1238 ANATOMICAL FEATURES OF ENHANCING RENAL MASSES PREDICT HISTOLOGY AND GRADE - AN ANALYSIS USING NEPHROMETRY

Abstract

You have accessJournal of UrologyKidney Cancer: Localized III1 Apr 20101238 ANATOMICAL FEATURES OF ENHANCING RENAL MASSES PREDICT HISTOLOGY AND GRADE - AN ANALYSIS USING NEPHROMETRY Alexander Kutikov, Brandon J. Manley, Daniel J. Canter, Brian L. Egleston, Debra L. Kister, David Y.T. Chen, Richard E. Greenberg, Stephen A. Boorjian, Rosalia Viterbo, and Robert G. Uzzo Alexander KutikovAlexander Kutikov More articles by this author , Brandon J. ManleyBrandon J. Manley More articles by this author , Daniel J. CanterDaniel J. Canter More articles by this author , Brian L. EglestonBrian L. Egleston More articles by this author , Debra L. KisterDebra L. Kister More articles by this author , David Y.T. ChenDavid Y.T. Chen More articles by this author , Richard E. GreenbergRichard E. Greenberg More articles by this author , Stephen A. BoorjianStephen A. Boorjian More articles by this author , Rosalia ViterboRosalia Viterbo More articles by this author , and Robert G. UzzoRobert G. Uzzo More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2010.02.782AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Radiographic predictors of renal mass pathology remain elusive. Data suggest that differences may exist in pathology based on tumor size, depth and location. Unfortunately studies are confounded by the lack of quantifiable anatomical variables. Using the Nephrometry score (NS), we evaluated whether preoperative radiographic attributes of renal masses predict pathological characteristics. METHODS We queried our prospective Kidney Cancer Database for renal mass where NS was available. The individual components of Nephrometry(size, endo/exophycity, nearness to sinus/urothelium, anterior/posterior, location relative to polar line and hilar structures) and the total NS were compared to pathological features (histology and grade) of resected tumors. Kruskal-Wallis, Fisher's Exact tests as proportional odds and multinomial logistic regressions were used to evaluate relationships between individual anatomic descriptors, overall NS, and pathology. RESULTS Nephrometry scores were available on 415/1650 (25%) of resected renal masses. The median size of tumors with Nephrometry was 4 cm (range 0.8-25 cm). Total Nephrometry score correlated with both tumor grade (p<0.0001) and histology (p<0.0001). Specifically, papillary tumors had the lowest scores in each attribute demonstrating they tend to be small, exophytic, away from central structures, and polar, thereby having the lowest total NS of all carcinomas. Comparatively, clear cells tend to be larger, more endophytic, closer to sinus, between the poles and hilar, thereby having higher Nephrometry scores. Benign lesions were most often small, relatively endophytic and rarely hilar. High grade tumors had higher NS based on size, interpolar/hilar locations compared to low grade tumors. No correlation was found between tumor grade and endophycity or nearness to sinus/urothelium. CONCLUSIONS Predicting renal mass pathology in the preoperative setting is a significant challenge. Quantifying and scoring the radiographic complexities of a renal mass not only provides a common comparator for treatment decisions/complications, but also helps characterize anatomical differences in tumor histology and stage. The features of renal masses captured by Nephrometry possess diagnostic value with regard to a tumor's histology and grade. Table 1. Correlation between a tumor's anatomical features - as captured by the R.E.N.A.L. Nephrometry score - and its pathological characteristics. Tumor Grade (correlation type) Tumor Histology (Lowest → Highest Score) Nephrometry Score p < 0.0001 (Direct) p < 0.0001 (Papillary, Benign, Chromophobe, Clear Cell, Other) (R)adius (diameter) p < 0.0001 (Direct) p = 0.0001 (Benign, Papillary, Clear Cell, Chromophobe, Other) (E)xophytic/endophytic properties p = 0.256 (None) p = 0.013 (Papillary, Other, Chromophobe, Clear Cell, Benign) (N)earness of the tumor to the collecting system or sinus p = 0.096 (None) p = 0.0006 (Papillary, Benign, Clear Cell, Chromophobe, Other) (A)nterior or (p)osterior or (x) p = 0.003 (Higher grade associated with “x”) p = 0.071 (no relationship) (L)ocation relative to the polar lines p < 0.0001 (Direct) p = 0.0044 (Papillary, Benign, Chromophobe, Clear Cell, Other) “H”ilar location (abutting main artery or vein) p = 0.013 (if hilar then higher grade) p = 0.002 (Benign, Papillary, Chromophobe, Clear Cell, Other) Philadelphia, PA© 2010 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 183Issue 4SApril 2010Page: e479 Advertisement Copyright & Permissions© 2010 by American Urological Association Education and Research, Inc.MetricsAuthor Information Alexander Kutikov More articles by this author Brandon J. Manley More articles by this author Daniel J. Canter More articles by this author Brian L. Egleston More articles by this author Debra L. Kister More articles by this author David Y.T. Chen More articles by this author Richard E. Greenberg More articles by this author Stephen A. Boorjian More articles by this author Rosalia Viterbo More articles by this author Robert G. Uzzo More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...