ROLE OF R.E.N.A.L NEPHROMETRY IN PREDICTING TUMOR HISTOLOGY AND GRADE OF RENAL MASS.

Dr Manu Gupta

doi:10.32553/ijmbs.v3i11.704

Abstract

Background: The R.E.N.A.L.(radius, exophytic/endophytic properties, nearness of tumor to the collecting systemor sinus in mm, anterior/posterior location relative to polar lines) nephrometry scoring system was recently introduced as an objective reproducible means to describe salient renal tumor anatomy. Objective of this study is to evaluate the role of R.E.N.A.L. Nephrometry score in predicting tumor histology and grade. Methods: It is a prospective study carried out in Lilawati Hospital and Research Centre, a tertiary care centre consisting of 40 patients including male and female who had T1 renal mass. Preoperative R.E.N.A.L. Nephrometry scoring done for every patient and after treatment (Open Partial Nephrectomy, Laproscopic partial Nephrectomy, Radical Nephrectomy) tumor sent for histopathology to predict tumor histology and grade for solid renal mass. Results: Clear cell histology also increased with R.E.N.A.L score, from 2/6 (33.3%) in patients with low R.E.N.A.L scores ( 4–6) up to 15/17 (88.24%) for patients with high R.E.N.A.L scores( 10–12) . Conversely, the probability of the potentially more indolent papillary RCC decreased with increasing lesion complexity (from 66.67% in low score to 11.76% in moderate score).The Fuhrman grade is an important prognostic indicator for RCCs. In our study Fuhrman grade 1 tumours represented 4/40 (66.7%) low and 2(13%)high- complexity lesions . Conversely, there is no grade 3 lesion in low score (0.0%) compared with 5/40 (33.3%%) moderate complexity lesions, respectively showing more the nephrometry score higher will be Fuhrman grade. Conclusions: Proportion with clear cell histology also increases with R.E.N.A.L score and the probability of the potentially more indolent papillary RCC decreased with increasing lesion complexity. The Fuhrman grade also increases with increase in nephrometry score Keywords: R.E.N.A.L Nephrometry score, Fuhrman grade, Tumor histology

Highlights

The biology of renal cell carcinoma (RCC) is hetttrogenous
The probability of the potentially more indolent papillary RCC decreased with increasing lesion complexity.The Fuhrman grade is an important prognostic indicator for RCCs
Proportion with  clear cell histology increases with R.E.N.A.L score and the probability of the potentially more indolent papillary RCC decreased with increasing lesion complexity

Summary

Introduction

The biology of renal cell carcinoma (RCC) is hetttrogenous. approximately one third of all renal mass presesent with systemic disease, many localized renal masses appear to follow a relatively slow growing clinical course[1].Option for the management of renal masses includes excision by partial or radical nephrectomy, ablation or active surveillance (AS)in the elderly or infirmed[2]. The R.E.N.A.L.(radius, exophytic/endophytic properties, nearness of tumor to the collecting systemor sinus in mm , anterior/posterior location relative to polar lines) nephrometry scoring system was recently introduced as an objective reproducible means to describe salient renal tumor anatomy[3]. There are other reported renal tumor methodologies, such as the PADUA (preoperative aspects and dimentions used for anatomic [classification]) and CI(centrality index) systems, the Nephrometry score is the first objective system that quantifies the complexity of the renal tumor[4,5]. The R.E.N.A.L. nephrometry scoring system has been shown to provide important preoperative and perioperative information used to predict long term outcomes and is increasingly being incorporated into clinical trials similar to the Response Evaluation Criteria In Solid Tumors guidelines( RECIST) [6].

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CONCLUSION