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In Vivo, Percutaneous, Needle Based, Optical Coherence Tomography of Renal Masses
Published on: March 30, 2015
Tumor complexity predicts malignant disease for small renal masses
Jeffrey K Mullins1, Jihad H Kaouk, Sam Bhayani
1James Buchanan Brady Urological Institute, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA. jmulli12@Jhmi.edu
The Journal of Urology
|October 23, 2012
Summary
High R.E.N.A.L. nephrometry score and male gender increase the risk of high-grade kidney cancer in patients undergoing partial nephrectomy. Tumor complexity is a key predictor of malignancy.
Area of Science:
- Urology
- Oncology
- Pathology
Background:
- Approximately 20-30% of small renal tumors are benign, and many malignant tumors are low-grade.
- Distinguishing benign from malignant or high-grade from low-grade renal tumors preoperatively is challenging.
Purpose of the Study:
- To evaluate if preoperative patient and tumor characteristics predict adverse pathological features in renal tumors.
- To identify factors associated with malignancy and high-grade renal cell carcinoma.
Main Methods:
- Analysis of 886 patients undergoing robot-assisted partial nephrectomy.
- Quantification of tumor complexity using the R.E.N.A.L. (radius, exophytic/endophytic, nearness of tumor to collecting system or sinus, anterior/posterior, hilar and location relative to polar lines) nephrometry score.
- Logistic regression analysis to assess associations between patient/tumor characteristics and high-grade renal cell carcinoma, including subanalyses for tumors ≤4 cm.
Main Results:
- Increasing tumor complexity (R.E.N.A.L. score) independently predicted malignancy, high-grade malignancy, and clear cell histology.
- Male gender was independently associated with malignancy and high-grade renal cell carcinoma.
- For tumors ≤4 cm, complexity predicted malignancy but not tumor grade.
Conclusions:
- A high R.E.N.A.L. nephrometry score and male gender are associated with an increased risk of malignancy and high-grade malignancy.
- Tumor complexity is a significant preoperative predictor of renal tumor malignancy and grade.
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