Incidence of benign pathologic findings at partial nephrectomy for solitary renal mass presumed to be renal cell carcinoma on preoperative imaging

Kutikov, Alexander; Fossett, Lindsay K.; Ramchandani, Parvati; Tomaszewski, John E.; Siegelman, Evan S.; Banner, Marc P.; Arsdalen, Keith N. Van; Wein, Alan J.; Malkowicz, S. Bruce

doi:10.1016/j.urology.2006.04.011

Cited by 286 publications

(158 citation statements)

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“…Subsequently, lesion size was divided into 3 categories: <20 mm, 20-40 mm, or >40 mm to assess the competence of this modality for various lesion sizes. 8 We used the Mann-Whitney U test to analyze each lesion size category (for strain ratio and pathology) and strain ratio (for gender). Kruskal-Wallis tests were conducted to compare strain ratio and the ordinal variables among the lesion size categories and lesion subtypes.…”

Section: Discussionmentioning

confidence: 99%

Strain elastography in the characterization of renal cell carcinoma and angiomyolipoma

Keskin

Güven

Keskin³

et al. 2015

CUAJ

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E67 ORIGINAL RESEARCHCite as: Can Urol Assoc J 2015;9(1-2):e67-71. http://dx.doi.org/10.5489/cuaj.2349 Published online February 9, 2015. AbstractIntroduction: We evaluate the diagnostic performance of strain elastography to differentiate renal cell carcinoma (RCC) from angiomyolipoma (AML). Methods: Strain elastography was performed in 65 patients (mean age 55.5 years; range: 32-81) who had renal lesions (24 AMLs and 41 RCCs) prospectively. Lesions were classified according to lesion size and histological subtypes. The strain ratios of the RCCs and AMLs were evaluated by a radiologist. The area under the curve and the cut-off point were used to assess diagnostic performance. Sensitivity, specificity, and positive and negative predictive values were obtained. Results: In assessing the mean strain ratio, we divided the groups in 3 according to size: (1) <20-mm lesions; (2) 20-to 40-mm lesions; and (3) >40-mm lesions; the respective mean strain ratios were: 1.5 ± 0.5 (range: 0.06-5.92), 2.8 ± 0.4 (range: 0.17-9.92), 2.7 ± 0.3 (range: 0.08-6.15). When RCCs and AMLs were compared, there was a statistically significant difference in the strain ratio among the 3 groups divided per lesion size (p < 0.01). For the strain ratio, the mean ± standard deviation was 1.1 ± 0.1 for AMLs and 3.4 ± 0.3 for RCCs (p < 0.01). When lesion subtypes were compared, there was a statistically significant difference in the strain ratio between the AML and clear cell RCC (p < 0.01). Conclusions: For assessing renal lesions, strain elastography and strain ratio values may be useful in differentiating RCCs from AMLs. IntroductionUltrasound (US) elastography is a new radiological modality. In conventional B-mode imaging, tissue hardness in real time is represented in colour. Because most malignant tumours are harder than benign tissues, benign and malignant tissues were differentiated significantly by this technique. In the literature, a good correlation between strain elastography and histologic analysis was reported, with high sensitivity and specificity for differentiation between benign and malignant masses in breast tissue. 1 We hypothesized that evaluation of tissue elasticity might be useful for renal mass characterization. Tan and colleagues found significant differences between strain ratios for angiomyolipomas (AMLs) and renal cell carcinomas (RCCs) (p < 0.01).2 The aim of our study, therefore, was to prospectively determine the diagnostic efficiency of sonoelastography for differentiating RCCs from AMLs. Methods Study populationThere were 65 patients in our study population (28 men and 37 women) who underwent US, including elastography of a renal mass, at our institution between March 2012 and February 2013. The mean age of patients was 55.5 ± 12.3 (range: 32-81). The study population had various renal masses, including 41 RCCs and 24 AMLs. The RCCs were diagnosed by resection. The histopathological examination was performed by our pathologists. Histological subtype was clear cell carcinoma in 26 patients, papillary cell carcinoma ...

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Section: Discussionmentioning

confidence: 99%

Strain elastography in the characterization of renal cell carcinoma and angiomyolipoma

Keskin

Güven

Keskin³

et al. 2015

CUAJ

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“…[1][2][3][4][5][6][7][8][9][10][11][12][13][14] Despite these advancements, some cases still remain for which CT or MRI cannot be used for the histological characterization of a renal tumor. For example, the differentiation of RCC from AML and infiltrating UC of the kidney can be difficult in some cases.…”

Section: Introductionmentioning

confidence: 99%

Utility of Apparent Diffusion Coefficients in the Evaluation of Solid Renal Tumors at 3T

Sasamori

Saiki

Suyama

et al. 2014

MRMS

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Purpose: We assessed the usefulness of apparent diffusion coefficients (ADCs) for solid renal tumor imaging using diffusion-weighted magnetic resonance imaging (DWI) at 3T.Methods: This retrospective study assessed ADCs of 31 patients with renal tumors that were imaged using preoperative DWI. DWI was performed with the b values of 50, 500, and 1000 s/mm 2 , using a 3T magnetic resonance imaging (MRI) system (MAGNETOM Trio, 3T, Siemens Healthcare, Erlangen, Germany). The ADC map was calculated using the b values of 50 and 1000 s/mm 2 . ADCs of the different tumors were compared according to the Tukey-Kramer test.Results: The tumors were diagnosed as clear cell renal cell carcinoma (RCC; n = 20), papillary RCC (n = 1), infiltrating urothelial carcinoma (UC) of the kidney (n = 4), cystic RCC (n = 1), poorly differentiated carcinoma (n = 1), and angiomyolipoma (AML; n = 4). The mean ADC of clear cell RCC was significantly higher than that of infiltrating UC of the kidney (1.423 vs. 0.931 © 10 ¹3 mm 2 /s; P < 0.05), and the mean ADC of AML was significantly lower than that of clear cell RCC (0.674 vs. 1.423 © 10 ¹3 mm 2 /s; P < 0.01). Conclusion: ADCs used in DWI at 3T may be useful for differentiation of different types of solid renal tumors.

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“…1,2,4,11,12 In synchronicity with the gradual dissemination of laparoscopic radical nephrectomy, 2,4 multiple investigators reported that, for selected patients with smaller renal tumors, partial nephrectomy yields oncologic outcomes that are indistinguishable from the outcomes achieved by radical excision. [13][14][15] Partial nephrectomy also preserves long-term renal function 16,17 while reducing over-treatment of patients with benign 18 or clinically indolent 19 tumors.…”

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confidence: 99%

Diffusion of surgical innovation among patients with kidney cancer

Miller

Saigal

Banerjee

et al. 2008

Cancer

107

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BACKGROUNDDespite their potential benefits to patients with kidney cancer, the adoption of partial nephrectomy and laparoscopy has been gradual and asymmetric. To clarify whether this trend reflects differences in kidney cancer patients or differences in surgeon practice styles, the authors compared the magnitude of surgeon‐attributable variance in the use of partial nephrectomy and laparoscopic radical nephrectomy with that attributable to patient and tumor characteristics.METHODSBy using linked Surveillance, Epidemiology, and End Results‐Medicare data, the authors identified a cohort of 5483 Medicare beneficiaries who underwent surgery for kidney cancer between 1997 and 2002. Two primary outcomes were defined: 1) the use of partial nephrectomy and (2) the use of laparoscopy among patients undergoing radical nephrectomy. By using multilevel models, surgeon‐ and patient‐level contributions to observed variations in the use of partial nephrectomy and laparoscopic radical nephrectomy were estimated.RESULTSOf the 5483 cases identified, 611 (11.1%) underwent partial nephrectomy (43 performed laparoscopically), and 4872 (88.9%) underwent radical nephrectomy (515 performed laparoscopically). After adjusting for patient demographics, comorbidity, tumor size, and surgeon volume, the surgeon‐attributable variance was 18.1% for partial nephrectomy and 37.4% for laparoscopy. For both outcomes, the percentage of total variance attributable to surgeon factors was consistently higher than that attributable to patient characteristics.CONCLUSIONSFor many patients with kidney cancer, the surgery provided depends more on their surgeon's practice style than on the characteristics of the patient and his or her disease. Consequently, dismantling barriers to surgeon adoption of partial nephrectomy and laparoscopy is an important step toward improving the quality of care for patients with early‐stage kidney cancer. Cancer 2008. © 2008 American Cancer Society.

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Incidence of benign pathologic findings at partial nephrectomy for solitary renal mass presumed to be renal cell carcinoma on preoperative imaging

Cited by 286 publications

References 14 publications

Strain elastography in the characterization of renal cell carcinoma and angiomyolipoma

Strain elastography in the characterization of renal cell carcinoma and angiomyolipoma

Utility of Apparent Diffusion Coefficients in the Evaluation of Solid Renal Tumors at 3T

Diffusion of surgical innovation among patients with kidney cancer

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