Abstract
BackgroundRenal masses are becoming an increasingly common finding on cross-sectional images. Characterization of the nature of the lesion either neoplastic or not, benign or malignant as well as further subtype characterization is becoming an important factor in determining management plan. The purpose of our study with to assess the sensitivity and specificity of both ADC mean value and ADC ratio in such characterization along with the calculation of different cutoff values to differentiate between different varieties, using pathological data as the main gold standard for diagnosis.ResultsOur study included 50 patients with a total of 72 masses. A final diagnosis was reached in 69 masses by pathological examination and three masses had clinical and laboratory signs of infection. We had a total of 49 malignant lesions (68%) and 23 benign lesions (32%). The ADC value of ccRCC (1.4 × 10−3 mm2/s) was significantly higher than all other renal masses. A cutoff ADC value of > 1.1 and a cutoff ADC ratio of > 0.56 can be used to differentiate between clear cell renal cell carcinoma and other lesions and an ADC value of < 0.8 and an ADC ratio of ≤ 0.56 to differentiate papillary renal cell carcinoma from other masses. There was no statistically significant ADC value to differentiate between benign and malignant lesions but a statistically significant ADC ratio (> 0.52) was reached.ConclusionADC value and ADC ratio can be used as an adjunct tool in the characterization of different renal masses, with ADC ratio having a higher sensitivity, which can affect the prognosis and management of the patient.
Highlights
Renal masses are becoming an increasingly common finding on cross-sectional images
The behavior of the masses was assessed in terms of local invasion, distant metastasis, nodal metastasis, and invasion of the pelvicalyceal system (PCS); nine masses were associated with local extra-renal invasion, and three with local and distant metastasis
Twenty masses were associated with invasion of the pelvicalyceal system and eight masses associated with regional lymph nodes
Summary
Renal masses are becoming an increasingly common finding on cross-sectional images. Renal cancer is one of the top ten common types of cancer, 90% of which are renal cell carcinoma (RCC) [1], and having a significant impact on health [2]. The increase in cross-sectional abdominal imaging has led to an increase in the number of incidentally discovered renal masses [3], most of these masses are small renal masses (< 4 cm), and out of these 20 percent are benign [4]. With regard to RCC, 75% are clear cell (ccRCC), 7% to 15% are papillary (pRCC), and 5% are chromophobe (chrRCC) subtypes. Clear cell renal cell carcinoma (ccRCC), the most common RCC subtype, has the greatest potential for aggressive behavior among the common subtypes [6]
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