Management Of Renal Masses Research Articles

The Role of Imaging in the Management of Renal Masses

The widespread availability of cross-sectional imaging is responsible for the increased detection of small, usually asymptomatic renal masses. More than 50% of renal cell carcinomas (RCCs) represent incidental findings on noninvasive imaging. Multimodality imaging, including conventional US, contrast-enhanced US (CEUS), multiparametric CT and MRI (mpMRI) is essential in diagnosing and characterizing renal masses, but also provides information regarding its prognosis, therapeutic management, and follow-up. In this review, the imaging data for renal masses that urologists require for accurate treatment planning will be discussed. The roles of US, CEUS, CT and mpMRI in the detection and characterization of renal masses, RCC staging and follow-up of treated or untreated local RCCs will be presented. The role of percutaneous image-guided ablation in the management of RCC will also be reviewed

66 Significance of Percutaneous Biopsy in the Clinical Management of Renal Masses

Abstract Aim Percutaneous renal mass biopsy is increasingly used in the management of renal masses. The objective of our study was to determine the significance of percutaneous renal mass biopsy and its impact on clinical management. Method Retrospective study of all patients who had image guided percutaneous renal mass biopsy health-board wide from April 2011 to April 2019. Renal mass biopsies were performed for either a localised or metastatic renal mass. Results of the renal biopsies were compared to final diagnosis to determine diagnostic accuracy measured by sensitivity, specificity, negative predictive value and positive predictive value. Results Out of 429 patients who had a renal biopsy, 91 patients- 55 males (61%) and 36 females (39%) were included in the final analysis. The mean age of the study population was 66 years (range 46-87). Renal mass biopsies were performed using coaxial 18-gauge core needle technique. We categorised patients into two groups (metastatic renal masses and localised renal mass). Sixty-eight patients had biopsies for metastatic disease and 23 patients had biopsies for a localised renal mass. In the localised disease group, the sensitivity was 100%, positive predictive value was 82% (95% CI, 48.2-97.7%) and the negative predictive value was 100% (95% CI, 66.4-100%) (Clopper Pearson Method). For patients with metastatic renal mass the positive predictive value was 83%. Conclusions Percutaneous renal mass biopsy may have a role for metastatic renal cancers that require targeted therapy and localised masses that require curative treatment.

Robot-assisted partial nephrectomy: 7-year outcomes.

The role of robot-assisted partial nephrectomy (RAPN) in the management of renal masses has exponentially grown over the past 10 years. Nevertheless, data on long term outcomes of the procedure remains limited. Herein we report oncological and functional outcomes of patients who underwent RAPN for a malignant mass with a median follow-up of 7 years, the longest follow-up to date. A retrospective analysis of an international multicenter database was performed. All consecutive patients undergoing surgery between 2009 and 2013 with a minimum of 3-year follow-up and complete data on renal function were included. Demographics, surgical and perioperative outcomes were analyzed. Overall survival (OS), disease-free survival (DFS), and cancer-specific survival (CSS) were evaluated using Kaplan-Meier analysis. Overall, our study cohort was composed of eighty-five patients with a median follow-up of 88 months. Median clinical tumor size was 3 cm, with mostly (74.1%) clinical stage T1a, and median RENAL score 6. Final histopathologic analysis revealed clear cell RCC in 76.5% of cases. PSM was present in seven patients (8.2%). Eleven overall deaths (12.9%) occurred in the cohort during the follow-up period. Two of these (2.33%) were attributed to metastatic RCC. The OS, CSS, and DFS rates were 91.7%, 97.7%, and 91.7% at 84 months, respectively. Regarding the renal functional outcomes, seventeen patients (20.1%) presented a CKD upstaging in our cohort. Our findings show excellent 7-year oncologic and functional outcomes of the procedure, which duplicate those achieved in historical series of open and laparoscopic surgery.

Radical nephrectomy and vena caval thrombectomy with the use of cardiopulmonary bypass and hypothermic circulatory arrest: Experience at a large tertiary institution

Objective: This study aimed to review the experience at a large regional tertiary centre of open radical nephrectomy (RN) with vena caval thrombectomy with cardiopulmonary bypass (CPB) and hypothermic circulatory arrest (HCA) for the management of renal masses. Method: Data on patients with renal masses who had undergone RN and vena caval thrombectomy with CPB and HCA had been prospectively collected at two centres over a 19-year period (2000–2019). Twenty-three consecutive patients were identified and retrospectively analysed for operative and tumour characteristics and for postoperative outcome. Kaplan–Meier survival analysis was performed to compare patient outcomes based on tumour characteristics. Results: Median operating time was 358 minutes (interquartile range (IQR)=94 minutes), median bypass time was 117 minutes (IQR=28.5 minutes) and median circulation arrest time was 25 minutes (IQR=18.5 minutes). The median hospital length of stay was 11 days (IQR=5.3 days). Total complication rate was 52% ( n=12), consisting of four minor and eight major complications (Clavien–Dindo score >IIIa), including one intraoperative death. The overall five-year survival rate was 73% (11/15), with a median follow-up time of 53.1 months. Eleven (48%) patients were surgically cured, with a median follow-up time of 60.1 months (IQR=71.8 months). Disease recurrence was seen in eight (35%) patients, of whom four died. Patients who died survived for a median of 46.5 months. Median survival after the diagnosis of metastatic disease was seven months. Conclusions: We report the largest Australian cohort of RN with vena caval thrombectomy with CPB and HCA. We demonstrate outcomes comparable to major overseas centres, with an overall five-year survival rate of 73%. This suggests that even patients with extensive venal caval thrombus from renal masses can experience long-term survival benefit from RN and venal caval thrombectomy. Level of evidence: Level 3.

Utilization of Renal Mass Biopsy for T1 Renal Lesions across Michigan: Results from MUSIC-KIDNEY, A Statewide Quality Improvement Collaborative

BackgroundRenal mass biopsy (RMB) has had limited and varied utilization to guide management of renal masses (RM). ObjectiveTo evaluate utilization of RMB for newly diagnosed cT1 RMs across diverse practice types and assess associations of outcomes with RMB. Design, setting, and participantsMUSIC-KIDNEY commenced data collection in September 2017 for all newly presenting patients with a cT1 RM at 14 diverse practices. Patients were assessed at ≥120 d after initial evaluation. Outcome measurements and statistical analysisDemographics and outcomes were compared for patients undergoing RMB versus no RMB. Clinical and demographic characteristics were summarized by RMB status using a χ2 test for categorical variables and Student t test for continuous variables. A mixed-effects logistic regression model was constructed to identify associations with RMB receipt. Results and limitationsRMB was performed in 15.5% (n = 282) of 1808 patients with a cT1 RM. Practice level rates varied from 0% to 100% (p = 0.001), with only five of 14 practices using RMB in >20% of patients. On multivariate analysis, predictors of RMB included greater comorbidity (Charlson comorbidity index ≥2 vs 0: odds ratio [OR] 1.44; p = 0.025) and solid lesion type (cystic vs solid: OR 0.17; p = 0.001; indeterminate vs solid: OR 0.58; p = 0.01). RMB patients were less likely to have benign pathology at intervention (5.0% vs 13.5%; p = 0.01). No radical nephrectomies were performed for patients with benign histology at RMB. The limitations include short follow-up and inclusion of practices with low numbers of RMBs. ConclusionsUtilization of RMB varied widely across practices. Factors associated with RMB include comorbidities and lesion type. Patients undergoing RMB were less likely to have benign histology at intervention. Patient summaryCurrent use of biopsy for kidney tumors is low and varies across our collaborative. Biopsy was performed in patients with greater comorbidity (more additional medical conditions) and for solid kidney tumors. Pretreatment biopsy is associated with lower nonmalignant pathology detected at treatment.

Diagnostic renal mass biopsy is associated with individual categories of PADUA and RENAL nephrometry scores: Analysis of diagnostic and concordance rates with surgical resection

BackgroundRenal mass biopsy (RMB) is a safe and accurate method for diagnosis and clinical management of renal masses. However, the non-diagnostic rate is a limiting factor. We tested the hypothesis that imaging characteristics and anatomic complexity of the mass may impact RMB diagnostic outcome using the preoperative aspects and dimensions used for an anatomical (PADUA) classification and radius-exophytic/endophytic-nearness-anterior/posterior-location (RENAL) score. Material and methodsSingle institution, retrospective study of 490 renal masses from 443 patients collected from 2001 to 2018. Outcome measurements include (1) diagnostic and concordance rates amongst RMB types and RMB with surgical resection specimens; (2) association between diagnostic RMB and anatomical complexity of renal masses. The analysis was conducted in unselected masses and small renal masses (SRMs). ResultsRMB was performed by fine needle aspiration (FNA), core needle biopsy (CNB), or both (FNA+CNB). Non-diagnostic rate was significantly higher for FNA compared to CNB and FNA+CNB in both unselected and SRMs. Subset analysis in the FNA+CNB group showed similar diagnostic rates for FNA and CNB. In unselected masses, specificity for FNA, CNB, and FNA+CNB was 100%. Sensitivity was higher for CNB (90.1%, P = 0.002) and FNA+CNB (96.3%, P = 0.004) compared to FNA (66.7%). For unselected masses, endophytic growth predicted a non-diagnostic CNB. R.E.N.A.L location entirely between the polar lines (central) and entirely above the upper polar line predicted a diagnostic CNB. Sonography-guidance predicted a diagnostic FNA. For SRMs, non-diagnostic CNB was associated with endophytic growth, while diagnostic CNB was associated with renal sinus invasion and operator experience. More cystic masses were sampled by FNA, but diagnostic results were similar for FNA and CNB. ConclusionsEndophytic growth consistently predicted a non-diagnostic CNB in unselected and SRMs, whereas sonography-guidance predicted a diagnostic FNA. Cystic masses could be adequately sampled by FNA.

EDITORIAL COMMENT

Partial nephrectomy has become a standard of care for the surgical management of renal masses when technically feasible in part due to the benefit of improved renal function preservation and similar oncological outcomes compared to radical nephrectomy. Renal artery pseudoaneurysm (RAP) is a rare and life-threatening complication that can occur following partial nephrectomy,1,2 but may become more common with the increasing use of minimally invasive surgeries. In fact, this study corroborates the relatively high incidence of asymptomatic RAP diagnosed on postoperative screening computed tomography (CT) after partial nephrectomy that was previously reported.

Role of minimally invasive partial nephrectomy in the management of renal mass.

Partial nephrectomy is recommended for surgical management of small renal masses (SRM), or lesions ≤7 cm. The decision for surgical intervention involves a balanced patient assessment. Minimally invasive approach, which includes laparoscopic and robotic techniques, has shown to have improved blood loss, length of hospitalization, and post-operative pain while maintaining oncologic efficacy when compared to an open approach. Transperitoneal approach is preferred at most centers; however, retroperitoneoscopic minimally invasive surgery (MIS) partial nephrectomy expertise is essential for comprehensive kidney cancer care. With advances in surgical technology and deep penetration of robotics into surgical training and practice, robotic partial nephrectomy has become the modality of choice in modern clinical practice. This review discusses the indications and outcomes for various minimally invasive approaches of partial nephrectomy.

Robot-assisted partial nephrectomy: 7-year outcomes.

BACKGROUND The role of robot-assisted partial nephrectomy (RAPN) in the management of renal masses has exponentially grown over the past 10 years. Nevertheless, data on long term outcomes of the procedure remains limited. Herein we report oncological and functional outcomes of patients who underwent RAPN for a malignant mass with a median follow-up of 7 years, the longest follow-up to date. METHODS A retrospective analysis of an international multicenter database was performed. All consecutive patients undergoing surgery between 2009 and 2013 with a minimum of 3-year follow-up and complete data on renal function were included. Demographics, surgical and perioperative outcomes were analyzed. Overall survival (OS), disease-free survival (DFS), and cancer-specific survival (CSS) were evaluated using Kaplan-Meier analysis. RESULTS Overall, our study cohort was composed of eighty-five patients with a median follow-up of 88 months. Median clinical tumor size was 3 cm, with mostly (74.1%) clinical stage T1a, and median RENAL score 6. Final histopathologic analysis revealed clear cell RCC in 76.5% of cases. PSM was present in seven patients (8.2%). Eleven overall deaths (12.9%) occurred in the cohort during the follow-up period. Two of these (2.33%) were attributed to metastatic RCC. The OS, CSS, and DFS rates were 91.7%, 97.7%, and 91.7% at 84 months, respectively. Regarding the renal functional outcomes, seventeen patients (20.1%) presented a CKD upstaging in our cohort. CONCLUSIONS Our findings show excellent 7-year oncologic and functional outcomes of the procedure, which duplicate those achieved in historical series of open and laparoscopic surgery.

Contemporary trends in percutaneous renal mass biopsy utilization in the United States

IntroductionPatients with a renal mass traditionally proceed directly to surgery without a preoperative tissue diagnosis confirming malignancy. Many surgically treated renal masses represent benign tumors or indolent malignancies on final pathology. This has led to a growing body of literature supporting an expanded role for percutaneous renal mass biopsy (RMB). This study aims to characterize national trends in RMB utilization. MethodsPatients undergoing renal biopsy during a 12-year period (2006–2017) in the Premier Hospital Database were captured using International Classification of Diseases, Ninth Revision and Tenth Revision codes. We restricted our analysis to patients with a concurrent diagnosis of a renal mass. We determined utilization rate, subsequent interventions within 90 days of biopsy, predictors of RMB, and 30-day RMB complication rates. We applied sampling weights and adjusted for hospital clustering to achieve a nationally representative analysis. ResultsAmong 115,511 patients who met the inclusion criteria, the annual number of RMB rose from 7,196 in 2006 to 11,528 in 2017; during this period, more than 3 times as many patients proceeded directly to surgery without a prior RMB. After RMB, 85,848 (74.32%) patients were not treated within 90 days. Of those treated, thermal ablation was more common than surgery (17,269 vs. 12,394). Trend analysis showed that patients with metastatic disease represented a decreasing proportion of patients receiving RMB (27.0%–21.8%; P < 0.001). Compared to patients who proceeded directly to surgery, RMB was more commonly performed in patients in the highest age group (80 years and older, 15.9% vs. 9.2%), unmarried (50% vs. 45.9%), with more medical comorbidities (Charlson comorbidity index ≥4, 30.9% vs. 17.4%), or with metastatic disease (24.5% vs. 10.4%). Multivariable regression analysis determined the primary predictor of RMB was the presence of metastatic disease. Hematuria was the most common complication present in 5.18% of patients followed by pneumothorax in 1.75%. All other complications were rare (<0.4%). ConclusionAlthough there has been progressive adoption of RMB for the management of renal masses in the United States, utilization remains relatively limited and differentially employed across the population based on both clinical and nonclinical patient factors. More research is needed to understand which factors are considered when determining whether to utilize RMB in the evaluation of a renal mass.

Re: Renal Mass Biopsy is Associated with Reduction in Surgery for Early-Stage Kidney Cancer.

No AccessJournal of UrologyUrological Survey1 May 2020Re: Renal Mass Biopsy is Associated with Reduction in Surgery for Early-Stage Kidney Cancer M. Pilar LagunaMD, PhD M. Pilar LagunaM. Pilar Laguna More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000777.01AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail "Re: Renal Mass Biopsy is Associated with Reduction in Surgery for Early-Stage Kidney Cancer." The Journal of Urology, 203(5), p. 878 Suggested Reading : Risk factors for complications and nondiagnostic results following 1,155 consecutive percutaneous core renal mass biopsies. J Urol 2019; 201: 1080. Link, Google Scholar : Renal mass and localized renal cancer: AUA guideline. J Urol 2017; 198: 520. Link, Google Scholar : Diagostic accuracy of multiparametric magnetic resonance imaging to identify clear cell renal cell carcinoma in cT1a renal masses. J Urol 2017; 198: 780. Link, Google Scholar : Percutaneous needle based optical coherence tomography for the differentiation of renal masses: a pilot cohort. J Urol 2016; 195: 1578. Link, Google Scholar : Age, gender and R.E.N.A.L. nephrometry score do not improve the accuracy of a risk stratification algorithm based on biopsy and mass size for assigning surveillance versus treatment of renal tumors. J Urol 2016; 195: 574. Link, Google Scholar : Percutaneous kidney biopsy for a small renal mass: a critical appraisal of results. J Urol 2016; 195: 568. Link, Google Scholar : Patient and tumor characteristics can predict nondiagnostic renal mass biopsy findings. J Urol 2015; 193: 1899. Link, Google Scholar : Accuracy of determining small renal mass management with risk stratified biopsies: confirmation by final pathology. J Urol 2013; 189: 441. Link, Google Scholar : Can renal mass biopsy assessment of tumor grade be safely substituted for by a predictive model?J Urol 2009; 182: 2585. Link, Google Scholar © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue 5May 2020Page: 878-878 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information M. Pilar Laguna More articles by this author Expand All Advertisement PDF DownloadLoading ...

The role of renal mass biopsy in the management of small renal masses – patterns of use and surgeon opinion

Aims: Renal mass biopsy (RMB) is advocated to improve management of small renal masses, however there is concern about its clinical utility. This study aimed to elicit opinions about the role of RMB in small renal mass management from surgeons managing renal cell carcinomas (RCC), and examine the frequency of pre-treatment biopsy in those with RCC. Methods: All surgeons in two Australian states (Queensland: n = 59 and Victoria: n = 108) who performed nephrectomies for RCC in 2012/2013 were sent questionnaires to ascertain views about RMB. Response rates were 54% for Queensland surgeons and 38% for Victorian surgeons. We used medical records data from RCC patients to determine RMB frequency. Results: Most Queensland (81%) and Victorian (59%) surgeons indicated they rarely requested RMB; however 34% of Victorians reported often requesting RMB, compared with no Queensland surgeons. This was consistent with medical records data: 17.6% of Victorian patients with T1a tumours received RMB versus 6.7% of Queensland patients ( p &lt; 0.001). Surgeons’ principal concerns regarding RMB related to sampling reliability (90%) and/or histopathological interpretation (76%). Conclusions: Most surgeons report infrequent use of RMB for small renal masses, however we observed practice variation. The principal reasons for infrequent use were concerns about sampling reliability and histopathological interpretation, which may be valid in regions with less access to interventional radiologists and uropathologists. Further evidence is required to define patient groups for whom biopsy results will alter management. Level of evidence: Not applicable for this multicentre audit.

Invasive management of renal cell carcinoma in von Hippel-Lindau disease.

IntroductionPatients affected by von Hippel-Lindau (VHL) disease experience an increased risk for bilateral, synchronous, and metachronous renal cell carcinoma (RCC). Oncologic and functional outcomes are the main goals in the management of renal masses. We present our protocol for patients with VHL disease-associated RCC alongside functional and oncologic results observed in our series.Material and methodsWe performed a retrospective analysis of our clinical database of patients with VHL disease-associated RCC referred to our department between June 2005 and December 2017. We offer surveillance for lesions <2 cm and active management with radiofrequency ablation (RFA) for lesions 2–3 cm, and nephron-sparing surgery (NSS), RFA or embolization techniques for lesions >3 cm or growth rate >1 cm/year.ResultsOur series comprises 14 patients, of whom 13 had undergone at least one invasive procedure for RCC, mean age at first intervention was 27 years (range 18–60). Overall, 30 interventions were performed in 21 kidneys: four radical nephrectomies, 13 RFAs, 12 NSSs, and one embolization. During follow-up (median time: 41 months, range: 6–149), eight patients (57%) presented with new lesions that required treatment, with a mean time between treatments of 32 ±18.5 months. No metastatic progression or need for dialysis was recorded; the success rate for RFA was 85%.ConclusionsManagement of VHL kidney disease by NSS is the standard of care with a cut-off at 3 cm, ablative procedures should be offered to lesions ranging 2–3 cm in size. Follow-up should be done strictly in referral centers that can provide all treatment options to renal function and control oncologic progression.

Histomorphological study of renal tumors in a tertiary care hospital

Introduction: Renal tumors can present as a mass or lump on the side or lower back along with other clinical symptoms such as fatique, loss of apetite and weight loss. Nephrectomy is done as a surgical management for renal masses. Aim: To study the histopathological spectrum of neoplastic lesions in nephrectomy specimen Methods: Study included all the nephrectomy cases done for renal tumor over a period of 10 years (November 2008-october2018) Results: Out of 85 neoplastic lesions, renal cell carcinoma was the most common lesion diagnosed in 68 (80%) specimens, followed by Wilms tumor in 9(10.58%) specimens, followed by metanephric adenoma in 3(3.52%) and squamous cell carcinoma in 2(2.35%) while angiomyolipoma, multicystic nephroma and renal sarcoma were diagnosed in 1 (1.17%) specimen each.

Renal Artery Embolization Before Radical Nephrectomy for Complex Renal Tumour: Which are the True Advantages?

IntroductionRenal artery embolization is performed before radical nephrectomy (RN) for renal mass in order to induce preoperative infarction and to facilitate surgical intervention through decrease of intraoperative bleeding. Moreover, in metastatic renal cancer it seems to stimulate tumour-specific antibodies, even if no established benefits in clinical response or survival have been reported. The role of preoperative renal artery embolization (PRAE) in management of renal masses has been often debated and its real benefits are still unclear. Nevertheless, in huge and complex renal masses, which are often characterized by a high and anarchic blood supply and rapid local invasion, radical nephrectomy can be challenging even for skilled surgeons. The aim of this prospective randomized study was to evaluate the effectiveness and safety of PRAE in complex masses by comparing perioperative outcomes of RN with and without PRAE.Materials and methodsFrom December 2015 to May 2018 we enrolled prospectively 64 patients who underwent RN for localized (T2a-b) or locally advanced (T3 and T4) or advanced (N+, M+) renal cancers. Patients were divided in two groups. The first group included 30 patients who underwent PRAE; in the second group we enrolled 34 patients who did not undergo RN without PRAE. Perioperative outcomes in terms of operative time, blood loss, transfusion rate and length of hospitalization were evaluated. Statistical analysis was performed using GraphPad Prism 6.0 software.ResultsMedian blood loss was 250 ml (50-500) and 400 ml (50-1000) in the first and second group, respectively, with a statistically significant difference (p=0.0066). Median surgical time was 200 min (90-390) and 240 min (130-390) in PRAE and No-PRAE group (p=0.06), respectively. No major complications occurred after embolization. Overall complication rate in Group 1 and 2 was 46.7% (14/30) and 50% (17/34), respectively (p=0.34). No major complications occurred in both groups. The mean follow up was 21,5 months.ConclusionsOur results prove PRAE to be a safe procedure with low complications rate. To our experience, PRAE seems to be a useful tool in surgical management of a large mass and advanced disease.

Re: Role of Virtual Biopsy in the Management of Renal Masses.

Re: Role of Virtual Biopsy in the Management of Renal Masses.

Evolving Trends for Selected Treatments of T1a Renal Cell Carcinoma

ObjectiveTo evaluate contemporary trends in the management of small renal masses and how patient age has impacted practice patterns. MethodsUsing the NCDB Participant User File (PUF) from 2002 to 2015, we identified patients with T1a renal masses. The initial treatment was categorized as radical nephrectomy (RN), partial nephrectomy (PN), ablation, or active surveillance (AS). A multinominal logistic regression model was used to identify significant factors impacting treatment. ResultsWe identified 75,691 patients for analysis. RN, PN, and ablation accounted for 28%, 52%, and 12%, respectively, while 8% were managed with AS. In the past decade the likelihood of undergoing PN, ablation, or surveillance compared to RN has consistently increased, independent of age, sex, race, comorbidity, tumor size, or institution. As age increased, patients were independently less likely to undergo PN and more likely to be managed with ablation or AS. Compared to patients under 40 years of age, patients between 70 and 79 were far less likely to undergo PN (RR 0.58, P< .01), and far more likely to undergo either ablation (RR 5.53, P< .01) or AS (RR 3.7, P< .01). ConclusionTrends in small renal mass management continue to evolve, with PN supplanting RN over the past decade as the predominant surgical treatment. Age significantly impacts treatment selection, particularly in older cohorts whom are much more likely to undergo ablation or AS. While the use of minimally invasive therapies has increased over the past decade, AS lags behind despite quality data supporting its use. When controlling for multiple clinical factors, PN, ablation and surveillance have consistently increased in utilization compared to RN.

Role of Virtual Biopsy in the Management of Renal Masses.

OBJECTIVE. Renal masses comprise a heterogeneous group of pathologic conditions, including benign and indolent diseases and aggressive malignancies, complicating management. In this article, we explore the emerging role of imaging to provide a comprehensive noninvasive characterization of a renal mass-so-called "virtual biopsy"-and its potential use in the management of patients with renal tumors. CONCLUSION. Percutaneous renal mass biopsy (RMB) remains a valuable method to provide a presurgical histopathologic diagnosis of renal masses, but it is an invasive procedure and is not always feasible. Accumulating data support the use of imaging features to predict histopathology of renal masses. Imaging may help address some of the inherent limitations of RMB, and in certain settings, a multimodal clinical approach may allow decreasing the need for RMB.

Evolving trends in the surgical management of renal masses over the past two decades: A contemporary picture from a large prospectively-maintained database.

To investigate the trends in the presentation and surgical management of renal tumors at Singapore General Hospital, Singapore. We accessed our uro-oncological registry to extract the clinicopathological data of patients with renal tumors who underwent nephrectomy from 2000 to 2015. Binary logistic regression was used to identify predictors of nephron-sparing surgery utilization, Clavien-Dindo grade≥III complications and progression to stage≥3 chronic kidney disease. Cox regression models were created to evaluate the proportional hazards of the risk factors for overall survival and cancer-specific survival. A total of 1208 cases of nephrectomy were carried out between 2000 and 2015. The proportion of cT1a tumors increased from 2000-2004 to 2010-2015, which was accompanied by the doubling of utilization rates of nephron-sparing surgery and minimally invasive surgery. Charlson Comorbidity Index score <2, asymptomatic presentation, clinical T1a tumors and having an estimated glomerular filtration rate ≥30mL/min/1.73m2 were all independent predictors of nephron-sparing surgery utilization. Age, symptomatic presentation and nephron-sparing surgery utilization were all significantly associated with greater odds of having Clavien-Dindo grade≥III complications, whereas minimally invasive surgery was associated with decreased risk. The utilization of partial nephrectomy and minimally invasive surgery was significantly associated with a decreased risk of developing postoperative stage≥3 chronic kidney disease. Both overall survival and cancer-specific survival were not significantly affected by whether nephron-sparing surgery was utilized. There has been an increasing proportion of small renal masses diagnosed incidentally with a shift towards nephron-sparing surgery for clinically localized tumors. With the adoption of nephron-sparing surgery, progression to stage3 chronic kidney disease has decreased, without any compromise in oncological and survival outcomes.

Reply by Authors

No AccessJournal of UrologyLetter to the Editor/Errata1 Oct 2018Reply by Authors View All Author Informationhttps://doi.org/10.1016/j.juro.2018.05.144AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail "Reply by Authors." The Journal of Urology, 200(4), p. 904 References 1 : Parenchymal volume preservation and ischemia during partial nephrectomy: functional and volumetric analysis. Urology2013; 82: 263. Google Scholar 2 : Management of renal masses and localized renal cancer: systematic review and meta-analysis. J Urol2016; 196: 989. Link, Google Scholar 3 : Impact of comorbidities on functional recovery from partial nephrectomy. J Urol2018; 199: 1433. Link, Google Scholar 4 : A mathematical method to calculate tumor contact surface area: an effective parameter to predict renal function after partial nephrectomy. J Urol2016; 196: 33. Link, Google Scholar © 2018 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 200Issue 4October 2018Page: 904 Advertisement Copyright & Permissions© 2018 by American Urological Association Education and Research, Inc.MetricsAuthor Information Expand All Advertisement PDF downloadLoading ...