Abstract
Increased detection of small renal masses (SRMs) has encouraged research for non-invasive diagnostic tools capable of adequately differentiating malignant vs. benign SRMs and the type of the tumour. Multi-detector computed tomography (MDCT) has been suggested as an alternative to intervention, therefore, it is important to determine both the capabilities and limitations of MDCT for SRM evaluation. In our study, two abdominal radiologists retrospectively blindly assessed MDCT scan images of 98 patients with incidentally detected lipid-poor SRMs that did not present as definitely aggressive lesions on CT. Radiological conclusions were compared to histopathological findings of materials obtained during surgery that were assumed as the gold standard. The probability (odds ratio (OR)) in regression analyses, sensitivity (SE), and specificity (SP) of predetermined SRM characteristics were calculated. Correct differentiation between malignant vs. benign SRMs was detected in 70.4% of cases, with more accurate identification of malignant (73%) in comparison to benign (65.7%) lesions. The radiological conclusions of SRM type matched histopathological findings in 56.1%. Central scarring (OR 10.6, p = 0.001), diameter of lesion (OR 2.4, p = 0.003), and homogeneous accumulation of contrast medium (OR 3.4, p = 0.03) significantly influenced the accuracy of malignant diagnosis. SE and SP of these parameters varied from 20.6% to 91.3% and 22.9% to 74.3%, respectively. In conclusion, MDCT is able to correctly differentiate malignant versus uncharacteristic benign SRMs in more than 2/3 of cases. However, frequency of the correct histopathological SRM type MDCT identification remains low.
Highlights
As various non-invasive imaging modalities, mainly ultrasound (US) and computed tomography (CT), become increasingly more accessible and utilized, incidental findings, such as renal lesions, are detected more frequently [1,2,3]
The goals of this study were to evaluate which radiological tumour features were indicative of malignancy in cases without obvious aggressive growth or gross fat, and to demonstrate the diagnostic capabilities and limitations of multi-detector CT (MDCT) scan imaging when it comes to determining the type and malignancy of incidentally detected lipid-poor SRMs
Patients with cystic lesions or masses less than 1 cm in diameter, insufficient medical record, inconclusive histological data, and poor quality or incomplete CT scans were excluded from the study
Summary
As various non-invasive imaging modalities, mainly ultrasound (US) and computed tomography (CT), become increasingly more accessible and utilized, incidental findings, such as renal lesions, are detected more frequently [1,2,3]. A biopsy is performed to determine the malignancy and type of the renal tumour, while imaging studies evaluate lesion invasion, spread, and related complications [9]. As the number of incidentally detected renal lesions increases, less invasive and cost-effective methods to differentiate between benign and malignant tumours are required. Reasonable cost, and accurate assessment of tumour morphology, location, and size, multi-detector CT (MDCT) is being researched as a modality of choice for solid renal mass evaluation
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