Preoperative Assessment of Renal Sinus Invasion by Renal Cell Carcinoma according to Tumor Complexity and Imaging Features in Patients Undergoing Radical Nephrectomy

Abstract

Objective To identify the association between renal tumor complexity and pathologic renal sinus invasion (RSI) and evaluate the usefulness of computed tomography tumor features for predicting RSI in patients with renal cell carcinoma (RCC). Materials and Methods This retrospective study included 276 consecutive patients who underwent radical nephrectomy for RCC with a size of ≤ 7 cm between January 2014 and October 2017. Tumor complexity and anatomical renal sinus involvement were evaluated using two standardized scoring systems: the radius (R), exophytic or endophytic (E), nearness to collecting system or sinus (N), anterior or posterior (A), and location relative to polar lines (RENAL) nephrometry and preoperative aspects and dimensions used for anatomical classification (PADUA) system. CT-based tumor features, including shape, enhancement pattern, margin at the interface of the renal sinus (smooth vs. non-smooth), and finger-like projection of the mass, were also assessed by two independent radiologists. Univariable and multivariable logistic regression analyses were performed to identify significant predictors of RSI. The positive predictive value, negative predictive value (NPV), accuracy of anatomical renal sinus involvement, and tumor features were evaluated. Results Eighty-one of 276 patients (29.3%) demonstrated RSI. Among highly complex tumors (RENAL or PADUA score ≥ 10), the frequencies of RSI were 42.4% (39/92) and 38.0% (71/187) using RENAL and PADUA scores, respectively. Multivariable analysis showed that a non-smooth margin and the presence of a finger-like projection were significant predictors of RSI. Anatomical renal sinus involvement showed high NPVs (91.7% and 95.2%) but low accuracy (40.2% and 43.1%) for RSI, whereas the presence of a non-smooth margin or finger-like projection demonstrated comparably high NPVs (90.0% and 91.3% for both readers) and improved accuracy (67.0% and 73.9%, respectively). Conclusion A non-smooth margin or the presence of a finger-like projection can be used as a preoperative CT-based tumor feature for predicting RSI in patients with RCC.

ctDNA predicts clinical T1a to pathological T3a upstaging after partial nephrectomy

“…36 SFI is the principal route for the extrarenal extension of RCC and is a prognostic factor for poor recurrence-free and overall survival after nephrectomy. 16,37 These findings are consistent with our result showing that the ctDNA detection rate was higher in patients with SFI.…”

“…5,32 Although the PADUA system can predict fat invasion to some extent, it is not sufficient to predict SFI or PFI. 37 As this system was originally designed for evaluating the surgical complexity and morbidity of PN, 13 the nephrometry system may be insufficient to predict SFI because tumor building into the renal sinus may not necessarily be a result of SFI. 37 The role of ctDNA has primarily been investigated in the monitoring of tumor progression during treatment because of the advantages of non-invasive ctDNA sampling methods.…”

“…37 As this system was originally designed for evaluating the surgical complexity and morbidity of PN, 13 the nephrometry system may be insufficient to predict SFI because tumor building into the renal sinus may not necessarily be a result of SFI. 37 The role of ctDNA has primarily been investigated in the monitoring of tumor progression during treatment because of the advantages of non-invasive ctDNA sampling methods. 24 Therefore, most of these studies were conducted on metastatic or large-sized ccRCCs.…”

Can lymphovascular invasion be predicted by contrast-enhanced CT imaging features in patients with esophageal squamous cell carcinoma? A preliminary retrospective study

“…In a previous study, Chou et al [ 33 ] found that nonsmooth tumor margin is a promising two-dimensional imaging feature for preoperative assessment of microvascular invasion (MVI). In patients with renal cell carcinoma (RCC), the presence of an unsmooth margin or a finger-like protrusion is a CT-based tumor feature that can be used to predict pathologic renal sinus invasion (RSI) preoperatively [ 38 ]. These two studies suggest that tumor margin morphology has the potential to predict LVI status.…”

How to Clearly and Accurately Report Odds Ratio and Hazard Ratio in Diagnostic Research Studies?

“…When 34 original research studies reporting OR published in the Korean Journal of Radiology in 2020–2021 [ 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 ] were evaluated against a rigorous standard (i.e., complete transparency in reporting), 91.2% (31/34) clearly mentioned how they defined the odds, 62.1% (18/29) unmistakably described the reference category for OR calculation for categorical variables, and 42.9% (9/21) specified the one-unit amount for OR for continuous variables. Therefore, there is room for improvement in reporting.…”