Renal oncocytoma: CT features cannot reliably distinguish oncocytoma from other renal neoplasms

Choudhary, S.; Arora, Rajesh; Mayer, Nick; Mulcahy, Kevin; Haroon, Asna

doi:10.1016/j.crad.2008.12.011

Cited by 167 publications

(108 citation statements)

References 19 publications

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“…Contrast-enhanced US can be helpful in specific cases (eg, chronic renal failure with a relative contraindication for iodinated or gadolinium contrast media, complex cystic masses, and differential diagnosis of peripheral vascular disorders such as infarction and cortical necrosis) (LE 3) [18]. However, CT and MRI features cannot reliably distinguish oncocytoma and fat-free angiomyolipoma from malignant renal neoplasms (LE 3) [19,20]. Advanced MRI techniques such as diffusionweighted and perfusion-weighted imaging are being explored in RM assessment [21].…”

Section: Imagingmentioning

confidence: 99%

EAU Guidelines on Renal Cell Carcinoma: The 2010 Update

Ljungberg¹,

Cowan²,

Hanbury³

et al. 2010

European Urology

1,334

1,008

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Context: The European Association of Urology Guideline Panel for Renal Cell Carcinoma (RCC) has prepared evidence-based guidelines and recommendations for RCC management. Objectives: To provide an update of the 2010 RCC guideline based on a standardised methodology that is robust, transparent, reproducible, and reliable. Evidence acquisition: For the 2014 update, the panel prioritised the following topics: percutaneous biopsy of renal masses, treatment of localised RCC (including surgical and nonsurgical management), lymph node dissection, management of venous thrombus, systemic therapy, and local treatment of metastases, for which evidence synthesis was undertaken based on systematic reviews adhering to Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. Relevant databases (Medline, Cochrane Library, trial registries, conference proceedings) were searched (January 2000 to November 2013) including randomised controlled trials (RCTs) and retrospective or controlled studies with a comparator arm. Risk of bias (RoB) assessment and qualitative and quantitative synthesis of the evidence were performed. The remaining sections of the document were updated following a structured literature assessment. Evidence synthesis: All chapters of the RCC guideline were updated. For the various systematic reviews, the search identified a total of 10 862 articles. A total of 151 studies reporting on 78 792 patients were eligible for inclusion; where applicable, data from RCTs were included and meta-analyses were performed. For RCTs, there was low RoB across studies; however, clinical and methodological heterogeneity prevented data pooling for most studies. The majority of studies included were retrospective with matched or unmatched cohorts based on single or multi-institutional data or national registries. The exception was for systemic treatment of metastatic RCC, in which several RCTs have been performed, resulting in recommendations based on higher levels of evidence.

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Section: Imagingmentioning

confidence: 99%

EAU Guidelines on Renal Cell Carcinoma: The 2010 Update

Ljungberg¹,

Cowan²,

Hanbury³

et al. 2010

European Urology

1,334

1,008

View full text Add to dashboard Cite

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“…Despite the widespread use of multimodality imaging, the characterisation of renal lesion still remains poor in some cases, particularly those of small size (<40 mm) [4][5][6]. In fact, while papillary RCC typically shows low contrast-enhancement at CT, oncocytoma and clear cell RCCs can have similar features and postcontrastographic behaviour, making a differential diagnosis difficult when it should be mandatory [7,15,16]. Several studies, using multiphase CT technique, identified differing degrees of enhancement in different postcontrast phases as the most reliable parameter to distinguish clear cell RCCs from other subtypes, including oncocytomas [16][17][18].…”

Section: Discussionmentioning

confidence: 99%

“…and hypervascular with a necrotic core (10 and 2 cases, resp. ); in a few cases, even chromophobe RCCs and papillary RCCs had the same CT appearances [7,16]. For this reason, we tested both multiphasic CT and CTp in discriminating malignant lesions in this subgroup.…”

Section: Discussionmentioning

confidence: 99%

“…RCC's incidence has risen over the last few years because the widespread use of crosssectional imaging has increased the incidental detection of renal lesions, particularly those of a small size (<4 cm) [4,5]. Although the great value of imaging for renal lesions detection has increased in recent years, the accuracy rate on preoperative characterisation of their nature remains low [6]; in particular the differential diagnosis of oncocytoma versus RCC represents a diagnostic challenge [7]. Percutaneous biopsy could be a useful tool in dubious cases, but it is an invasive approach [8,9].…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Risk Determination for Localised Renal Cell Carcinomas under 4 cm or Less: A Multi-institutional Analysis

Kim

Lee

Hong

et al. 2016

Korean J Urol Oncol

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Objective. To prospectively evaluate if computed tomography perfusion (CTp) could be a useful tool in addition to multiphasic CT in renal lesion characterisation. Materials and Methods. Fifty-eight patients that were scheduled for surgical resection of a renal mass with a suspicion of renal cell carcinoma (RCC) were enrolled. Forty-one out of 58 patients underwent total or partial nephrectomy after CTp examination, and a pathological analysis was obtained for a total of 49 renal lesions. Perfusion parameters and attenuation values at multiphasic CT for both lesion and normal cortex were analysed. All the results were compared with the histological data obtained following surgery. Results. PS and MTT values were significantly lower in malignant lesions than in the normal cortex ( < 0.001 and = 0.011, resp.); PS, MTT, and BF values were also statistically different between oncocytomas and malignant lesions. According to ROC analysis, the accuracy, sensitivity, and specificity to predict RCC were 95.92%, 100%, and 66.7%, respectively, for CTp whereas they were 89.80%, 93.35%, and 50%, respectively, for multiphasic CT. Conclusion. A significant difference between renal cortex and tumour CTp parameter values may suggest a malignant renal lesion. CTp could represent an added value to multiphasic CT in differentiating renal cells carcinoma from oncocytoma.

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“…However, classical hypo-attenuation of the central stellate scar on CT scan is seen in less than one third of RO, and although characteristic of RO, it is not diagnostic (Chawla et al 2006;Khoo et al 2001). Moreover, there are no consistently reliable pathognomic CT scan features that can safely differentiate RO from RCC (Choudhary et al 2009). Therefore, most RO are treated as suspicious of RCC based on imaging, and thereafter are subjected to surgical resection.…”

Section: Distant Metastasis (M) M0 No Distant Metastasis M1 Distant Mmentioning

confidence: 99%

Identification of immunohistochemical biomarkers that differentiate chromophobe renal cell carcinoma from renal oncocytoma through molecular profiling of renal tumours

Ng¹

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There is increasing detection of renal tumours, especially small renal masses largely due to widespread availability of radiological imaging modalities. However, imaging techniques and renal lesion biopsies cannot accurately define malignant from benign renal tumours.Therefore such indeterminate renal tumours undergo surgical resection. Unfortunately a significant proportion of resected renal tumours turn out to be benign on histopathological diagnosis. The impact of this scenario is the morbidities of unnecessary surgery and loss of valuable nephrons with the associated increased risk of chronic kidney disease and cardiovascular complications. Reduction of unnecessary surgeries would also translate into decreased costs, and allow for more efficient utilisation of health budgets.Another diagnostic dilemma faced by pathologists is the occasional difficulty in distinguishing some renal tumour subtypes, due to overlapping morphological and histological features. Differentiating malignant chromophobe renal cell carcinoma (chRCC) from benign renal oncocytoma (RO) is one such dilemma. Their correct diagnosis is crucial as prognosis, management and surveillance protocols differ between the two tumour subtypes. Therefore effective and reproducible immunohistochemistry (IHC) biomarkers need to be identified, together with novel biomarkers, through molecular profiling of these tumour subtypes.In Chapter 1, the relevant background, significance of the research topic, literature review, hypothesis and aims of this PhD research were presented. Contents of this chapter have also been published as a review article. The review article provided the clinical presentation, ii explained the diagnostic dilemma, and described the value of current molecular markers to assist in differentiation between chRCC and RO.The aims of this research project were to: 1) identify a panel of IHC biomarkers which can effectively differentiate chRCC from RO through a comprehensive literature search and meta-analysis approach, as well as using some of the research results from my laboratory; 2) analyse the molecular profiles of renal cancers via IHC and morphometry techniques using Biobank. This work involved a significant amount of time and resources throughout the PhD research project, achieved Aim 4 of the thesis, and will be a legacy of this PhD research.Chapter 3 examined the existing IHC biomarkers that have been reported as useful in differentiating chRCC from RO. A meta-analysis and systematic review was conducted in iii this chapter to assess the most effective IHC biomarkers, and it has been published. In summary, we recommended a selection from a panel of IHC biomarkers, namely, amylase α1A, Wnt-5a, FXYD2, ARPP, CD63, TGFβ1, CK7, S100A1, caveolin-1 and claudin-7 to aid in the differentiation of chRCC and RO.In Chapter 4, we investigated the molecular profiles of nuclear factor-κB (NF-κB) subunits in RCC disease. Our results represent the first and largest study to report on the IHC expression of NF-κB subunits (p65, p50, p52, cRel)...

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Renal oncocytoma: CT features cannot reliably distinguish oncocytoma from other renal neoplasms

Cited by 167 publications

References 19 publications

EAU Guidelines on Renal Cell Carcinoma: The 2010 Update

EAU Guidelines on Renal Cell Carcinoma: The 2010 Update

Risk Determination for Localised Renal Cell Carcinomas under 4 cm or Less: A Multi-institutional Analysis

Identification of immunohistochemical biomarkers that differentiate chromophobe renal cell carcinoma from renal oncocytoma through molecular profiling of renal tumours

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