Standardized Reporting of Microscopic Renal Tumor Margins: Introduction of the Renal Tumor Capsule Invasion Scoring System

Snarskis, Connor; Calaway, Adam; Wang, Lu; Gondim, Dibson D.; Hughes, Ian; Idrees, Muhammad T.; Kliethermes, Stephanie; Maniar, Viraj; Picken, Maria M.; Boris, Ronald S.; Gupta, Gopal N.

doi:10.1016/j.juro.2016.07.086

Cited by 22 publications

(26 citation statements)

References 27 publications

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“…No statistically significant association was found between RTPI pattern and pathological size and stage, whereas a significant association was described for grade and histologic subtype (no RTPI was reported in 31.2% of chromophobe RCCs, 11.1% of papillary RCCs, and 6.4% of clear cell RCCs) [30]. At a multivariate analysis, both tumor histology and higher Fuhrman grade were associated with an increased risk of i-Cap 3 score, with papillary type and Fuhrman grade 4 carrying the highest risk (OR 3.04, 95% CI 1.52-6.09, p = 0.002; OR 14.68, 95% CI 2.16-123.18, p = 0.007) [13].…”

Section: Discussionmentioning

confidence: 98%

“…Tumor PC was defined as a thin linear regular hypointense band surrounding the tumor on T2-and T1-weighted images. Similarly to the invasion of PC scoring system (i-Cap), recently developed by Snarskis et al to standardize the histopathology report of tumor PC integrity, we proposed a new classification system to standardize MRI report on PC status: MRI-Cap [13]. MRI-Cap was evaluated on both T2-WI and T1WI + T2WI, and it was defined as follows:…”

Section: Imaging Analysismentioning

confidence: 99%

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Accuracy of magnetic resonance imaging to identify pseudocapsule invasion in renal tumors

et al. 2019

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Purpose To evaluate accuracy of MRI in detecting renal tumor pseudocapsule (PC) invasion and to propose a classification based on imaging of PC status in patients with renal cell carcinoma. Methods From January 2017 to June 2018, 58 consecutive patients with localized renal cell carcinoma were prospectively enrolled. MRI was performed preoperatively and PC was classified, according to its features, as follows: MRI-Cap 0 (absence of PC), MRI-Cap 1 (presence of a clearly identifiable PC), MRI-Cap 2 (focally interrupted PC), and MRI-Cap 3 (clearly interrupted and infiltrated PC). A 3D image reconstruction showing MRI-Cap score was provided to both surgeon and pathologist to obtain complete preoperative evaluation and to compare imaging and pathology reports. All patients underwent laparoscopic partial nephrectomy. In surgical specimens, PC was classified according to the renal tumor capsule invasion scoring system (i-Cap). Results A concordance between MRI-Cap and i-Cap was found in 50/58 (86%) cases. ρ coefficient for each MRI-cap and iCap categories was: MRI

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Section: Discussionmentioning

confidence: 98%

Section: Imaging Analysismentioning

confidence: 99%

Accuracy of magnetic resonance imaging to identify pseudocapsule invasion in renal tumors

et al. 2019

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“…1 The recognition of the importance of PCs led to a proposed standardized PC invasion scoring system to classify PC integrity, as current standard pathological reporting do not routinely report PC integrity. 2 A major component of the fibrous PC is collagen. 3 Collagen, being an abundant Extra-Cellular Matrix (ECM) component, is the strongest and hardest to penetrate by tumor cells.…”

Section: Introductionmentioning

confidence: 99%

Multiphoton Microscopic Study of the Renal Cell Carcinoma Pseudocapsule: Implications for Tumour Enucleation

Tan

Tay

Ooi

et al. 2020

Preprint

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Background To utilise Multiphoton Microscopy as a novel imaging technique to characterize and quantify collagen at the Renal Cell Carcinoma Pseudocapsule, to assess for both intra-tumoral and inter-tumoral variation of collagen characteristics. MPM combines Second Harmonic Generation and Two Photon Excitation Fluorescence to image extracellular matrix architecture. Methods 20 partial nephrectomy specimen tissues were retrieved, cut into 5‎-micron sections, mounted on slides and deparaffinized. The pseudocapsules were imaged with 2X and 20X objective at selected Regions of Interest. Corresponding clinical information was retrieved. Pseudocapsule thickness was determined. Collagen parameters measured included quantification by the Collagen Area Ratio, and qualitative measurements by the Collagen Fiber Density and Collagen Reticulation Index. Results The boundaries between tumor, PC and normal renal parenchyma were distinguished by Multiphoton Microscopy without the need for staining. In the thickest areas of the pseudocapsule, collagen content and density were quantitatively higher compared to the thinnest areas. Median Collagen Area Ratio was higher in the thickest compared to the thinnest areas of the PC (p=0.01). Clear Cell RCC specimens had a consistently higher Collagen Fiber Density in both the thickest and thinnest areas compared to non-Clear Cell RCC specimens (p=0.02). Conclusions In this study, we demonstrated the ability of Multiphoton Microscopy to quantify collagen characteristics of pseudocapsules without fluorescent labelling. Tumor enucleation for Renal Cell Carcinoma along its Pseudocapsule remains debatable with regards to oncological safety. Even with a complete and intact pseudocapsule, the pseudocapsule is not a homogenous structure, and varies in its thickness and its collagen characteristics within, and between, tumours.

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“…[ 5 – 9 ] A recent study showed that renal capsule invasion was independently associated with prognosis, while lymphovascular invasion was not. [ 10 ] Snarskis et al [ 11 ] proposed a system for scoring renal capsule invasion on surgical specimens, but no system exists for imaging, which would be more valuable because this information could be used when planning the treatments.…”

Section: Introductionmentioning

confidence: 99%

Multislice spiral computed tomography signs of invasion of the renal capsule by renal cell carcinoma

Zhang¹,

Tian²,

Zhang³

et al. 2018

Medicine

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Capsular invasion is frequently detected in localized renal cell carcinoma (RCC) specimens and is associated with a poor prognosis, but the pretreatment imaging features are poorly known. This study aimed to explore the positions and margin types of RCC and various computed tomography (CT) signs, as well as the correlations with the presence/absence of RCC invasion of the renal capsule.This was a retrospective study of 158 consecutive patients treated for pathologically confirmed RCC between January 2013 and December 2016 at the Nantong University Affiliated Hospital. The patients were divided into the capsule invasion and noninvasion groups. The CT signs were analyzed (position type, margin type, and CT findings in the perirenal fat).There were 92 (58.2%) men and 66 (41.8%) women; mean age was 59.1 ± 12.8. Renal capsule invasion was confirmed in 45 cases. There was no difference in the position types between the 2 groups (all P > .05). The smooth margin was more common in the noninvasion group (53.1% vs 15.6%, P < .01). The deep lobulated type and the saw tooth sign were more common in the invasion group (57.8% vs 7.1%; and 40.0% vs 6.2%; both P < .01). The deep lobulated (OR = 2.03, 95%CI: 1.21–3.39, P = .007) and saw tooth (OR = 1.036, 95%CI: 1.008–1.065, P = .011) signs were independently associated with renal capsule invasion.Smooth tumor margin suggests the absence of renal capsule invasion, while the deep lobulated and the saw tooth signs strongly suggest the presence of renal capsule invasion in patients with RCC.

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Standardized Reporting of Microscopic Renal Tumor Margins: Introduction of the Renal Tumor Capsule Invasion Scoring System

Cited by 22 publications

References 27 publications

Accuracy of magnetic resonance imaging to identify pseudocapsule invasion in renal tumors

Accuracy of magnetic resonance imaging to identify pseudocapsule invasion in renal tumors

Multiphoton Microscopic Study of the Renal Cell Carcinoma Pseudocapsule: Implications for Tumour Enucleation

Multislice spiral computed tomography signs of invasion of the renal capsule by renal cell carcinoma

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