, 585 University Ave, Toronto, ON, Canada M5G 2N2
| | - Hadas Moshonov
- From the Departments of Medical Imaging (M.A., L.T., H.J.J.), Urology (A.F., M.J.), and Statistics (H.M.), University Health Network, Toronto General Hospital, 585 University Ave, Toronto, ON, Canada M5G 2N2
| | - Michael Jewett
- From the Departments of Medical Imaging (M.A., L.T., H.J.J.), Urology (A.F., M.J.), and Statistics (H.M.), University Health Network, Toronto General Hospital, 585 University Ave, Toronto, ON, Canada M5G 2N2
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Role of MRI in indeterminate renal mass: diagnostic accuracy and impact on clinical decision making. Int Urol Nephrol 2015; 47:585-93. [DOI: 10.1007/s11255-015-0928-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2014] [Accepted: 01/30/2015] [Indexed: 01/28/2023]
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50
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Woo S, Cho JY. Imaging findings of common benign renal tumors in the era of small renal masses: differential diagnosis from small renal cell carcinoma: current status and future perspectives. Korean J Radiol 2015; 16:99-113. [PMID: 25598678 PMCID: PMC4296282 DOI: 10.3348/kjr.2015.16.1.99] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2014] [Accepted: 10/28/2014] [Indexed: 12/17/2022] Open
Abstract
The prevalence of small renal masses (SRM) has risen, paralleling the increased usage of cross-sectional imaging. A large proportion of these SRMs are not malignant, and do not require invasive treatment such as nephrectomy. Therefore, differentation between early renal cell carcinoma (RCC) and benign SRM is critical to achieve proper management. This article reviews the radiological features of benign SRMs, with focus on two of the most common benign entities, angiomyolipoma and oncocytoma, in terms of their common imaging findings and differential features from RCC. Furthermore, the role of percutaneous biopsy is discussed as imaging is yet imperfect, therefore necessitating biopsy in certain circumstances to confirm the benignity of SRMs.
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Affiliation(s)
- Sungmin Woo
- Department of Radiology, Seoul National University College of Medicine, Seoul 110-744, Korea
| | - Jeong Yeon Cho
- Department of Radiology, Seoul National University College of Medicine, Seoul 110-744, Korea. ; Institute of Radiation Medicine and Kidney Research Institute, Seoul National University Medical Research Center, Seoul 110-744, Korea
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