Evaluation Of Renal Masses Research Articles

Magnetic Resonance Imaging in Evaluation of Cystic Renal Masses Using Bosniak Classification Version 2019

Abstract Background Cystic renal lesions are very commonly encountered at abdominal imaging. Most lesions are asymptomatic and incidentally found. When a confident diagnosis cannot be rendered, incidental renal masses are considered indeterminate and typically are furtherly evaluated with CT or MRI using Bosniak classification that is specifically designed to evaluate them. Objective To assess MRI in evaluation of cystic renal masses using Bosniak classification version 2019 to stratify the risk of malignancy in correlation to histo-pathological analysis. Patients and Methods This was a cross sectional study that included 60 patients who were diagnosed to have cystic renal lesion either outpatients or referred from the urology department at Ain Shams University Hospitals to the radiodiagnosis department For pelvi-abdominal MRI examination. An acceptance from the ethical committee of the Radiology Department and the ethical Committee of faculty of medicine - Ain Shams University hospitals was obtained to use the data stared on PACs system With the patient’s consent waived. All patients gone through MR assessment utilizing 1.5 T machine (inginea Philips). Results From our study simple renal cyst (bosniak I) were the most common benign lesion and Cystic renal masses classified as Bosniak IV were the most common malignant lesion. After exclusion of benign causes 17 cases were included in histopathology. Clear cell Renal cell carcinomas were the most common finding and we correlate Histopathology with MRI results and It shows high significant relation between Bosniak classification and histopathology. Conclusion Bosniak classification version 2019 has high sensitivity and specifity in correlation to histopathology.

Limited Utility of Quantitative Thresholds on 99mTc-Sestamibi Single-Photon Emission Computed Tomography/Computed Tomography for Distinguishing Renal Cell Carcinoma From Oncocytic Renal Masses

Purpose: 99mTc-sestamibi single-photon emission CT/x-ray CT (SPECT/CT) uses a mitochondria-targeting tracer to differentiate renal cell carcinoma from oncocytomas and hybrid oncocytoma/chromophobe tumors. Initial studies support 99mTc-sestamibi SPECT/CT’s accuracy, but we previously found that oncocytomas still account for 20% of lesions with low tracer uptake in qualitatively interpreted scans. Here, we assess performance of 99mTc-sestamibi SPECT/CT utilizing quantitative assessment thresholds, hypothesizing that this may improve test performance. Materials and Methods: All 99mTc-sestamibi SPECT/CT performed for renal mass evaluation between February 2020 and December 2021 was analyzed. A “hot” mass had qualitatively equivalent or higher 99mTc-sestamibi uptake than normal renal parenchyma; a “cold” mass did not. Target-to-background ratios (TBRs) were calculated using tracer counts in the masses vs nearby normal parenchyma. Quantitative “hot”/“cold” determinations were made using published TBR cutoffs. Findings were correlated with histology. Results: Seventy-eight patients underwent 99mTc-sestamibi SPECT/CT for 98 renal masses. For the 52 masses with diagnostic pathology, the negative predictive value (NPV) of qualitatively interpreted 99mTc-sestamibi SPECT/CT for ruling out oncocytoma was 80%, with a 1.9% false-positive rate. A TBR cutoff of 0.46 achieved the highest NPV of 89.3%, with a 23.1% false-positive rate. A TBR cutoff of 0.74 achieved the lowest false-positive rate of 1.9%, with a 78.3% NPV. No TBR cutoff achieved both higher NPV and lower false positives than the qualitatively interpreted scans. Conclusions: Quantitative TBR cutoffs for interpretation of 99mTc-sestamibi SPECT/CT scans for renal masses do not offer meaningful improvements in accuracy over qualitative reads. Additional studies are required to better characterize the utility of 99mTc-sestamibi SPECT/CT in the real-world setting.

Contrast-Enhanced Ultrasound in the Diagnosis of Solid Renal Lesions.

The availability of imaging methods has enabled increased detection of kidney lesions, which are a common clinical problem. It is estimated that more than half of patients over the age of 50 have at least one undetermined mass in the kidney. The appropriate characterization and diagnosis of lesions imaged in the kidney allows for proper therapeutic management. Previously, contrast-enhanced computed tomography (CT) and contrast-enhanced magnetic resonance imaging (MRI) have been used in their extended diagnosis. However, the limitations of these techniques, such as radiation exposure, renal toxicity, and allergies to contrast agents, must be considered. Contrast-enhanced ultrasound (CEUS) is increasingly being used as an examination to resolve interpretive doubts that arise with other diagnostic methods. Indeed, it can be considered both as a problem-solving technique for diagnosing and distinguishing lesions and as a technique used for observation in preservative treatment. Evaluation of the enhancement curve over time on CEUS examination can help to differentiate malignant renal cell carcinoma (RCC) subtypes that should be resected from benign lesions, such as oncocytoma or angiomyolipoma (AML), in which surgery can be avoided. It allows for distinguishing between benign and malignant tumors, renal and pseudotumors, and solid and cystic tumors. Therefore, with recent advances in ultrasound technology, CEUS has emerged as a fast, reliable, and cost-effective imaging tool in the preoperative evaluation and diagnosis of solid renal masses.

Update on Renal Cell Carcinoma Diagnosis with Novel Imaging Approaches.

This review highlights recent advances in renal cell carcinoma (RCC) imaging. It begins with dual-energy computed tomography (DECT), which has demonstrated a high diagnostic accuracy in the evaluation of renal masses. Several studies have suggested the potential benefits of iodine quantification, particularly for distinguishing low-attenuation, true enhancing solid masses from hyperdense cysts. By determining whether or not a renal mass is present, DECT could avoid the need for additional imaging studies, thereby reducing healthcare costs. DECT can also provide virtual unenhanced images, helping to reduce radiation exposure. The review then provides an update focusing on the advantages of multiparametric magnetic resonance (MR) imaging performance in the histological subtyping of RCC and in the differentiation of benign from malignant renal masses. A proposed standardized stepwise reading of images helps to identify clear cell RCC and papillary RCC with a high accuracy. Contrast-enhanced ultrasound may represent a promising diagnostic tool for the characterization of solid and cystic renal masses. Several combined pharmaceutical imaging strategies using both sestamibi and PSMA offer new opportunities in the diagnosis and staging of RCC, but their role in risk stratification needs to be evaluated. Although radiomics and tumor texture analysis are hampered by poor reproducibility and need standardization, they show promise in identifying new biomarkers for predicting tumor histology, clinical outcomes, overall survival, and the response to therapy. They have a wide range of potential applications but are still in the research phase. Artificial intelligence (AI) has shown encouraging results in tumor classification, grade, and prognosis. It is expected to play an important role in assessing the treatment response and advancing personalized medicine. The review then focuses on recently updated algorithms and guidelines. The Bosniak classification version 2019 incorporates MRI, precisely defines previously vague imaging terms, and allows a greater proportion of masses to be placed in lower-risk classes. Recent studies have reported an improved specificity of the higher-risk categories and better inter-reader agreement. The clear cell likelihood score, which adds standardization to the characterization of solid renal masses on MRI, has been validated in recent studies with high interobserver agreement. Finally, the review discusses the key imaging implications of the 2017 AUA guidelines for renal masses and localized renal cancer.

Scientific Status Quo of Small Renal Lesions: Diagnostic Assessment and Radiomics.

Background: Small renal masses (SRMs) are defined as contrast-enhanced renal lesions less than or equal to 4 cm in maximal diameter, which can be compatible with stage T1a renal cell carcinomas (RCCs). Currently, 50-61% of all renal tumors are found incidentally. Methods: The characteristics of the lesion influence the choice of the type of management, which include several methods SRM of management, including nephrectomy, partial nephrectomy, ablation, observation, and also stereotactic body radiotherapy. Typical imaging methods available for differentiating benign from malignant renal lesions include ultrasound (US), contrast-enhanced ultrasound (CEUS), computed tomography (CT), and magnetic resonance imaging (MRI). Results: Although ultrasound is the first imaging technique used to detect small renal lesions, it has several limitations. CT is the main and most widely used imaging technique for SRM characterization. The main advantages of MRI compared to CT are the better contrast resolution and tissue characterization, the use of functional imaging sequences, the possibility of performing the examination in patients allergic to iodine-containing contrast medium, and the absence of exposure to ionizing radiation. For a correct evaluation during imaging follow-up, it is necessary to use a reliable method for the assessment of renal lesions, represented by the Bosniak classification system. This classification was initially developed based on contrast-enhanced CT imaging findings, and the 2019 revision proposed the inclusion of MRI features; however, the latest classification has not yet received widespread validation. Conclusions: The use of radiomics in the evaluation of renal masses is an emerging and increasingly central field with several applications such as characterizing renal masses, distinguishing RCC subtypes, monitoring response to targeted therapeutic agents, and prognosis in a metastatic context.

Clinical Evaluation of Cystic Renal Masses With Bosniak Classification by Contrast-Enhanced Ultrasound and Contrast-Enhanced Computer Tomography.

The study aims to compare retrospectively three clinically applied methods for the diagnostic performance of cystic renal masses (CRMs) by contrast-enhanced ultrasound (CEUS) and contrast-enhanced computer tomography (CECT) with Bosniak classification system. A total of 52 cases of Bosniak II-IV CRMs in 49 consecutive patients were diagnosed from January 2013 to July 2022 and their data were analyzed. All patients had been subjected to CEUS and CECT simultaneously. Pathological diagnoses and masses stability were used as standard references to determine whether lesions were malignant or benign. Then 49 CRMs only with pathologic results were classified into group 1 and 2. A total of 52 CRMs in 49 enrolled patients were classified into 8 category II, 16 category IIF, 15 category III, and 13 category IV by CEUS (EFSUMB 2020), 10 category II, 13 category IIF, 16 category III, and 13 category IV by CEUS (V2019), while 15 category II, 9 category IIF, 13 category III, and 15 category IV by CECT (V2019). Pathological results and masses stability longer than 5 years follow-up performed substantially for CEUS (EFSUMB 2020), CEUS (V2019), and CECT (V2019) (kappa values were 0.696, 0.735, and 0.696, respectively). Among 49 pathologic approving CRMs, wall/septation thickness ≥4 mm, wall/septation thickness, presence of enhancing nodule and the diameter were found to be statistically significant for malignancy. Twenty-two malignant masses were correctly diagnosed by CEUS (V2019), while 21 malignant masses were both correctly diagnosed by CEUS (EFSUMB 2020) and CECT (V2019), and 1 mass was misdiagnosed. Bosniak classification of EFSUMB 2020 version might be as accurate as version 2019 CEUS and version 2019 CECT in diagnosing CRMs, and CEUS is found to have an excellent safety profile in dealing with clinical works.

Role of Contrast-Enhanced Ultrasound in Evaluation of Cystic Renal Mass.

Contrast-enhanced ultrasound (CEUS) allows excellent delineation of perfusion in septa and nodules without exposure to ionizing radiation or nephrotoxic contrast media. The aim of our study was to evaluate the role of CEUS for the assessment of cystic renal masses and compare its diagnostic performance with that of CECT. Exactly 40 patients diagnosed to have cystic renal masses on CECT scan were prospectively evaluated with CEUS and were assigned a Bosniak class. Based on results of final histopathology and clinical follow-up, internal validity of both CEUS and CECT was evaluated, including agreement between these two modalities. Out of the 40 patients (mean size 3.1 ± 2.5 cm), 23 patients had benign lesions and 17 patients had malignant lesions. For CEUS, the sensitivity and negative predictive value was 100%, the specificity and positive predictive value was 73.9%. For CECT, the sensitivity and negative predictive value were 88.2 and 83.3%, respectively, whereas the specificity and positive predictive value was 87 and 90.9%, respectively. Both imaging modalities had similar accuracy with fair to good agreement with the final diagnosis (Κ = 0.71 and 0.75 for CEUS and CECT, respectively). Concordance between CEUS and CECT was seen in 29 patients (72.5%) with fair agreement between the two modalities (K = 0.66). CEUS has comparable accuracy with CECT and could be used as screening modality to rule out the presence of complex cystic renal masses without exposure of nephrotoxic contrast media and ionizing radiation.

Computed Tomographic Evaluation of Renal Mass with Histopathological Correlation

Renal cell carcinoma (RCC) is the seventh most common cancer and the most common primary renal malignant neoplasm in adults. Computed Tomography (CT) is of a great value in differentiating malignant from benign masses of RCC. This cross-sectional study was conducted among 61 clinically suspected cases of renal mass at Sir Salimullah Medical College and Mitford Hospital (SSMC and Mitford Hospital) in the Department of Radiology and Imaging in collaboration with the Department of Urology and Pathology, from July ’2011 to June’ 2013. However, in 05 cases, histopathological reports were not available and 07 patients refused surgery after enrolling. Finally, histopathology reports were collected from 49 patients and they were considered as study subjects. Aim of the study was to evaluate the accuracy of CT scan findings in compere with the histopathological report for the diagnosis of renal mass and to differentiate its benign and malignant forms. The age range of the patients was 2 to 73 years, where more than two-third (69.38%) were male and rest of them were female. Maximum number of malignant cases observed in the age range of 50-59 years. In comparison, inflammatory and benign conditions dominate in early age group, mostly before 40 years. Among 49 cases, 41 (83.68%) cases were diagnosed as malignant renal mass by CT scan, 01 (2.04) case was missed, which was confirmed by histopathology. Rest 07 (14.28%) patients were diagnosed as benign both in CT scan and histopathology. The sensitivity of CT for malignant renal mass was found 97.62% and specificity was 100%. The positive and negative predictive values of CT were 87.5% and 97.59% respectively. Computed tomography is a valid diagnostic modality for differentiating benign and malignant renal mass. Bangladesh Med J. 2021 Sept; 51(1): 41-46

External Validation of a Five-Tiered CT Algorithm for the Diagnosis of Clear Cell Renal Cell Carcinoma: A Retrospective Five-Reader Study.

BACKGROUND. In 2022, a five-tiered CT algorithm was proposed for predicting whether a small (cT1a) solid renal mass represents clear cell renal cell carcinoma (ccRCC). OBJECTIVE. The purpose of this external validation study was to evaluate the proposed CT algorithm for diagnosis of ccRCC among small solid renal masses. METHODS. This retrospective study included 93 patients (median age, 62 years; 42 women, 51 men) with 97 small solid renal masses that were seen on corticomedullary phase contrast-enhanced CT performed between January 2012 and July 2022 and subsequently underwent surgical resection. Five readers (three attending radiologists, two clinical fellows) independently evaluated masses for the mass-to-cortex corticomedullary attenuation ratio and heterogeneity score; these scores were used to derive the CT score by use of the previously proposed CT algorithm. The CT score's sensitivity, specificity, and PPV for ccRCC were calculated at threshold of 4 or greater, and the NPV for ccRCC was calculated at a threshold of 3 or greater (consistent with thresholds in studies of the MRI-based clear cell likelihood score and the CT algorithm's initial study). The CT score's sensitivity and specificity for papillary RCC were calculated at a threshold of 2 or less. Interreader agreement was assessed using the Gwet agreement coefficient (AC1). RESULTS. Overall, 61 of 97 masses (63%) were malignant and 43 of 97 (44%) were ccRCC. Across readers, CT score had sensitivity ranging from 47% to 95% (pooled sensitivity, 74% [95% CI, 68-80%]), specificity ranging from 19% to 83% (pooled specificity, 59% [95% CI, 52-67%]), PPV ranging from 48% to 76% (pooled PPV, 59% [95% CI, 49-71%]), and NPV ranging from 83% to 100% (pooled NPV, 90% [95% CI, 84-95%]), for ccRCC. A CT score of 2 or less had sensitivity ranging from 44% to 100% and specificity ranging from 77% to 98% for papillary RCC (representing nine of 97 masses). Interreader agreement was substantial for attenuation score (AC1 = 0.70), poor for heterogeneity score (AC1 = 0.17), fair for five-tiered CT score (AC1 = 0.32), and fair for dichotomous CT score at a threshold of 4 or greater (AC1 = 0.24 [95% CI, 0.14-0.33]). CONCLUSION. The five-tiered CT algorithm for evaluation of small solid renal masses was tested in an external sample and showed high NPV for ccRCC. CLINICAL IMPACT. The CT algorithm may be used for risk stratification and patient selection for active surveillance by identifying patients unlikely to have ccRCC.

Virtual Non-Contrast Spectral CT in Renal Masses: Is It Time to Discard Conventional Unenhanced Phase?

Dual-layer Dual-Energy CT (dl-DECT) allows one to create virtual non-contrast (VNC) reconstructions from contrast-enhanced CT scans, with a consequent decrease of the radiation dose. This study aims to assess the reliability of VNC for the diagnostic evaluation of renal masses in comparison with true non-contrast (TNC) images. The study cohort included 100 renal masses in 40 patients who underwent dl-DECT between June and December 2021. Attenuation values and standard deviations were assessed through the drawing of regions of interest on TNC and VNC images reconstructed from corticomedullary and nephrographic phases. A Wilcoxon signed-rank test was performed in order to assess equivalence of data and Spearman's Rho correlation coefficient to evaluate correlations between each parameter. The diagnostic accuracy of VNC was estimated through the performance of receiver operating characteristic (ROC) curve analysis. Differences between attenuation values were, respectively, 74%, 18%, 5% and 3% (TNC-VNCcort), and 74%, 15%, 9% and 2% (TNC-VNCneph). The Wilcoxon signed-rank test demonstrated the equivalence of attenuation values between the TNC and VNC images. The diagnostic performance of VNC images in the depiction of kidney simple cysts remains high compared to TNC (VNCcort-AUC: 0.896; VNCneph-AUC: 0.901, TNC-AUC: 0.903). In conclusion, quantitative analysis of attenuation values showed a strong agreement between VNC and TNC images in the evaluation of renal masses.

Clinical Performance of Technetium-99m-Sestamibi SPECT/CT Imaging in Differentiating Oncocytic Tumors From Renal Cell Carcinoma in Routine Clinical Practice.

Technetium-99m-sestamibi single-photon emission CT/x-ray CT is an emerging clinical tool to differentiate oncocytic tumors from renal cell carcinomas. We report data from a large institutional cohort of patients who underwent technetium-99m-sestamibi scans during evaluation of renal masses. Patients who underwent technetium-99m-sestamibi single-photon emission CT/x-ray CT between February 2020 and December 2021 were included in the analysis. Scans were defined as "hot" for oncocytic tumor when technetium-99m-sestamibi uptake was qualitatively equivalent or higher between the mass of interest and normal renal parenchyma, suggesting oncocytoma, hybrid oncocytic/chromophobe tumor, or chromophobe renal cell carcinoma. Demographic, pathological, and management strategy data were compared between "hot" and "cold" scans. For individuals who underwent diagnostic biopsy or extirpative procedures, the concordance between radiological findings and pathology was indexed. A total of 71 patients (with 88 masses) underwent technetium-99m-sestamibi imaging with 60 (84.5%) patients having at least 1 "cold" mass on imaging and 11 (15.5%) patients exhibiting only "hot" masses. Pathology was available for 7 "hot" masses, with 1 biopsy specimen (14.3%) being discordant (clear cell renal cell carcinoma). Five patients with "cold" masses underwent biopsy. Out of 5 biopsied masses, 4 (80%) were discordant oncocytomas. Of the extirpated specimens, 35/40 (87.5%) harbored renal cell carcinoma and 5/40 (12.5%) yielded discordant oncocytomas. In sum, 20% of pathologically sampled masses that were "cold" on technetium-99m-sestamibi imaging still harbored oncocytoma/hybrid oncocytic/chromophobe tumor/chromophobe renal cell carcinoma. Further work is needed to define utility of technetium-99m-sestamibi in real-world clinical practice. Our data suggest this imaging strategy is not yet ready to replace biopsy.

Guideline Compliance Regarding Chest Imaging of Suspicious cT1 Renal Masses in MUSIC-KIDNEY.

Multiple urological societies recommend chest imaging for suspicious renal masses using chest x-ray or CT as clinically indicated. The purpose of chest imaging is to assess for thoracic metastasis at the time of renal mass diagnosis. Ideally, imaging use and type are commensurate with risk related to tumor size and clinical stage. We examined current practice patterns with chest imaging compliance in the state of Michigan and implemented clinician education and value-based reimbursement incentivization on guideline adherence. MUSIC (Michigan Urological Surgery Improvement Collaborative)-KIDNEY (Kidney mass: Identifying and Defining Necessary Evaluation and therapY) is a statewide initiative focusing on quality improvement for patients with cT1 renal masses. Data regarding chest imaging in MUSIC and panel discussion occurred at an in-person MUSIC meeting in October 2019. Adherence to chest imaging guidelines was made a value-based reimbursement metric at the triannual MUSIC meeting in January 2020. Adherence was defined as optional in renal masses <3 cm (CT not indicated), recommended in renal masses 3-5 cm (chest x-ray preferred), and required in renal masses >5 cm (CT preferred). The MUSIC registry was queried for percentage of patients receiving chest imaging by type. Factors associated with adherence were assessed. There was significant practice-level variation in chest imaging rates across the 14 contributing practices, ranging from 11% to 68%. Compliance with MUSIC guidelines for chest imaging during evaluation of T1 renal masses was 81.8% overall, with only 61.8% of patients with masses >5 cm meeting the guideline requiring imaging with preference for CT. Factors associated with increased adherence included larger tumor size (T1b vs T1a) and solid (vs cystic or indeterminate) tumor (P < .05 for each). Prior to value-based reimbursement introduction, 46.7% of patients underwent imaging of either type, compared to 49.0% post-intervention. Imaging rates only slightly increased in masses >5 cm (58.3% before value-based reimbursement vs 61.2% after, P = .56) and 3-5 cm (50.0% before value-based reimbursement vs 56.2% after, P = .0585). Chest imaging guideline adherence during the initial evaluation of cT1 renal masses is acceptable, particularly given that most masses are <3 cm, for which metastatic risk is low. However, despite consensus from major urological societies regarding imaging for masses >4-5 cm, imaging rates were low across MUSIC. After educational and value-based reimbursement incentive initiation, rates of imaging for 3-5-cm and >5-cm masses changed only slightly. There remains significant practice variability and room for improvement.

MP09-17 EFFICACY AND SAFETY OF CT-GUIDED MICROWAVE ABLATION IN PATIENTS WITH LOCALIZED SMALL RENAL MASSES

You have accessJournal of UrologyCME1 Apr 2023MP09-17 EFFICACY AND SAFETY OF CT-GUIDED MICROWAVE ABLATION IN PATIENTS WITH LOCALIZED SMALL RENAL MASSES Shivani Jain, Ashley Foret, Chelsea Baumgartner, Megan Escott, Benjamin Henderson, Sean O'Brien, Scott Delacroix, Jessie Gills, and Mary Westerman Shivani JainShivani Jain More articles by this author , Ashley ForetAshley Foret More articles by this author , Chelsea BaumgartnerChelsea Baumgartner More articles by this author , Megan EscottMegan Escott More articles by this author , Benjamin HendersonBenjamin Henderson More articles by this author , Sean O'BrienSean O'Brien More articles by this author , Scott DelacroixScott Delacroix More articles by this author , Jessie GillsJessie Gills More articles by this author , and Mary WestermanMary Westerman More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003224.17AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: CT-guided microwave ablation (MWA) is increasingly used for the treatment of localized small renal masses, especially in patients with co-morbidities that increase the risks of traditional nephrectomy. The main advantages of a percutaneous ablative approach over surgery include less invasiveness and lower reported complication rates. We report patient characteristics and outcomes following MWA of clinically localized small renal masses. METHODS: A retrospective chart review of our institution’s biopsy database was conducted to identify all patients with clinically localized renal masses 3 cm or less on abdominal imaging and who underwent a subsequent renal mass biopsy (RMB) and MWA between the years of 2012 and 2022. RESULTS: 135 patients met inclusion criteria. MWA was technically successful in 98.4% of patients. The majority of patients were male (59.9%) and Caucasian (82.5%). Median (IQR) tumor size was 2.2 cm (0.7,3). The median (IQR) for age and BMI was 70 (38,94) and 30.7 (15.0,52.7), respectively. These parameters for MWA ablation time in minutes and watts were 10 (1,20) and 65 (65,140), respectively. 36% of lesions biopsied were benign oncocytomas. In those with biopsy-proven clear cell RCC, 4.3% of patients had complications following MWA. Complications requiring readmission, albeit rare, included urosepsis, lung collapse, and retroperitoneal hematoma. Renal function was conserved in all except 2 patients. Local recurrence requiring repeat ablation (4, 3.27%) or surgery (partial nephrectomy (2, 1.64%), radical nephrectomy (5, 4.10%) was rare. Metastatic-free survival was 95.6% at 24 months for patients who underwent MWA (95% CI 93.4 – 98.7). CONCLUSIONS: In this retrospective review of renal masses 3 cm or less that subsequently underwent RMB and MWA, procedural complication requiring admission or readmission was rare. Local control rates were 98.3% for cT1a malignancies. Complication and local control rates found in this large contemporary study are lower than those reported in previously published data. A majority of research on thermal ablation for renal masses focuses on cryoablation and RFA, and AUA 2021 guidelines on renal mass evaluation and management consider MWA an investigational technique. Nonetheless, MWA has potential advantages of higher ablation volume and shorter ablation time compared against other thermal techniques. MWA for renal masses 3 cm or less should be further investigated as a safe and efficacious option for patients who have co-morbidities that increase the risk of surgical complications. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e112 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Shivani Jain More articles by this author Ashley Foret More articles by this author Chelsea Baumgartner More articles by this author Megan Escott More articles by this author Benjamin Henderson More articles by this author Sean O'Brien More articles by this author Scott Delacroix More articles by this author Jessie Gills More articles by this author Mary Westerman More articles by this author Expand All Advertisement PDF downloadLoading ...

Contrast-enhanced ultrasonography in the differential diagnosis of complex renal cysts and small renal masses

BackgroundRenal masses can be divided into complex cysts and solid lesions. The Bosniak classification divides renal cysts into IV categories bases on different criteria. Based on this characterization, a decision about further management can be made. Sonography or contrast-enhanced sonography is one of the standard diagnostic procedures for renal cysts and is a useful method for classification into the Bosniak categories.ObjectivesThis review describes cystic kidney lesions and their differentiation using contrast-enhanced sonography, which is intended to support further management.Materials and methodsA selective literature search and evaluation of the own patient collective were carried out for the preparation of the review.ConclusionContrast-enhanced sonography is a simple and inexpensive technique. In the evaluation of complex renal cysts and small solid renal masses, it allows rapid determination of the appropriate therapeutic approach, especially since additional information about the vascularization of the renal masses is obtained.

Diagnostic Performance of Contrast-Enhanced Ultrasound in the Evaluation of Small Renal Masses: A Systematic Review and Meta-Analysis.

Ultrasound (US) is a highly sensitive imaging tool in the detection of renal masses. However, the detection rate of small renal masses (SRMs) (<4 cm) is still limited. In this scenario, contrast-enhanced ultrasound (CEUS) is a relatively novel, but increasingly utilized, diagnostic modality which aims to increase the overall diagnostic ability in the identification of SRMs. In consequence, we performed a systematic review (SR) and pooled meta-analysis to investigate the diagnostic performance of CEUS in the evaluation of SRMs confirmed by pathology. A SR up to April 2022 was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. The diagnostic performance of CEUS was evaluated basing on malignant vs. benign SMRs. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) from eligible studies were pooled, and summary receiver operating characteristic (SROC) curves were constructed for each endpoint. Overall, five qualified studies were deemed suitable for this meta-analysis. Finally, diagnostic performance of CEUS showed an accuracy of 0.93 in detecting malignant masses (sensitivity of 0.94, PPV of 0.95, specificity of 0.78, and NPV of 0.73). Taken together, CEUS may represent a promising minimally invasive diagnostic tool for characterization of SMRs, since it allows clinicians to identify malignant lesions.

724 Do Renal Mass Biopsies Influence Patient Management? a Case Series Study in a Tertiary Hospital

Abstract In recent years renal mass biopsy (RMB) has been increasingly adopted to guide management in patients with renal lesions. Indications include the evaluation of renal masses or cysts, and diagnosis prior to initiating targeted chemotherapy or ablation. A case series of 232 RMBs was collected from 2009–2020. Inclusion criteria were RMBs taken from native kidneys. Participants' mean age was 64.7 years (SD = 13.57 years), with 67% being male. The diagnostic rate of RMB was 78.45% (n = 182/232). Whether masses were solid or cystic did not influence diagnostic rate (p = .94143). Positive predictive value (PPV) of RMB compared with surgical histology was .8775. Only 1.3% (n = 3/232) of cases had significant complications. Patients with non-diagnostic biopsies were more likely to be managed with surveillance alone (56.0% vs 32.4%; p &amp;lt; .05). Diagnostic RMBs did not statistically influence whether patients had surgical management (p = .188914). Of non-diagnostic RMBs, 100% (n = 7/7) of patients with surgical histology had renal cell carcinoma (RCC). RMB has specific implications in two special populations: In small renal masses, PPV of RMB increased to 1.0. 16.7% (n = 3/18) of patients diagnosed with oncocytoma at RMB had a diagnosis of RCC. RMBs are safe with a high diagnostic rate. However, it seems to not influence definitive patient management. Clinicians should be wary when dealing with special populations. Results must be viewed in the context of the patient's history and imaging, and management should be determined using a multi-disciplinary approach.

Radiomics quality score in renal masses: a systematic assessment on current literature.

To perform a systematic assessment and analyze the quality of radiomics methodology in current literature in the evaluation of renal masses using the Radiomics Quality Score (RQS) approach. We systematically reviewed recent radiomics literature in renal masses published in PubMed, EMBASE, Elsevier, and Web of Science. Two reviewers blinded by each other's scores evaluated the quality of radiomics methodology in studies published from 2015 to August 2021 using the RQS approach. Owing to the diversity in the imaging modalities and radiomics applications, a meta-analysis could not be performed. Based on our inclusion/exclusion criteria, a total of 87 published studies were included in our study. The highest RQS was noted in three categories: reporting of clinical utility, gold standard, and feature reduction. The average RQS of the two reviewers ranged from 5 ≤ RQS≤19, with the maximum attainable RQS being 36. Very few (7/87 i.e., 8%) studies received an average RQS that ranged from 17 < RQS≤19, which represents studies with the highest RQS in our study. Many (39/87 i.e., 45%) studies received an average RQS that ranged from 13 < RQS≤15. No significant interreviewer scoring differences were observed. We report that the overall scientific quality and reporting of radiomics studies in renal masses is suboptimal, and subsequent studies should bolster current deficiencies to improve reporting of radiomics methodologies. The RQS approach is a meaningful quantitative scoring system to assess radiomics methodology quality and supports a comprehensive evaluation of the radiomics approach before its incorporation into clinical practice.

Contrast-Enhanced Ultrasound (CEUS) in the Evaluation of Renal Masses with Histopathological Validation-Results from a Prospective Single-Center Study.

Background: To evaluate the diagnostic accuracy of contrast-enhanced ultrasound (CEUS) in characterizing between malignant and benign renal lesions confirmed by histological examination. Methods: Overall, 110 patients, for a total of 118 renal masses previously identified at CT and MRI underwent CEUS. An expert radiologist evaluated morphological, qualitative and quantitative parameters. Acquired data were analyzed to assess the value of each parameter to differentiate between malignant and benign lesions. Results: Histological results of 118 renal masses showed 88 (75%) malignant lesions and 30 (25%) benign lesions. Among morphological features, inhomogeneous echogenicity was the best predictor of malignancy depicting a sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of 76%, 76%, 88% and 57%, respectively. Among qualitative parameters, the most reliable parameter was the presence of pseudo-capsule. Here, sensitivity, specificity, positive PPV and NPV were 85%, 86%, 94% and 71%, respectively. Among quantitative parameters, the most reliable parameters were peak intensity (PI) and the area under the (AUC) with sensitivity, specificity, PPV and NPV values of 94%, 92%, 96% and 87% and 99%, 92%, 97% and 97%, respectively. Finally, the most reliable parameters were combined to distinguish between benign and malignant lesions. The best combination obtained was restricted to CEUS parameters (PI and AUC). Here, sensitivity, specificity, PPV, NPV and accuracy rate were 93%, 100%, 100%, 83% and 93%, respectively. Conclusions: CEUS increases the US accuracy to discriminate between benign and malignant renal lesions.

Diagnostic Accuracy of Multi-Detector CT for Evaluation of Renal Masses

Objective: To determine the accuracy of multi-detector computed tomography (MDCT) in differentiation of renal masses taking histopathology as gold standard. Methods: This cross-validation study was conducted from March 2021 to August 2021 at Al Hussain Diagnostic &amp; Medical center Nishtar Road Multan. We included 100 patients presenting with renal masses on clinical and ultrasonography. All patients underwent MDCT for evaluation of renal masses. After MDCT, biopsy specimens were obtained for histopathological diagnosis of renal masses. The MDCT findings were correlated with histopathology diagnosis to determine the accuracy of MDCT. Results: Mean age was 45.8±12.36 years, 67% patients were male and 33% were female. Malignancy was diagnosed in 83% patients and remaining 17% patients were diagnosed of having benign lesions. Out of malignant lesions, 65% patients had RCC, 07% Wilm’s tumor, 6% lymphoma, meta-stasis was diagnosed 04% patients and 01% renal pelvic TCC. Among the benign lesions 11% patients had Angiomyolipoma and oncocytoma was diagnosed in 6.0% patients. The overall sensitivity of CT scan was 97.6%, specificity was 100%, PPV was 100% and NPV was 89.5%. Conclusion: MDCT can be used as the imaging method of choice for initial evaluation and diagnosis of RCC as it is associated with high sensitivity and specificity for differentiating malignant from benign lesions. Keywords: Diagnostic Accuracy, Histopathology, Multi detector CT, Renal Masses

Secondary Tumors of the Kidney: A Comprehensive Clinicopathologic Analysis.

Metastases to the kidney are rare and were historically described in autopsy series, and the incidence ranged between 2.36% and 12.6%. However, in the contemporary literature with the improvements in imaging modalities (computed tomography scan and magnetic resonance imaging) and other health care screening services, metastatic tumors to the kidney are being diagnosed more frequently in surgical specimens. The utility of needle core biopsies in the primary evaluation of renal masses has also increased the number of sampled metastases, and as a result, only limited histologic material is available for evaluation in some cases and may potentially lead to diagnostic pitfalls. In the last decade, a few large clinical series have been published. In these series, the majority of metastatic tumors to the kidney are carcinomas, with the lung being the most common primary site. A significant number of the various tumor types with metastasis to the kidney are also associated with widespread metastases to other organs, and the renal metastasis may present several years after diagnosis of the primary tumor. The majority of secondary tumors of the kidney are asymptomatic, incidentally discovered, and solitary. There should be a high index of suspicion of metastasis to the kidney in patients with an associated enlarging renal lesion with minimal to no enhancement on imaging and tumor progression of a known high-grade nonrenal malignancy. Secondary tumors of the kidney can be accurately diagnosed by correlating histopathologic features with clinical and radiographic findings and the judicious use of ancillary studies.