Renal tumour size measured radiologically before surgery is an unreliable variable for predicting histopathological features: benign tumours are not necessarily small

Remzi, Mesut; Katzenbeisser, Daniela; Waldert, Matthias; Klingler, Hans-Christoph; Susani, Martin; Memarsadeghi, Mazda; Heinz-Peer, Gertraud; Haitel, Andrea; Herwig, Ralf; Marberger, Michael

doi:10.1111/j.1464-410x.2007.06758.x

Cited by 89 publications

(43 citation statements)

References 32 publications

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“…This is in line with published results from surgically resected SRM with a mean percentage of 15 % (range 7 -33 %) benign tumors, especially in T1a lesions [30]. It is a known problem that preinterventional imaging has poor predictive values concerning differentiation of benign vs. malignant SRM with as little as 17 % of benign lesions being diagnosed correctly on CT [31,32].…”

supporting

confidence: 77%

Percutaneous CT-Guided Radiofrequency Ablation of Solitary Small Renal Masses: A Single Center Experience

Pieper

Fischer

Strunk

et al. 2015

Fortschr Röntgenstr

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Purpose: To analyze the outcome of patients undergoing percutaneous CT-guided radiofrequency ablation (RFA) of small renal masses (SRM) at a single center during a ten-year time period. Materials and Methods: Patient records of renal RFAs (07/2003???11/2013) were reviewed. Indications were SRM suspicious of malignancy on imaging and one of the following: severe comorbidity; old age; solitary kidney; impaired renal function; patient wish. Biopsy was performed at the time of RFA. Patients were excluded if no follow-up was available. Patient and procedural characteristics were recorded. Survival rates were calculated using the Kaplan-Meier?s method and compared with log-rank or cox tests. Results: 38 patients (16 females, mean age 70.0 years [range 52???87]) presenting with a solitary SRM were included in the study. Biopsy showed malignancy in 29 patients; 9 had benign tumors. 26 patients suffered from cardiovascular, respiratory or hepatic comorbidities. Technical success (complete ablation on first follow-up) was achieved in 95?% of cases. Two major complications (bowel perforation; hematothorax) occurred. The 3- and 7-year overall survival (OS) [any cause] rates were 73.4???0.8?% and 50.3???1.0?%, respectively (mean follow-up 54.6 months, range 1???127). 4 recurrences and 2 metastases were observed. The presence of comorbidities was the only independent predictor of OS.?There was no difference in survival between patients with benign and malignant tumors. Conclusion: RFA of SRM is successful in a large percentage of cases with a low complication rate and durable local control. As RFA is typically performed in multimorbid patients, overall survival seems to depend primarily on comorbidities rather than cancer progression. Key Points ??RFA of SRM is technically successful in the majority of cases. ??RFA leads to a high degree of local tumor control. ??Post-RFA most patients ultimately die of comorbidities. ??Overall survival post-RFA does not significantly differ between benign and malignant tumors in multimorbid patients. Citation Format: ??Pieper C. C., Fischer S., Strunk H. et?al. Percutaneous CT-Guided Radiofrequency Ablation of Solitary Small Renal Masses: A Single Center Experience. Fortschr R?ntgenstr 2015; 187: 577???583

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supporting

confidence: 77%

Percutaneous CT-Guided Radiofrequency Ablation of Solitary Small Renal Masses: A Single Center Experience

Pieper

Fischer

Strunk

et al. 2015

Fortschr Röntgenstr

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“…Current OnCOlOgy-VOlume 16, Supplement 1 As indicated earlier, srms show heterogeneous pathologic features ranging from totally benign to highly aggressive, and hence determination of the exact nature of an incidentally discovered mass is crucial before a treatment decision is made.…”

Section: S3mentioning

confidence: 99%

“…However, oncocytomas and occasionally low-fat angiomyolipomas are often difficult to differentiate from rccs with current imaging modalities. Remzi et al found that only 17% of all benign lesions were correctly identified as benign on preoperative computed tomography (ct) imaging, and that 43% of patients who were assessed incorrectly on preoperative ct underwent unnecessary radical surgery 16 .…”

Section: Imaging and Pathologymentioning

confidence: 99%

Natural History and Management of Small Renal Masses

Youssif

Tanguay

2009

Current Oncology

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Peak rcc incidence occurs in patients more than 65 years of age 4 . Patients in that age group often have significant medical comorbidities that might affect the choice of therapeutic options.Management of srms must be individualized, because several patient-and tumour-related factors affect management strategy. The identification of these parameters necessitates revisiting the natural history of srms and the safety and efficacy of the various available treatment modalities. NATURAL HISTORY OF SRMsUnderstanding the biologic behaviour and natural history of srms is crucial in predicting tumour growth and metastatic potential, so as to properly select the methods and optimal timing of intervention. Pathologic FeaturesA significant number of srms will prove to be benign. Vasudevan et al. reported a 33% benign histology in 70 renal masses smaller than 5 cm 5 . Similarly, a report of 100 laparoscopic partial nephrectomies for a mean tumour size of 2.9 cm showed that 32% of the surgeries were performed for benign disease, as indicated by the final pathology specimen 6 .The common perception that srms are always indolent tumours is not completely true. Of renal masses smaller than 4 cm, 20%-30% are reported to be aggressive tumours with highly metastatic potential, even if dimensionally small 7,8 . Other reported series identified aggressive pathology features in 25%-38% of srms 7,9 . In addition, Hsu et al. also demonstrated extracapsular extension in 38% of 50 resected rccs smaller than 3 cm 7 .Lesions between 3 cm and 4 cm in diameter are most likely to have aggressive pathologic features. Perinephric fat invasion is found in 4.2% of tumours smaller than 2 cm, 14.9% of tumours 2.1-3 cm, and 35.7% of tumours 3.1-4 cm 9 . The Fuhrman grade of small rcc tumours is low in most cases; only 5%-6.5% of tumours 2-3 cm and 18.7%-25.5% of tumours 3-4 cm have a high Fuhrman grade (3 or 4) 9,10 . ABSTRACTThe recent stage migration observed for renal tumours is contributing to a significant increase in the diagnosis of small renal masses. This evolution has led to a significant change in the approach to renal masses. New options such as observation or energy ablation are gaining popularity in a subset of this patient population. In addition, the observed changes directly contribute to the increased use of nephron-sparing surgery. A better understanding of the various characteristics of these masses will allow for a better understanding of the natural history of these masses and for selection of the optimal therapeutic approach.

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“…En un estudio retrospectivo realizado por Remzi 6 , donde se analizan una serie de 543 tumores de pequeño tamaño, se detectó que un 23% eran oncológicamente agresivos, mientras que el 14,7% fueron etiquetados como benignos.…”

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Tratamiento conservador del cáncer renal mediante HIFU: Técnica, indicaciones y resultados

et al. 2009

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E l manejo de los tumores renales menores de 3-4 cm ha sufrido un cambio importante en la última década. Está científicamente demostrado que la nefrectomía parcial consigue unas tasas de curación similares a la nefrectomía radical 1,2 y que además puede hacerse, en un porcentaje alto de casos, mediante cirugía laparoscópica, asumiendo una tasa del 15-20% de complicaciones [3][4][5] .Por otro lado es cada vez más frecuente el diagnóstico precoz de los tumores renales y, por tanto, el porcentaje de tumores pequeños está aumentando con claridad en la última década, y sin embargo la información que nos dan las técnicas de imagen no permiten predecir su potencial agresividad.En un estudio retrospectivo realizado por Remzi 6 , donde se analizan una serie de 543 tumores de pequeño tamaño, se detectó que un 23% eran oncológicamente agresivos, mientras que el 14,7% fueron etiquetados como benignos.Es en esta encrucijada donde surge, cada vez con más fuerza, el concepto de técnicas de ablación tisular mediante distintas formas de energía y dentro de ellas, junto con la crioterapia y la radiofrecuencia, es donde se engloban los ultrasonidos de alta intensidad "HIFU".Todas ellas pretenden alcanzar objetivos similares: control oncológico parecido al resto de alternativas más invasivas, una tasa mínima de complicaciones y la posibilidad de poderse repetir en el futuro en el caso de ser necesario. OriginalTratamiento conservador del cáncer renal mediante HIFU. Técnica, indicaciones y resultadosCarlos Hernández Fernández, Enrique Lledó García, David Subirá Ríos, Gonzalo Bueno Chomón Servicio de Urología. Hospital General Universitario Gregorio Marañón. Madrid, España ResumenEn este artículo se revisan los mecanismos de acción de los ultrasonidos de alta intensidad HIFU, así como los trabajos tanto experimentales como clínicos en relación con el tratamiento de los tumores renales.Aunque hasta la actualidad la mayor parte de la experiencia oncológica en Urología con HIFU tiene relación con el cán-cer de próstata, son cada vez más los trabajos que avalan su eficacia y seguridad en la destrucción de tumores renales, completando, junto con la crioterapia y la radiofrecuencia, el espectro de la cirugía mínimamente invasiva en el cáncer renal, tratamientos que pretenden disminuir la morbilidad operatoria alcanzando similares tasas de control oncológico.Es aún pronto para recomendar esta técnica en la práctica clínica diaria, ya que conocemos su seguridad y pocos efectos secundarios, pero es preciso que se completen muchos de los trabajos, en marcha en la actualidad, que confirmen su eficacia oncológica a medio y largo plazo.Palabras clave: Ultrasonidos de alta intensidad (HIFU). Cáncer renal. Cirugía mínimamente invasiva. Conservative treatment of renal cancer using HIFU. Procedure, indications, and results AbstractThis article reviews the mechanisms of action of high-intensity focused ultrasound (HIFU), as well as both experimental and clinical work related to renal tumor treatment.While most currently available experience in urologi...

show abstract

Renal tumour size measured radiologically before surgery is an unreliable variable for predicting histopathological features: benign tumours are not necessarily small

Cited by 89 publications

References 32 publications

Percutaneous CT-Guided Radiofrequency Ablation of Solitary Small Renal Masses: A Single Center Experience

Percutaneous CT-Guided Radiofrequency Ablation of Solitary Small Renal Masses: A Single Center Experience

Natural History and Management of Small Renal Masses

Tratamiento conservador del cáncer renal mediante HIFU: Técnica, indicaciones y resultados

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