DWI for Renal Mass Characterization: Systematic Review and Meta-Analysis of Diagnostic Test Performance

Kang, Stella K.; Zhang, Angela; Pandharipande, Pari V.; Chandarana, Hersh; Braithwaite, R. Scott; Littenberg, Benjamin

doi:10.2214/ajr.14.13930

Cited by 79 publications

(48 citation statements)

References 36 publications

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“…Second, DWI was not used as it was not consistently acquired in all cases. Although there is no strong evidence for the use of DWI in the differentiation of histological subtypes of RCC (25), DWI may be used as an ancillary input to differentiate among some renal masses (26). Third, although conclusions on the diagnostic performance could have been influenced by the lack of strict adherence to the algorithm, our results suggest that accuracy was indeed higher when reviewers complied with the algorithm versus those instances when it was overruled; therefore, a trend caused by such factor would likely result in underestimation rather than overestimation of the algorithm performance.…”

Section: Discussionmentioning

confidence: 99%

Diagnostic Performance and Interreader Agreement of a Standardized MR Imaging Approach in the Prediction of Small Renal Mass Histology

Kay

Canvasser

et al. 2018

Radiology

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Purpose To determine the diagnostic performance and inter-reader agreement of a standardized diagnostic algorithm for determining the histologic type of small (<=4cm) renal masses (SRM) with multiparametric magnetic resonance imaging (MRI). Materials and Methods This single-center, retrospective, HIPAA-compliant, IRB-approved study included 103 patients with 109 SRM, resected between December 2011 and July 2015. The requirement for informed consent was waived. Pre-surgical renal MRIs were reviewed by 7 radiologists with diverse experience. Eleven MRI features were assessed and a standardized diagnostic algorithm used to determine the most likely histologic diagnosis, which was compared to histopathology after surgery. Inter-reader variability was tested with Cohen’s κ. Regression models using MRI features were used to predict the histopathologic diagnosis with 5% significance level. Results Clear-cell (ccRCC) and papillary type renal cell carcinomas (pRCC) were diagnosed with respective sensitivities of 85% (47/55) and 80% (20/25), and specificities of 76% (41/54) and 94% (79/84). Inter-reader agreement was moderate-to-substantial (ccRCC, κ=0.58; pRCC, κ=0.73). Signal intensity of the lesion on T2-weighted images (T2W) and degree of contrast enhancement during corticomedullary phase (CE) were independent predictors of ccRCC (T2W OR: 3.19 CI95%: [1.4, 7.1], p=0.003; CE OR: 4.45 [1.8, 10.8], p<0.001) and pRCC (CE OR: 0.053 [0.02, 0.2], p<0.001), both with substantial inter-reader agreement (T2W, κ=0.69; CE, κ=0.71). Lower performance was observed for chromophobe histology, oncocytomas, and minimal-fat angiomyolipomas, [ranges, sensitivity=14%(1/7)–67%(4/6), specificity=97%(100/103)–99%(101/102)], with fair-to-moderate inter-reader agreement (κ=0.23–0.43). Segmental enhancement inversion was an independent predictor of oncocytomas (OR: 16.21 [1.0, 275.4], p=0.049), with moderate inter-reader agreement (κ=0.49). Conclusion The proposed standardized MRI-based diagnostic algorithm had a diagnostic accuracy of 81% (88/109) and 91% (99/109) for the diagnosis of ccRCC and pRCC, respectively, while achieving moderate to substantial inter-reader agreement among 7 radiologists.

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Section: Discussionmentioning

confidence: 99%

Diagnostic Performance and Interreader Agreement of a Standardized MR Imaging Approach in the Prediction of Small Renal Mass Histology

Kay

Canvasser

et al. 2018

Radiology

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“…A systematic review and meta-analysis by Kang et al of diffusion-weighted imaging (DWI) studies in the characterization of renal masses showed moderate accuracy for distinguishing between benign vs. malignant lesions (86% sensitivity and 78% specificity) and low- vs. high-grade ccRCC (AUC of 0.83) (21). They found insufficient evidence, however, for discrimination of ccRCC from other histologies.…”

Section: Imaging Biomarkersmentioning

confidence: 99%

Renal cell carcinoma: the search for a reliable biomarker

et al. 2017

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One particular challenge in the treatment of kidney tumors is the range of histologies and tumor phenotypes a renal mass can represent. A kidney tumor can range from benign (e.g., oncocytoma) to a clinically indolent malignancy (e.g., papillary type I, chromophobe) to aggressive disease [e.g., papillary type II or high-grade clear cell renal cell carcinoma (ccRCC)]. Even among various subtypes, kidney cancers are genetically diverse with variable prognoses and treatment response rates. Therefore, the key to proper treatment is the differentiation of these subtypes. Currently, a wide array of diagnostic, prognostic, and predictive biomarkers exist that may help guide the individualized care of kidney cancer patients. This review will discuss the various serum, urine, imaging, and immunohistological biomarkers available in practice.

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“…Some investigators have reported some value in the determination of the histologic diagnosis in renal masses 35,36 and the characterization of high-grade RCC 37 . However, a recent meta-analysis indicated only moderate diagnostic accuracy in the characterization of renal masses and determination of high-grade clear cell histology 38 . The lack of standardization of the DWI acquisition protocols across different MRI vendors and different medical centers is likely responsible, at least in part, for the less than optimal diagnostic performance.…”

Section: Imaging Of Renal Cell Carcinomamentioning

confidence: 99%

Imaging and Screening of Kidney Cancer

Leon¹,

Pedrosa²

2017

Radiologic Clinics of North America

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SYNOPSIS Renal cell carcinoma (RCC) exhibits a diverse and heterogeneous disease spectrum, but insight into its behavior has provided an improved understanding of potential risk factors, natural history of disease, and imaging features. Appropriately performed, CT and MRI may allow for the identification and accurate preoperative subtyping of RCC and for the assessment of a response to various therapies. Active surveillance is receiving increasing attention as a viable management option in select subgroup of patients and has provided further insight into the natural history of RCC, including the favorable prognosis of cystic renal neoplasms. In this article, we provide a brief review of the epidemiologic, clinical, and imaging features of RCC and the potential role of screening in selected high-risk populations.

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DWI for Renal Mass Characterization: Systematic Review and Meta-Analysis of Diagnostic Test Performance

Cited by 79 publications

References 36 publications

Diagnostic Performance and Interreader Agreement of a Standardized MR Imaging Approach in the Prediction of Small Renal Mass Histology

Diagnostic Performance and Interreader Agreement of a Standardized MR Imaging Approach in the Prediction of Small Renal Mass Histology

Renal cell carcinoma: the search for a reliable biomarker

Imaging and Screening of Kidney Cancer

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