Abstract
PurposeSeveral nephrometry scoring systems have been developed based on two-dimensional computerized tomography images to quantify anatomical features of renal tumors. We have developed an accurate three-dimensional nephrometry scoring system to respond to the urgent need for advanced systems based on three-dimensional images.Materials and MethodsWe retrospectively reviewed 135 patients who underwent partial nephrectomy in our institution. Stereoscopic models were reconstructed from preoperative computerized tomography images and three-dimensional scores were assigned directly on stereoscopic models. All tumors were analyzed for following features: tumor volume; endophytic tumor proportion; renal vascular variations; tumor’s relationships with urinary collecting system or renal sinus; longitudinal distance from tumor to equatorial plane. Correlation between three-dimensional score and warm ischemic time was calculated compared with existing classical nephrometry scoring systems. The value of nephrometry scoring systems predicting longer warm ischemic time was explored by receiver operating characteristic curves.ResultsMean tumor volume was 31.25 ml; endophytic volume was less than 50% in 42 cases, more than 50% in 79 cases, and 100% in 14 cases; mean longitudinal distance from tumor to equatorial plane was 1.41 cm; 30 patients (22.2%) presented renal vascular variations; 18 cases (13.3%) involved both urinary collecting system and sinus. Mean three-dimensional score was 8.3. Variance analysis and covariance analysis revealed warm ischemic time a significant association with all evaluated tumor features. Furthermore, three-dimensional scores most highly correlated with warm ischemic time (rs = 0.64, p < 0.001), followed by R.E.N.A.L. scores (rs = 0.21, p = 0.012), centrality index (rs = − 0.20, p = 0.019) and Preoperative Aspects and Dimensions Used for Anatomy score (rs = 0.20, p = 0.019). Area under curve of above nephrometry scoring systems was 0.91, 0.67, 0.68 and 0.67 respectively (p < 0.05).ConclusionsThe three-dimensional scoring system developed in this study was a highly-accurate system to quantify the anatomical features of renal tumors. It was identified to have a value in predicting duration of warm ischemic time.
Highlights
Partial Nephrectomy (PN) surgery was recommended as the gold standard of care for tumors ≤4 cm (T1a) by American Urological Association and European Association of Urology guidelines (Campbell et al, 2009; Ljungberg et al, 2015)
The most popular systems such as R.E.N.A.L. score, PADUA score and CI score could help surgeons to objectively predict the complexity of renal tumors and various perioperative outcomes (Kutikov & Uzzo, 2009; Ficarra et al, 2009; Simmons et al, 2010)
Two-dimension (2D) has its limitations and inaccuracy compared with three-dimension (3D): (1) Tumors with a longer diameter in 2D cross-sections may hold a smaller volume in 3D images, which is illustrated intuitively by Fig. 1. (2) 2D images cannot precisely present the condition of renal vascular variation, while this can be illustrated in 3D images. (3) 3D images can provide more accurate imagery of many anatomical features
Summary
Partial Nephrectomy (PN) surgery was recommended as the gold standard of care for tumors ≤4 cm (T1a) by American Urological Association and European Association of Urology guidelines (Campbell et al, 2009; Ljungberg et al, 2015). (radius, exophytic/endophytic properties, nearness of tumor to collecting system or sinus, anterior/posterior, location relative to polar lines and tumor touching main renal artery or vein) score, PADUA (preoperative aspects and dimensions used for anatomy) score and CI (centrality index) score could help surgeons to objectively predict the complexity of renal tumors and various perioperative outcomes (Kutikov & Uzzo, 2009; Ficarra et al, 2009; Simmons et al, 2010). These nephrometry scoring systems greatly improved surgical planning of clinicians and counseling of patients. This 3D scoring system had a predictive value for duration of warm ischemic time (WIT) in our study
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
