Evaluation Of Renal Masses Research Articles

Use of quantitative SPECT/CT reconstruction in 99mTc-sestamibi imaging of patients with renal masses.

Technetium-99m (99mTc)-sestamibi single-photon emission computed tomography/computed tomography (SPECT/CT) has previously been shown to allow for the accurate differentiation of benign renal oncocytomas and hybrid oncocytic/chromophobe tumors (HOCTs) apart from other malignant renal tumor histologies, with oncocytomas/HOCTs showing high uptake and renal cell carcinoma (RCC) showing low uptake based on uptake ratios from non-quantitative single-photon emission computed tomography (SPECT) reconstructions. However, in this study, several tumors fell close to the uptake ratio cutoff, likely due to limitations in conventional SPECT/CT reconstruction methods. We hypothesized that application of quantitative SPECT/CT (QSPECT) reconstruction methods developed by our group would provide more robust separation of hot and cold lesions, serving as an imaging framework on which quantitative biomarkers can be validated for evaluation of renal masses with 99mTc-sestamibi. Single-photon emission computed tomography data were reconstructed using the clinical Flash 3D reconstruction and QSPECT methods. Two blinded readers then characterized each tumor as hot or cold. Semi-quantitative uptake ratios were calculated by dividing lesion activity by background renal activity for both Flash 3D and QSPECT reconstructions. The difference between median (mean) hot and cold tumor uptake ratios measured 0.655 (0.73) with the QSPECT method and 0.624 (0.67) with the conventional method, resulting in increased separation between hot and cold tumors. Sub-analysis of 7 lesions near the separation point showed a higher absolute difference (0.16) between QPSECT and Flash 3D mean uptake ratios compared to the remaining lesions. Our finding of improved separation between uptake ratios of hot and cold lesions using QSPECT reconstruction lays the foundation for additional quantitative SPECT techniques such as SPECT-UV in the setting of renal 99mTc-sestamibi and other SPECT/CT exams. With robust quantitative image reconstruction and biomarker analysis, there may be an expanded role for SPECT/CT imaging in renal masses and other pathologic conditions.

Differentiation of Solid Renal Tumors with Multiparametric MR Imaging.

Characterization of renal tumors is critical to determine the best therapeutic approach and improve overall patient survival. Because of increased use of high-resolution cross-sectional imaging in clinical practice, renal masses are being discovered with increased frequency. As a result, accurate imaging characterization of these lesions is more important than ever. However, because of the wide array of imaging features encountered as well as overlapping characteristics, identifying reliable imaging criteria for differentiating malignant from benign renal masses remains a challenge. Multiparametric magnetic resonance (MR) imaging based on various anatomic and functional parameters has an important role and adds diagnostic value in detection and characterization of renal masses. MR imaging may allow distinction of benign solid renal masses from several renal cell carcinoma (RCC) subtypes, potentially suggest the histologic grade of a neoplasm, and play an important role in ensuring appropriate patient management to avoid unnecessary surgery or other interventions. It is also a useful noninvasive imaging tool for patients who undergo active surveillance of renal masses and for follow-up after treatment of a renal mass. The purpose of this article is to review the characteristic MR imaging features of RCC and common benign renal masses and propose a diagnostic imaging approach to evaluation of solid renal masses using multiparametric MR imaging. ©RSNA, 2017.

Role of Diffusion MRI in Evaluation of Renal Masses

Background: renal masses are being exposed more frequently in the last decades due to advances in cross sectional imaging such as CT and MR. Accurate characterization of renal masses is essential to ensure appropriate case management, to assist in staging and prognosis and to differentiate surgical lesions from nonsurgical lesions. However, in some cases there is an overlapping between the ADC values of benign and malignant masses. Thus, the use of ADC values alone may lead to inaccurate assessment of renal masses. Aim of the Study: to assess the roles of DWI in combination with quantitative ADC measurements the differentiation between benign and malignant renal masses. Conclusion: The combination of conventional MRI and ADC value in the diagnosis of renal masses can increase the diagnostic accuracy and considered of most value in cases where IV contrast agents are contraindicating.

A Retrospective Comparative Outcomes and Cost Analysis of Office Based, Ultrasound Guided Renal Mass Biopsy Performed by Urologists and Standard Hospital Biopsies for Small Renal Masses

IntroductionRenal mass biopsy is useful in the evaluation of small renal masses. We have previously reported that office based, ultrasound guided renal mass biopsy is safe, effective and feasible when performed by urologists. This study compares office based, ultrasound guided renal mass biopsy performed by urologists and hospital based renal mass biopsy. MethodsWe retrospectively studied 70 patients who underwent office based, ultrasound guided renal mass biopsy and 155 who underwent hospital based, ultrasound or computerized tomography guided renal mass biopsy for evaluation of a small renal mass (4.0 cm or less) between January 2010 and February 2016. ResultsA total of 70 patients underwent office based, ultrasound guided renal mass biopsy. Median age in this group was 69.5 years, median body mass index was 29.5 kg/m2 and 61.4% of the patients (43) were male. A total of 103 patients underwent hospital based, ultrasound guided biopsy. Median age in this group was 68.0 years, median body mass index was 29.3 kg/m2 and 53.4% of the patients (55) were male. Finally, 52 patients underwent hospital based, computerized tomography guided biopsy. Median age in this group was 69 years, median body mass index was 30.1 kg/m2 and 51.9% of the patients (27) were male. Median tumor size was 2.7 cm in patients undergoing office based, ultrasound guided renal mass biopsy, 2.2 cm in those undergoing hospital based, ultrasound guided biopsy and 2.1 cm in those undergoing hospital based, computerized tomography guided biopsy (p = 0.001). Renal cell carcinoma was found in 43 of 70 (61.4%), 74 of 103 (71.8%) and 33 of 52 (63.5%) respective biopsies. Respective diagnostic rates were 81.4% (57 of 70 cases), 88.3% (91 of 103) and 86.5% (45 of 52, p = 0.434). Concordance with surgical pathology was 97.7% (42 of 43 cases), 100% (35 of 35) and 100% (15 of 15), respectively. Complication rates were 4.3% (3 of 70 patients), 13.6% (14 of 103) and 13.5% (7 of 52), respectively (p = 0.096). Cost analysis revealed that when available, office based, ultrasound guided renal mass biopsy provides the health care system a total savings of approximately $46,011 yearly. ConclusionsOffice based, ultrasound guided renal mass biopsy for small renal masses is a safe and efficacious option for select patients, and potentially offers greater convenience and availability as well as decreased health care costs.

Imaging evaluation of renal masses

Introduction: This article demonstrate the imaging characteristics of cystic and solid renal masses, along with a summary of identified imaging criteria that may be of use to differentiate masses that are more likely to be benign from those that are more likely to be malignant. Aim and Objectives: To evaluate the patients with renal cancer by ultrasonography (USG) and computed tomography (CT) and to compare the findings of USG and CT. Material and Methods: Present study was conducted on 60 patients presented with renal masses, initially evaluated with ultrasonography (USG) and later on characterization of the mass was done by using computed tomography (CT). Results: CT has higher sensitivity, specificity, accuracy, positive predictive value and negative predictive value for renal cell carcinoma (RCC) on correlation with USG. Conclusion: CT is capable of detecting tumor invasion of perinephric fat and adjacent muscles, which cannot usually seen by ultrasound. While both CT and ultrasound demonstrate venous and retroperitoneal tumor extension, CT is more reliable.

CEUS of Problematic Renal Masses: Comparison with CECT and CEMRI

Ultrasound (US) is often the first-line imaging modality in the evaluation of the renal masses. If the findings of a renal mass do not meet all of US criteria of a simple cyst, it should be characterized further. Usually characterization of indeterminate renal masses is well done with CT or MRI, but sometimes it is inconclusive on these imaging techniques. In thoses cases and in patients to whom radiation exposure or use of iodine or gadolinium contrast agents is undesirable, contrast-enhanced US (CEUS) may be a valuable alternative to evaluate those problematic renal masses. CEUS may replace CECT or CEMRI if the patient has marginal or poor renal function, hypersensitivity to iodine contrast agent, or fear of radiation exposure. CEUS has long history in medical US but drew attention only recently. With the first generation microbubble agents several studies showed added value of CEUS as compared to the conventional Doppler US. We reported that CEUS provided better visualization of tumor vascularity in indeterminate cystic renal lesions than other imaging modalities using a first-generation agtent. The most important limitation of the first generation agent was that it could not provide an enough duration of contrast enhancing effect. With introduction of the second generation microbubble agents with better stability and duration of contrast effect, CEUS examination became a practical alternative of CECT or CEMRI in evaluation of problematic renal masses. We do not think that CEUS will be used routinely in US examination of renal masses like contrast enhancement is routine in CT for renal masses. However, we are sure that CEUS will be a valuable imaging technique if it is used in well selected cases of problematic renal masses. In evaluating problematic renal masses, CEUS may reveal findings that were not seen or confirm findings equivocal at other imaging studies. Results of CEUS can be analyzed qualitatively as to the presence or absence of enhancement, vascular pattern and heterogeneity etc. Quantitative analysis can be done on peak intensity, time to peak, and rate of wash-in and wash-out, etc.

Retrospective evaluation of ultrasound-indeterminate renal multilocular cystic masses by using neutrophil-lymphocyte ratio and computed tomography

PurposeTo evaluate the clinical usefulness of neutrophil-lymphocyte ratio (NLR) in differentiating the ultrasound-indeterminate renal multilocular cystic masses (RMCM) in comparison with computed tomography (CT) and whether NLR has additional benefits to CT on sensitivity of detecting the malignant. Materials and methodsOverall, 93 patients who underwent normal ultrasound with a conclusion of indeterminate RMCM were examined by NLR and CT within 30 days before surgery or follow-up from March to September 2014 at PLA General Hospital and enrolled in this retrospective study. Logistic regression model was performed to find independent predictors for differentiating true nature of RMCM; differences in the validity parameters and diagnostic power of CT, NLR, and their combination were compared using McNemar tests and AUC model, respectively. ResultsThe final diagnoses of the 93 patients consisted of 36 patients with benign complex cysts, 16 with multilocular cystic renal cell carcinoma, 9 with multilocular cystic nephroma, and 32 with clear cell renal cell carcinoma. Higher NLR were strongly associated with malignant masses. Multivariate logistic regression analysis revealed that NLR could be an independent predictor for differentiating true nature of these masses (OR = 3.617; 95% CI: 1.219–10.727; P = 0.020). For detecting the malignant masses, the sensitivity, specificity, and accuracy were 71.9%, 80.6%, and 75.3% for CT and 57.9%, 88.9%, and 69.9% for NLR under cutoff value of 2.31, respectively, whereas those of CT+NLR were 89.5%, 69.4%, and 81.7%. No significant difference was found between CT and NLR in sensitivity (P = 0.185), specificity (P = 0.549), and accuracy (P = 0.428). But the sensitivity of CT+NLR was significantly higher than those of CT (P = 0.002) and NLR (P<0.001), respectively; AUC model analysis indicated that CT+NLR got the largest area of 0.795 (P<0.001, 95% CI: 0.693–0.896) in comparison with those of CT (area = 0.795, P<0.001, 95% CI: 0.661–0.864) and NLR (area = 0.734, P<0.001, 95% CI: 0.631–0.836). ConclusionsGiven that NLR, under cutoff value of 2.31, had no diagnostic difference with CT in evaluating the ultrasound-indeterminate RMCM. However, combination of CT and NLR could increase the sensitivity of detecting malignant masses and acquire the best diagnostic power. Prospectively larger cohort and multicenter studies are still necessary.

Cystic renal masses

The purpose of the study is to provide an update on the imaging evaluation of cystic renal masses, to review benign and malignant etiologies of cystic renal masses, and to review current controversies and future directions in the management of these lesions. Cystic renal masses are relatively common in daily practice. The Bosniak classification is a time-proven method for the imaging classification and management of these lesions. Knowledge of the pathognomonic features of certain benign Bosniak 2F/3 lesions is important to avoid surgery on these lesions (e.g., localized cystic disease, renal abscess). For traditionally surgical Bosniak lesions (Classes 3 and 4), there are evolving data that risk stratification based on patient demographics, imaging size, and appearance may allow for expanded management options including tailored surveillance or ablation, along with the traditional surgical approach.

Utilization and contemporary results of renal mass biopsy.

623 Background: Renal mass biopsy (RMB) for localized renal masses (RM) is being re-evaluated to improve risk stratification and minimize morbidity from over-treatment. We review our institutional experience with RMB to identify performance characteristics and highlight opportunities to improve management. Methods: Using our prospectively maintained database, we identified patients who underwent core RMB +/- fine needle aspiration (FNA). We describe performance characteristics and assess pathologic concordance. Using the University of Michigan (UM) algorithm, we reviewed the potential that RMB influenced therapeutic decision-making. Results: We noted 374 RMBs performed from 1999-2015 (66% within last 5 years). Core RMB (+/- FNA) was performed in 65.2% (244/374) of cases, of which 41% (99/244) underwent surgical resection. Initial core RMB was non-diagnostic in 9% (9/99) of surgical cases and subsequently diagnosed with RCC. RCC diagnosed on core RMB that underwent surgical resection demonstrated histologic and grade concordance of 94.3% and 62.5%. All discordant grades were upgraded at surgery. 11% of all RMB were benign and no surgical intervention occurred. In our cohort, 19% of all RMB patients treated surgically had tumors classified as favorable or intermediate &lt; 2cm using the UM algorithm and might otherwise have been candidates for AS. Conversely, 42% of all surgically treated patients had UM favorable characteristics but had tumors &gt; 4cm and therefore underwent surgical resection based on size criteria in the context of RMB results. Conclusions: RMB is effective in the evaluation of RM with minimal morbidity. Our histologic/grade concordance is consistent with published data and underscores that RMB harbors clinical uncertainties. Clinical management pathways incorporating RMB may decrease over-treatment but also may risk under-treatment based on poor grade concordance. Using the UM algorithm, 30% of lesions in our cohort were AS candidates after RMB (over-treatment risk). Conversely, 18% of surgically treated lesions were UM AS candidates after RMB and upgraded on final pathology, demonstrating the risk of under treatment. RMB may be considered in patients where results would influence clinical decision-making.

DWI for Renal Mass Characterization: Systematic Review and Meta-Analysis of Diagnostic Test Performance.

The objective of our study was to perform a systematic review and meta-analysis of the test performance of DWI in the characterization of renal masses. We performed searches of three electronic databases for studies on renal mass characterization using DWI. Methodologic quality was assessed for each study. We quantitatively analyzed test performance for three clinical problems: first, benign versus malignant lesions; second, clear cell renal cell carcinoma (RCC) versus other malignancies; and, third, high-versus low-grade clear cell RCCs. We summarized performance as a single pair of sensitivity and specificity values or a summary ROC curve. The studies in the literature were limited in both quantity and quality. For classification of benign versus malignant lesions, four studies with 279 lesions yielded a single summary estimate of 86% sensitivity and 78% specificity. For differentiation of clear cell RCC from other malignancies, five studies showed marked heterogeneity not conducive to meta-analysis. For differentiation of high-from low-grade clear cell RCCs, three studies with 110 lesions showed a threshold effect appropriate for summary ROC construction: The AUC was 0.83. Evidence suggests moderate accuracy of DWI for the prediction of malignancy and high-grade clear cell cancers, whereas DWI performance for ascertaining clear cell histologic grade remains unclear. To develop DWI as a noninvasive approach for the evaluation of solid renal masses, prospective studies with standardized test parameters are needed to better establish DWI performance and its impact on patient outcomes.

Comparison between computed tomography multislice and high-field magnetic resonance in the diagnostic evaluation of patients with renal masses.

Renal masses are a common finding in diagnostic imaging; these lesions usually are solid or cystic, benign or malignant, and the correct diagnosis may be difficult. The aim of our study was the comparison of multi-slice computed tomography (MSCT) and high-field magnetic resonance (MR) in the diagnostic evaluation of renal masses. We studied 29 patients, 16 men and 13 women aged 8-85 years (mean 61±17 years) with histo-cytological diagnosis of renal masses (n=31), of which the majority (74%; n=23) was represented by malignant lesions [renal cell carcinoma (Ca) =16, chromophobe renal cell Ca =2, squamous cell Ca =1, urothelial Ca =2, lymphoma =1, Wilms tumor =1]; the remaining 8 masses (26%) were benign (pyelonephritis =2, simple cyst =1, hematic cyst =1, lipoma =1 and oncocytoma =3). All patients underwent MSCT and MR (3.0 Tesla) before and after contrast injection; the images were evaluated in double-blind by two expert radiologists. The results of the images were then compared with the histo-cytological data to calculate the values of diagnostic accuracy for both methods in the identification and characterization of renal masses. The benign or malignant nature of the lesions was established according to the regularity of the margins, presence or absence of significant contrast enhancement, infiltration of perirenal fat and vascular invasion. The concordance of the results of the two imaging techniques was then calculated using the coefficient Kappa Cohen. For both identification and characterization of renal masses, MSCT and MR showed comparable values of diagnostic accuracy with a significant concordance (k=1); in particular, the diagnostic accuracy of MSCT/MR was 100%/100% for lesion identification, 90%/90% for lesion characterization in terms of benign or malignant nature, 97%/97% for the evaluation of lesion edges, 90%/90% for the assessment of lesion contrast enhancement, 93%/93% for the evaluation of peri-renal fat infiltration and 96%/96% for the evaluation of vascular infiltration. Only in three cases of oncocytoma the two imaging methods were both inaccurate for diagnosis of benignity classifying the lesions as probably malignant on the basis of the absence of central scar and of dynamic contrast enhancement pattern. The results of our study show comparable diagnostic accuracy of computed tomography (CT) and MR for the identification and characterization of expansive renal lesions. High-field MR is, therefore, a valid alternative to MSCT in the evaluation of renal masses avoiding exposure to ionizing radiation.

MP50-17 INCIDENCE OF HYBRID TUMORS FOUND IN EXCISED RENAL MASSES: A MULTI-INSTITUTIONAL ANALYSIS

You have accessJournal of UrologyKidney Cancer: Evaluation and Staging III1 Apr 2015MP50-17 INCIDENCE OF HYBRID TUMORS FOUND IN EXCISED RENAL MASSES: A MULTI-INSTITUTIONAL ANALYSIS David Fumo, Khaled Shahrour, Ravi Munver, and Samay Jain David FumoDavid Fumo More articles by this author , Khaled ShahrourKhaled Shahrour More articles by this author , Ravi MunverRavi Munver More articles by this author , and Samay JainSamay Jain More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.2928AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The use of renal biopsy has gained popularity as an adjunct in the work up of renal masses, particularly masses ≤ 4cm suspicious for renal cell carcinoma (RCC). Our present study attempts to quantify the prevalence of tumors that contain more than one histology as a means of determining the potential accuracy of renal biopsy. METHODS In this IRB approved, multi-institutional study, a retrospective review of renal masses removed for RCC from January 1998- December 2013 was performed. Patients and masses were included in the study if information pertaining to demographics and pathologic stage, mass size, and histology were present. Tumors were considered to be hybrid if more than one distinct histology was reported in the final pathology. An independent pathology review was performed on 39 tumors from UTMC, of which 39% were hybrid and 41% were single histology. Statistical analyses were completed with paired T-tests and Chi Squared analysis, where appropriate. RESULTS A total of 447 tumors were included in the analysis, summarized in Table 1. After completion of pathology review, 39 tumors were found to be hybrid. pT1a masses accounted for 17 (43.6%) hybrid tumors, the majority of which (13/17) were a combination of clear cell and papillary cell RCC. Four hybrid tumors showed a combination of malignant and benign histology. Two of these were pT1a, and two were pT1b. Hybrid tumors made up 8.7% of all masses, with benign/malignant combinations accounting for 0.9% of all masses. An independent pathology review of 39 masses demonstrated a 64% concordance rate (14 discordant findings). Four of these 14 discordances involved a discrepancy between Oncocytoma and Chromophobe histologies. The pathologist suggested that immunohistochemical staining would have been beneficial in the initial diagnosis, which was not a common practice at that time. CONCLUSIONS Based on the low incidence of combined benign and malignant hybrid tumors, renal biopsy can be considered an accurate determinant of tumor histology. However, care should be taken in differentiating chromophobe from oncocytoma and should include the use of specialty staining. Larger studies are needed to confirm our findings. Table 1. Hybrid Histology Single Histology P Value Total Masses 39 408 Mean Size (cm) 5.2 5.2 .63 Mean Age 63.2 61.8 .65 Male 31 243 pT1a 17 169 .74 pT1b 6 112 .12 pT2a 2 27 1 pT2b 2 16 .66 pT3a 7 51 .31 pT3b 3 28 .74 pT3c 1 2 pT4 1 3 Mixed Histology Clear Papillary 24 Clear Chromophobe 5 Papillary Other Malignant 5 Undifferentiated CDC 1 Oncocytic Chromophobe 2 Oncocytic Papillary Patient Demographics, tumor stages, and hybrid tumor histology © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e617-e618 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information David Fumo More articles by this author Khaled Shahrour More articles by this author Ravi Munver More articles by this author Samay Jain More articles by this author Expand All Advertisement Advertisement PDF DownloadLoading ...

Small renal masses

Small renal masses are increasingly diagnosed incidentally. This results in management dilemma because at histopathology significant numbers of small renal masses are either benign tumors such as angiomyolipoma (AML) or oncocytoma, or are neoplasms with relatively indolent behavior [1]. Surgical treatments such as partial and total nephrectomy although provide excellent oncologic control is associated with development and worsening of renal insufficiency and associated cardiovascular morbidity [2]. Therefore, ability to non-invasively investigate renal tumor histopathology and aggressiveness can guide treatment decision and lower treatment cost. Within this paradigm, the role of radiologist and imaging is evolving from traditional role of identifying renal lesion and detecting enhancement, to predicting aggressiveness and biology of the tumor as well as providing operative guidance. MR imaging can play a very important role not only as a problem solving tool in traditional sense by detecting subtle enhancement and macroscopic and microscopic fat, but can provide deeper insight into tumor biology. Number of key observations highlighting the role of MR in evaluation of renal masses is as listed below:

Primary renal teratoma: an important differential diagnosis in the evaluation of cystic renal masses in infants

Renal teratoma is an extremely rare condition and may create diagnostic confusion with teratoid nephroblastomas or retroperitoneal teratomas with secondary involvement of the kidney. We report a 35 day old female child presenting in paediatric surgery OPD with complaints of pain abdomen and abdominal distension.. On palpation, a lump was felt in the lower abdomen measuring around 5x4x3 cms and a diagnosis of multilocular cystic nephroma was given on CECT abdomen. The kidney mass was excised and on gross examination, multiloculated thin walled cysts containing both mucinous and serous fluid with some areas of hemorrhage were noted. Microscopy revealed areas of columnar epithelium, squamous epithelium with keratin deposition, cartilage, bone, fibrocollageneous tissue and muscle tissue. A diagnosis of mature primary renal teratoma was given. This case was presented as primary renal teratomas are extremely rare and must be considered in the differential diagnosis of infantile renal masses.

Prospective evaluation of CT indeterminate renal masses using US and contrast-enhanced ultrasound.

The aim of this study was to assess the accuracy of Ultrasound (US) and contrast-enhanced ultrasound (CEUS) in the characterization of renal nodules indeterminate on CT by identifying benign cystic lesions not requiring further examination. 72 patients with 83 indeterminate renal nodules on CT underwent baseline US and CEUS that classified lesions as benign (Bosniak I, II or IIF cysts) or potentially malignant (Bosniak III or IV cysts, solid nodules). The accuracy of US and CEUS in the differentiation between benign cysts and potentially malignant nodules was analyzed and compared with the final diagnosis obtained by histology or follow-up of at least 23 months with CEUS ± a conclusive CT/MR study. Final diagnoses comprised 50 benign complex cysts, 1 focal nephritis, 1 multilocular cystic nephroma, 3 oncocytomas, 1 transitional cell carcinoma and 27 renal cell carcinomas. Unenhanced US correctly classified 18/50 (36%) benign cysts and 17/33 (51.5%) of the potentially malignant lesions obtaining a sensitivity of 36%, specificity of 51.5%, and overall accuracy of 42.2%. The addition of CEUS allowed a correct diagnosis of 48 /50 (96%) benign cysts and of 31/33 (93.9%) nodules as potentially malignant, with a sensitivity of 96%, specificity of 93.9%, and overall accuracy of 95.2%. CEUS is very useful in the differentiation between benign complex cysts and other lesions that require further investigation in non-conclusive renal nodules detected on CT, improving the accuracy of baseline US from 42.2 to 95.2%.

MP12-12 CONTRAST-ENHANCED ULTRASOUND FOR SMALL RENAL MASSES

You have accessJournal of UrologyImaging/Radiology III1 Apr 2014MP12-12 CONTRAST-ENHANCED ULTRASOUND FOR SMALL RENAL MASSES Tae Hoon Oh, Seong Hoon Ahn, Whi An Kwon, Jea Whan Lee, Dong Youp Han, Seung Chul Park, Hee Jong Jeong, and Ill Young Seo Tae Hoon OhTae Hoon Oh More articles by this author , Seong Hoon AhnSeong Hoon Ahn More articles by this author , Whi An KwonWhi An Kwon More articles by this author , Jea Whan LeeJea Whan Lee More articles by this author , Dong Youp HanDong Youp Han More articles by this author , Seung Chul ParkSeung Chul Park More articles by this author , Hee Jong JeongHee Jong Jeong More articles by this author , and Ill Young SeoIll Young Seo More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2014.02.447AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Introduction : Ultrasonography (US) is highly sensitive in the detection of the renal mass. However, it may not show characterized findings to differentiate benign and malignant in small masses. The purpose of this study is to determine the diagnostic efficacy of contrast-enhanced ultrasound (CEUS), US using contrast media, for small renal masses. METHODS Materials and Methods: From January 2011 to September 2013, 71 patients underwent CEUS for evaluation of renal masses. Among of them, CEUS findings of small renal masses, renal cell carcinoma (RCC) cases (n = 25) and angiomyolipoma (AML) cases (n = 10) were retrospectively analyzed. The tumor echogenicity and enhancement patterns and degrees were evaluated. The diagnostic efficacy of CEUS in differentiating the two diseases was compared. RESULTS Results: On CEUS of small renal tumors with less than 4 cm diameter, the findings of diffuse heterogeneous enhancement (observed in 76.0% of RCC and 30.0% of AML; p = 0.020), wash-out from hyper-enhancement or isoenhancement to hypo-enhancement in late phase (64.0% of RCC and 20.0% of AML; p = 0.027), and perilesional rim-like enhancement (60.0% of RCC and 10.0% of AML; p = 0.010) achieved significant difference between AML and RCC cases. The corresponding sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were 80.0% (20 of 25), 70.0% (7 of 10), 87.0% (20 of 23), 58.3% (7 of 12), and 77.1% (27 of 35), respectively. CONCLUSIONS Conclusion: Our results suggest that the characteristic findings of CEUS features could have a potential diagnostic factor in evaluation of small renal mass. It showed a better diagnostic efficacy than US for differentiating RCC and AML. © 2014FiguresReferencesRelatedDetails Volume 191Issue 4SApril 2014Page: e109-e110 Advertisement Copyright & Permissions© 2014MetricsAuthor Information Tae Hoon Oh More articles by this author Seong Hoon Ahn More articles by this author Whi An Kwon More articles by this author Jea Whan Lee More articles by this author Dong Youp Han More articles by this author Seung Chul Park More articles by this author Hee Jong Jeong More articles by this author Ill Young Seo More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Ancillary Diagnostic Techniques in the Evaluation of Adult Epithelial Renal Neoplasms

The role played currently by the different ancillary diagnostic techniques in the diagnosis of adult epithelial renal tumors continues to be debated. It has also become clear that in some instances light microscopic appearance alone cannot be used to classify these neoplasms into specific categories with the degree of precision required for therapeutic purposes. Renal cell carcinoma (RCC) subtypes may share common histologic characteristics but exhibit different biological behavior and response to therapy which clearly indicates the crucial role that advanced pathologic speciation plays in the current assessment of these neoplasms. Although immunohistochemistry is widely used for the purpose of categorizing renal tumors because of its widespread availability, the immunoprofiles of the various types of renal neoplasms overlap significantly, making definitive diagnostic determinations difficult and challenging at times. This manuscript will address how ancillary diagnostic techniques can be incorporated into the routine evaluation of neoplastic renal masses to improve classification. Both cytology and surgical specimens will be addressed, as fine needle aspiration (FNA) is being used with preference in many cases in the diagnosis of renal masses. Surgical and cytopathologists must intelligently select the ancillary diagnostic technique/s that will provide the information needed to solve the differential diagnosis under consideration in a given case. However, in some cases >1 of these techniques should be used to make an accurate diagnosis with the aim of arriving at an unequivocal diagnosis. The identification of specific signaling pathways that are defective in certain types of renal neoplasms has made possible the design of target-specific therapies that are directed towards the aberrant pathways associated with the defective proteins found in these tumors. This makes the exact classification of these neoplasms and the detection of these aberrant proteins targeted for treatment an absolute requirement for the application of these molecular-based therapeutic interventions. The role that the pathologic assessment plays in the classification of renal tumors becomes more important than ever to take advantage of this and similar new molecular-oriented therapies.

Diagnostic efficacy of contrast-enhanced ultrasound for small renal masses.

PurposeUltrasound (US) is highly sensitive in the detection of renal masses. However, it may not be able to differentiate benign and malignant lesions in smaller masses. The purpose of this study was to determine the diagnostic efficacy of contrast-enhanced ultrasound (CEUS) for small renal masses.Materials and MethodsFrom January 2011 to December 2013, a total of 85 patients underwent CEUS for evaluation of renal masses. Of these patients, CEUS findings were retrospectively analyzed for small renal cell carcinoma (RCC) cases (n=38) and angiomyolipoma (AML) cases (n=11). The tumor echogenicity and enhancement patterns and degrees were evaluated. The diagnostic efficacy of CEUS in differentiating the two diseases was compared.ResultsOn CEUS, the findings of diffuse heterogeneous enhancement (observed in 78.9% of RCCs and 27.3% of AMLs, p=0.003), washout from hyperenhancement or iso-enhancement to hypoenhancement in late phase (73.7% of RCCs and 18.2% of AMLs, p=0.001), and perilesional rim-like enhancement (57.9% of RCCs and 9.1% of AMLs, p=0.006) were significantly different between AML and RCC cases. The corresponding sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were 86.8% (33/38), 63.6% (7/11), 89.2% (33/37), 58.3% (7/12), and 81.6% (40/49), respectively.ConclusionsOur results suggest that the characteristic CEUS features could have diagnostic value in the evaluation of small renal mass. CEUS showed a higher diagnostic efficacy than conventional US for differentiating RCC and AML.

Primary synovial sarcoma of kidney: a rare differential diagnosis of renomegaly.

Synovial sarcomas (SS) are classified as subgroup of soft tissue sarcomas affecting mainly extremities of young adults. Primary SS of kidney are very rare tumours with poor prognosis. Though they have characteristic histology and immunohistochemistry (IHC) due to rarity of incidence it is difficult to diagnose them. Sometimes chromosomal rearrangement studies are required to confirm the diagnosis. We are presenting a case of 41-year-old male who was referred to our cancer centre for evaluation of left renal mass. CT scan of abdomen revealed a large left renal mass encasing the aorta. Biopsy of renal mass revealed poorly differentiated sarcoma and IHC was positive for vimentin, CD99, and BCL2 and negative for AE1, epithelial membrane antigen, and leukocyte common antigen. The patient was clinically inoperable as renal mass was encasing the aorta. So he was subsequently offered palliative chemotherapy in form of ifosfamide and adriamycin. CT abdomen shows partial response after 3 cycles of chemotherapy according to RECIST criteria.

Evaluation of Indeterminate Renal Masses with Contrast-enhanced US: A Diagnostic Performance Study

To determine the utility of contrast material-enhanced ultrasonography (US) in the characterization of indeterminate renal masses. This retrospective performance study was approved by the institutional review board and was HIPAA compliant, with waiver of informed consent. Patients included 721 individuals referred for contrast-enhanced US with 1018 indeterminate renal masses from 1999 to 2010, identified initially with an imaging study. Three hundred twenty patients (44.4%) were female, and 401 (55.6%) were male. Patient ages ranged from 17 to 95 years (mean ± standard deviation, 70 years ± 15). Lesion size varied from 2 to 161 mm (mean, 26.6 mm ± 19.5). Contrast-enhanced US enhancement patterns were used to characterize masses as benign or malignant. For lesions with a definitive diagnosis, 306 of 1018 (30.0%) were correlated with contrast-enhanced US findings: 167 (54.6%) were benign, and 139 (45.4%) were malignant. For lesions without a pathologic diagnosis, 712 (70.0%) were followed for as long as 10 years. Diagnostic accuracy measures were calculated by using pathologic diagnosis as the reference standard, as well as lesion stability at 3 and 5 years. Contrast-enhanced US had a sensitivity of 100% (126 of 126; 95% confidence interval [CI]: 97.1%, 100%), specificity of 95.0% (132 of 139; 95% CI: 89.9%, 98.0%), positive predictive value (PPV) of 94.7% (126 of 133), and negative predictive value (NPV) of 100% (132 of 132). The five false-positive masses included three oncocytomas and two Bosniak category 3 cystic lesions. Of the 290 lesions that had follow-up of at least 36 months, none of the lesions demonstrated changes that necessitated lesion reclassification. If these lesions were included, assuming lesions classified as malignant were malignant, then of the 596 lesions, sensitivity was 100% (161 of 161), specificity was 96.6% (420 of 435), PPV was 91.5% (161 of 176), and NPV was 100% (420 of 420). Contrast-enhanced US evaluation is a highly sensitive and specific method for characterization of indeterminate renal masses. Online supplemental material is available for this article.