Current management of small renal masses

Rodríguez, Carlos; Fuente, G. Tardáguila de la; Campos, A.M. Villanueva

doi:10.1016/j.rxeng.2020.02.002

Cited by 3 publications

(3 citation statements)

References 72 publications

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“…If the mpMRI strongly suggests a benign or indolent tumour (e.g. AML, oncocytoma, chromophobe or type 1 papillary RCC) and the patient is at high risk of complications from biopsy or excision, the urologist and patient may reach a shared decision for initial surveillance of the renal mass, given the risks of invasive procedures likely outweigh the risks of surveillance 29 . Conversely, in cases where the differential on mpMRI includes an aggressive malignancy (e.g.…”

Section: Discussionmentioning

confidence: 99%

Chemical shift imaging in the identification of those renal tumours that contain microscopic fat and the utility of multiparametric MRI in their differentiation

et al. 2020

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Introduction: The aim of this study was to assess the qualitative and MRI findings of renal tumours, to determine which lesions contain microscopic fat, one of the potential differentiating factors between tumour types. Methods: 73 patients who underwent 3 Tesla MRI including chemical shift imaging, with subsequent biopsy or excision for histopathological diagnosis, were included in the study. The images were reviewed for a decrease in signal intensity (SI) on the opposed phase compared with the in-phase gradient echo T1 images, indicating the presence of microscopic fat. The chemical shift index was then calculated as a percentage of SI change and compared with the pathological diagnosis. Results: In total, 38 (52%) of lesions demonstrated a decrease in SI, consistent with microscopic fat. Microscopic fat was found in 28 (80%) clear cell renal cell carcinomas (RCCs), 6 (66.7%) angiomyolipomas, 2 (20%) papillary RCCs, 1 (20%) chromophobe RCC and 1 (9.1%) oncocytoma. Pairwise comparison of means indicated that the amount of microscopic fat was significantly larger only for angiomyolipomas compared with clear cell RCCs (P < 0.001) and other renal lesions (P < 0.001). Conclusions: A decrease in SI on opposed phase compared with in-phase chemical shift imaging favours the diagnosis of either clear cell RCC or an angiomyolipoma. When combined with other parameters in mpMRI, this may aid differentiation of benign from malignant tumours and differentiation of aggressive from indolent RCC subtypes. This may be of value where biopsy is non-diagnostic, not feasible due to location or in high-risk patients.

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Section: Discussionmentioning

confidence: 99%

Chemical shift imaging in the identification of those renal tumours that contain microscopic fat and the utility of multiparametric MRI in their differentiation

et al. 2020

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“…The study population was composed of fifty-one RCC (thirty-seven clear cell, seven chromophobe and seven papillary), seven lipid-poor angiomyolipoma, twenty-five oncocytoma, and two renal leiomyomas (Table 1). (7) Papillary RCC (7) M: Male; F: Female. Age and size are reported as median and interquartile range.…”

Section: Patientsmentioning

confidence: 99%

“…The diagnosis of renal cell carcinoma (RCC) can only be performed by imaging (ultrasound, CT, MRI), however, imaging methods are also not always reliable in distinguishing between benign neoplasms (oncocytoma and angiomyolipoma are among the most frequent) and malignant cancer (in particular, clear cell carcinoma, papillary carcinoma and chromophobe carcinoma) [ 5 ]. Diagnostic uncertainty in the differentiation between benign and malignant cases is particularly high when dealing with small renal masses (SRMs), i.e., a renal mass that has a diameter of less than 4 cm, as the specificities of contrast-enhanced CT and MRI for predicting RCC are as low as 44.4 and 33.3%, respectively [ 6 , 7 ].…”

Section: Introductionmentioning

confidence: 99%

Small Renal Masses: Developing a Robust Radiomic Signature

Maddalo,

Bertolotti,

Mazzilli

et al. 2023

Cancers

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(1) Background and (2) Methods: In this retrospective, observational, monocentric study, we selected a cohort of eighty-five patients (age range 38–87 years old, 51 men), enrolled between January 2014 and December 2020, with a newly diagnosed renal mass smaller than 4 cm (SRM) that later underwent nephrectomy surgery (partial or total) or tumorectomy with an associated histopatological study of the lesion. The radiomic features (RFs) of eighty-five SRMs were extracted from abdominal CTs bought in the portal venous phase using three different CT scanners. Lesions were manually segmented by an abdominal radiologist. Image analysis was performed with the Pyradiomic library of 3D-Slicer. A total of 108 RFs were included for each volume. A machine learning model based on radiomic features was developed to distinguish between benign and malignant small renal masses. The pipeline included redundant RFs elimination, RFs standardization, dataset balancing, exclusion of non-reproducible RFs, feature selection (FS), model training, model tuning and validation of unseen data. (3) Results: The study population was composed of fifty-one RCCs and thirty-four benign lesions (twenty-five oncocytomas, seven lipid-poor angiomyolipomas and two renal leiomyomas). The final radiomic signature included 10 RFs. The average performance of the model on unseen data was 0.79 ± 0.12 for ROC-AUC, 0.73 ± 0.12 for accuracy, 0.78 ± 0.19 for sensitivity and 0.63 ± 0.15 for specificity. (4) Conclusions: Using a robust pipeline, we found that the developed RFs signature is capable of distinguishing RCCs from benign renal tumors.

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Small Renal Masses

Gholami,

Kaouk,

Zargar

2023

Urological Science

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Small renal masses (SRM) are defined as contrast-enhancing solid masses detected on diagnostic imaging, with a size of less than or equal to 4cm, corresponding to renal cell carcinoma stage T1a. These tumours are mainly benign, with an indolent nature and rare metastatic potential. Given the size and nature of these tumours, there has been a significant evolution and in management modalities of these tumours. These range from conventional radical approaches such as radical nephrectomy, partial nephrectomy, to more conservative approaches such as active surveillance, and some novel emerging management strategies such as various thermal ablation techniques. The treatment decision depends on patient factors such as age and co-morbidity, and tumour factor on radiological imaging, such as tumour size, location, growth rate and biopsy result. In this review, we aim to provide the latest updates on approaching SRM and various management modalities.

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Current management of small renal masses

Cited by 3 publications

References 72 publications

Chemical shift imaging in the identification of those renal tumours that contain microscopic fat and the utility of multiparametric MRI in their differentiation

Chemical shift imaging in the identification of those renal tumours that contain microscopic fat and the utility of multiparametric MRI in their differentiation

Small Renal Masses: Developing a Robust Radiomic Signature

Small Renal Masses

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