Enhancing Component on CT to Predict Malignancy in Cystic Renal Masses and Interobserver Agreement of Different CT Features

Benjaminov, Ofer; Atri, Mostafa; O’Malley, Martin; Lobo, Kevin; Tomlinson, George

doi:10.2214/ajr.04.0372

Cited by 56 publications

(23 citation statements)

References 19 publications

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“…The best predictor of malignancy in an equivocal cystic lesion on CT is the septal and nodular enhancement [7]. The absence of such an enhancement goes in favour of benign cyst.…”

Section: Resultsmentioning

confidence: 99%

Isolated Renal Hydatid Cyst Masquerading as Cystic Renal Cell Carcinoma: A Case Report

Bhat

Burude

Hegde

et al. 2015

JCDR

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A 48-year-old lady presented to our outpatient department with a vague pain in the abdomen weight loss since last six months. The lady appeared moderately built but poorly nourished without any other positive findings on clinical examination. Her blood and biochemical examination gave no clue to the diagnosis as there was only raised Erythrocyte Sedimentation Rate (ESR). Abdominal ultrasound detected a left upper pole mixed density lesion in the kidney [ With this investigation background, we suspected a cystic RCC and planned a trans abdominal approach. On entering the retroperitoneum we found a cystic mass in upper pole of the left kidney with no lymph nodes. The boundaries were defined, vessels were isolated and then renal capsule was opened at the point where the mass abutted with normal lower pole. Rest of the abdomen was isolated by sterile mops so that any inadvertent leakage doesn't lead to abdominal seedling. Upper pole nephrectomy was planned and dissection was carried out. The cyst opened at the lateral most part while taking the specimen out of the abdomen, when we found daughter cysts coming out to our surprise [Table /Fig-4 Incidentally detected renal cysts are always a diagnostic challenge especially when they present with equivocal features on imaging. Proper diagnosis is of paramount importance as it affects the treatment decisions. Septal and nodular enhancement on computed tomography (CT) is the strongest predictor of malignant process. A multilocular cystic lesion with heterogeneity on CT goes in favour of hydatid disease. Though the treatment in both these cases is surgical excision, a more careful study of image may ease the treatment planning process much more. We report a case in middle aged lady who presented with vague abdominal pain with loss of weight, who was found to have a cystic mass in the upper pole of the left kidney on imaging turned out to be hydatid cyst though the radiological features were in favour of cystic renal cell carcinonoma.

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“…The best predictor of malignancy in an equivocal cystic lesion on CT is the septal and nodular enhancement [7]. The absence of such an enhancement goes in favour of benign cyst.…”

Section: Resultsmentioning

confidence: 99%

Isolated Renal Hydatid Cyst Masquerading as Cystic Renal Cell Carcinoma: A Case Report

Bhat

Burude

Hegde

et al. 2015

JCDR

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“…They describe the exact CT technique that should be utilized. Nodular or septal enhancement has the highest sensitivity and specificity for predicting malignancy with good interobserver variability however [24]. With septal enhancement there is a sensitivity of 83% [95% confidence interval (CI) 65-93%] and specificity of 82% (95% CI 56-94%), and with nodular enhancement there is a sensitivity of 67% (95% CI 49-81%) and specificity of 96% (95% CI 75-99%).…”

Section: Imagingmentioning

confidence: 99%

“…With septal enhancement there is a sensitivity of 83% [95% confidence interval (CI) 65-93%] and specificity of 82% (95% CI 56-94%), and with nodular enhancement there is a sensitivity of 67% (95% CI 49-81%) and specificity of 96% (95% CI 75-99%). Combining septal or nodular enhancement gives greater sensitivity and specificity for malignancy with a sensitivity of 100% (95% CI 86-100%) and specificity of 86% (95% CI 67-95%) [24].…”

Section: Imagingmentioning

confidence: 99%

The diagnosis and management of complex renal cysts

McGuire

Fitzpatrick

2010

Current Opinion in Urology

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The ability to accurately identify complex renal cysts that are malignant remains a major challenge to the clinician. Regularly there is no other way to identify malignant features than to biopsy or continue surveillance. Recent literature would suggest that percutaneous biopsy has a good yield and is accurate in the majority of cases. Current apprehension with regard to iatrogenic complications from percutaneous renal biopsy may be exaggerated, as complication rates are higher in patients with intrinsic real disease rather than this cohort of patients. The overlap in diagnosing Bosniak IIf versus III is heavily influenced by interobserver variability and this needs to be a significant factor in making any decision.

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“…Cuando los quistes son de tamaño suficiente la TC muestra una lesión mixta en la que se aprecian zonas de contenido líquido que pueden ser de gran tamaño, relacionadas con otras áreas más sólidas. La pared de los quistes suele mostrar áreas irregulares, engrosadas y que captan contraste iodado, siendo éste un aspecto muy específico de malignidad 30 . Los tumores quís-ticos renales pueden mostrar también un patrón avascular 31 si bien las paredes y septos tumorales pueden estar dotados de neovascularización 32 .…”

Section: Cr Con Patrón De Crecimiento Quísticounclassified

Componente quístico del cáncer renal: Revisión conceptual

et al. 2008

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RESUMENCOMPONENTE QUÍSTICO DEL CÁNCER RENAL: REVISIÓN CONCEPTUAL El componente quístico del cáncer renal (CR) aparece en el estudio radiológico y queda consolidado con el examen anatomopatológico. El concepto "cáncer renal quístico" o "tumor renal quístico" es de uso habitual y comprende una serie de entidades que van desde los CR con patrón de crecimiento quístico a aquellos que poseen cavidades pseudoquísticas o se hallan imbricados en cualquiera de las enfermedades renales que presentan quistes renales. Diversas publicaciones utilizan de forma indistinta el calificativo "quístico" sin esperar al estudio anatomopatológico, provocando confusión en la terminología. La gran variabilidad en la forma de presentación tanto del CR como de las enfermedades quísticas renales produce distintas formas de presentación radiológica en que se mezclan áreas sólidas y otras de contenido líquido, aunque sólo el examen patológico podrá afirmar que se trata de un CR quístico genuino. Sólo el CR con patrón de crecimiento quístico y el carcinoma multilocular quístico pueden ser llamados con propiedad tumores renales quísticos. Para el resto de entidades, en especial durante el estudio iconográfico, es más adecuado utilizar expresiones no concluyentes como "masa renal de configuración quística" o "tumor renal de aspecto quístico". ABSTRACT THE CYSTIC COMPONENT IN THE RENAL CANCER: CONCEPTUAL OVERIEWThe renal cancer (RC) cystic component is on the radiological tests and could be consolidate with pathological analysis. The concepts "cystic renal cancer" or "cystic renal tumor" contain a group of entities range from cystic grown pattern RCs to pseudocystic tumors as well as cystic renal diseases coinciding with the RC. The CR and the cystic renal diseases have a great variety to sorts of presentations, giving different ways of radiological images, blending solid and cystic areas. Some papers use indiscriminately expression "cystic" without pathologic proof. Just cystic grown pattern RCs and multilocular cystic carcinoma could be named "cystic renal tumors". For de rest, especially over image study, is more suitable to use expressions as "renal tumor of cystic configuration", while pathologic report are available. ORIGINAL E l componente quístico del cáncer renal (CR) se manifiesta durante el estudio radiológico (que traduce la imagen macroscópica) y con el examen anatomopatológico (que aporta, además de la visión macro, la imagen microscópica y definitiva sobre la naturaleza del tumor). Las denominaciones "cáncer renal quístico" o "tumor renal quístico" comprenden, desde el punto de vista clínico y radiológico, cualquier tumoración renal sugestiva de proceso neoformativo en la que hay presencia de cavidades llenas de líquido a la visión macroscópica, tanto constitutivas del propio tumor como asociadas a enfermedades quísticas renales preexistentes 1,2 . El estudio anatomopatológico permite emplear la terminología "quístico" de forma más objetiva, para los tumores que contienen un componente intrínseco de lesiones cavitarias, rellenas ...

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Enhancing Component on CT to Predict Malignancy in Cystic Renal Masses and Interobserver Agreement of Different CT Features

Abstract: The presence of either nodular or septal enhancement shows the highest sensitivity for predicting malignancy with moderate to good interobserver agreement.

Cited by 56 publications

References 19 publications

Isolated Renal Hydatid Cyst Masquerading as Cystic Renal Cell Carcinoma: A Case Report

Isolated Renal Hydatid Cyst Masquerading as Cystic Renal Cell Carcinoma: A Case Report

The diagnosis and management of complex renal cysts

Componente quístico del cáncer renal: Revisión conceptual

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