Exophytic Renal Urothelial Carcinoma Versus Renal Clear-cell Carcinoma: Clinical Data and Computed Tomography Findings

Abstract

Background: Distinguishing exophytic renal urothelial carcinoma (ERUC) from exophytic renal clear-cell carcinoma (ERCCC) with collecting system invasion may be difficult as they involve similar locations and collecting system invasion. Objective: To characterize the clinical data and computed tomography (CT) features that can aid in differentiating ERUC from ERCCC. Methods: Data from 17 patients with ERUC and 222 patients with ERCCC were retrospectively assessed. CT and clinical features exhibiting significant differences in t-tests/Mann-Whitney U-test and chi-square tests/Fisher’s exact tests were analyzed using receiver operating characteristic (ROC) curves. Variables with area under the curve (AUC) <0.7 were excluded. Univariate logistic regressions analysis was used to analyze the associations of CT and clinical features with ERUC or ERCCC. Variables with odds ratio (OR) values being close to 1 in univariate logistic regression were excluded from multivariate logistic regression. A predictive model was then constructed based on the predictors (p<0 in multivariate logistic regression). Differential diagnostic performance was assessed AUC values. Results: Multivariate logistic regression analysis identified preserving reniform contour (OR: 45.27, 95% confidence interval [CI]: 4.982–411.390) and infiltrative growth pattern (OR: 21.741, 95% CI: 1.898–249.049) as independent predictors that can be used to distinguish ERUC from ERCCC. AUC values for preserving reniform contour , infiltrative growth pattern, and Model-1 were 0.907 (95% CI: 0.817-0.998), 0.837 (95% CI: 0.729-0.946), and 0.947 (95% CI: 0.874–1) respectively. Conclusion: The independent predictors and predictive model may play an important role in preoperative differentiation between ERUC and ERCCC.

CT findings and clinical characteristics in distinguishing renal urothelial carcinoma mimicking renal cell carcinoma from clear cell renal cell carcinoma

“…Although some features were excluded in the construction of the predictive model, such as age, CP, NP, and EP for the avoidance of over tting; location and pseudo-capsular sign were excluded for predictor screening, they still represented positive function in differentiating RUC from ccRCC. In this study, patients with ccRCC were younger than those with RUC, similar to results from previous reports [12,13,15,16]. Different from the report of Bata et al (Only in CP and NP, the attenuation of ccRCC was signi cantly higher than RUCs') [13], the attenuation of ccRCC (Fig.…”

“…Some characteristics of RUCs in our study were different from previous literature. The presence of nephrolith, hydronephrosis, ank pain, hematuria, and the cyst-solid lesion was not found in previous research articles [12,18,19], except Chen et al [15,16]. These consistencies might be attributed to different populations, lifestyles, and large lesions analyzed in this study.…”

“…6). Chen et al reported a pseudo-sign in an RUC case with a kidney rupture [15]. Moreover, Chen et al have also reported a pseudo-capsule sign in endophytic RUC [16].…”

“…Chen et al constructed an easy-to-reach differential model for distinguishing exophytic/endophytic RUC mimicking RCC from ccRCC, respectively [15,16]. Previous studies explored the diagnostic potential of CT features in identifying and assessing the prognosis of ccRCCs with CSI [14,17].…”