Oncocytoma: risk of promoting unnecessary surgery

Warren, Hannah; Neves, Joana B.; Tran, Maxine

doi:10.1007/s00345-020-03347-0

Cited by 3 publications

(3 citation statements)

References 8 publications

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“…A recent publication suggested that active surveillance for renal oncocytomas is associated with higher renal function decline than partial nephrectomy, and advocated surgery over monitoring [20]. However, in our view, the unreported and unmeasured confounding biases that led to the choice of initial management strategy (active surveillance vs partial nephrectomy) [21] is likely to have contributed significantly to the decline in renal function in the cohort studied.…”

Section: Discussionmentioning

confidence: 87%

Growth and renal function dynamics of renal oncocytomas in patients on active surveillance

et al. 2021

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To study the natural history of renal oncocytomas and address indications for intervention by determining how growth is associated with renal function over time, the reasons for surgery and ablation, and disease-specific survival. Patients and MethodsThe study was conducted in a retrospective cohort of consecutive patients with renal oncocytoma on active surveillance reviewed at the Specialist Centre for Kidney Cancer at the Royal Free London NHS Foundation Trust (2012 to 2019. Comparison between groups was performed using Mann-Whitney U-tests and chi-squared tests. A mixed-effects model with a random intercept for patient was used to study the longitudinal association between tumour size and estimated glomerular filtration rate (eGFR). ResultsLongitudinal data from 98 patients with 101 lesions were analysed. Most patients were men (68.3%) and the median (interquartile range [IQR]) age was 69 (13) years. The median (IQR) follow-up was 29 (26) months. Most lesions were small renal masses, and 24% measured over 4 cm. Over half (64.4%) grew at a median (IQR) rate of 2 (4) mm per year. No association was observed between tumour size and eGFR over time (P = 0.871). Nine lesions (8.9%) were subsequently treated. Two deaths were reported, neither were related to the diagnosis of renal oncocytoma. ConclusionNatural history data from the largest active surveillance cohort of renal oncocytomas to date show that renal function does not seem to be negatively impacted by growing oncocytomas, and confirms clinical outcomes are excellent after a median follow-up of over 2 years. Active surveillance should be considered the 'gold standard' management of renal oncocytomas up to 7cm.

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Section: Discussionmentioning

confidence: 87%

Growth and renal function dynamics of renal oncocytomas in patients on active surveillance

et al. 2021

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“…Here, all three lesions were misdiagnosed by CEUS as RCCs. Although based on a small sample size, imaging diagnosis of small oncocytomas is confirmed to be challenging, making oncocytoma one of the most commonly excised benign renal lesion [ 30 ].…”

Section: Discussionmentioning

confidence: 99%

Diagnostic Performance of Contrast-Enhanced Ultrasound in the Evaluation of Small Renal Masses: A Systematic Review and Meta-Analysis

et al. 2022

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Ultrasound (US) is a highly sensitive imaging tool in the detection of renal masses. However, the detection rate of small renal masses (SRMs) (<4 cm) is still limited. In this scenario, contrast-enhanced ultrasound (CEUS) is a relatively novel, but increasingly utilized, diagnostic modality which aims to increase the overall diagnostic ability in the identification of SRMs. In consequence, we performed a systematic review (SR) and pooled meta-analysis to investigate the diagnostic performance of CEUS in the evaluation of SRMs confirmed by pathology. A SR up to April 2022 was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. The diagnostic performance of CEUS was evaluated basing on malignant vs. benign SMRs. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) from eligible studies were pooled, and summary receiver operating characteristic (SROC) curves were constructed for each endpoint. Overall, five qualified studies were deemed suitable for this meta-analysis. Finally, diagnostic performance of CEUS showed an accuracy of 0.93 in detecting malignant masses (sensitivity of 0.94, PPV of 0.95, specificity of 0.78, and NPV of 0.73). Taken together, CEUS may represent a promising minimally invasive diagnostic tool for characterization of SMRs, since it allows clinicians to identify malignant lesions.

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“…5,17,18 Patient selection for AS depends on several factors include age, comorbidities, symptomatic presentation, risk for concurrent chRCC/hybrid oncocytomas, and known tumor growth rate (<5 mm/year). 19 Neves et al 16 showed that while on AS >50% of lesions grow with approximately 25% grow ≥5 mm/ year, approximately 15% will shrink, and that lesion size does not predict growth rates. Locally invasive RO exists with 1.5% of ROs showing vascular and/or perinephric invasion with no disease recurrence, metastasis, or death after tumor resection, further highlighting RO's benign nature when compared with more aggressive tumors of the same advanced stage.…”

Section: Introductionmentioning

confidence: 99%

Molecular Characterization of Metastatic Oncocytoma With Exceptional Response to Treatment: A Case Report

Webster,

Ricketts,

Vocke

et al. 2024

JCO Precis Oncol

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Oncocytoma: risk of promoting unnecessary surgery

Cited by 3 publications

References 8 publications

Growth and renal function dynamics of renal oncocytomas in patients on active surveillance

Growth and renal function dynamics of renal oncocytomas in patients on active surveillance

Diagnostic Performance of Contrast-Enhanced Ultrasound in the Evaluation of Small Renal Masses: A Systematic Review and Meta-Analysis

Molecular Characterization of Metastatic Oncocytoma With Exceptional Response to Treatment: A Case Report

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