Distinguishing malignant and benign renal masses with composite models and nomograms: A systematic review and meta‐analysis of clinically localized renal masses suspicious for malignancy

Abstract

Solid renal masses and cystic lesions with solid components are suspicious for renal cell carcinoma. Without an effective screening test, composite models and nomograms rely on patient and tumor characteristics to stratify the risk of benign disease versus malignant disease. To guide decisions about the use of renal mass sampling or excision, a systematic review and meta-analysis of the ability of composite models to predict the likelihood of malignancy on the basis of preoperative clinical variables was performed. MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials were searched from January 1, 1997, through May 1, 2015, according to the Preferred Reporting Items for Systematic Review and Meta-Analyses statement. Composite models necessarily included imaging results and at least 1 element from the following to be compared with surgical pathology: demographic characteristics, clinical characteristics, and blood or urine tests. Two independent reviewers screened citations and extracted data. Quality Assessment Tool for Diagnostic Accuracy Studies 2 was used to assess the risk of bias. The strength of evidence was graded with the scheme recommended by Methods Guide for Effectiveness and Comparative Effectiveness Reviews. Twenty studies (12,149 patients) were included in this review. The only significant predictors of malignancy in the composite models were tumor size (effect size, 1.33-fold increased risk per centimeter; 95% confidence interval [CI], 1.22-1.43) and male sex (effect size, 2.71; 95% CI, 2.39-3.02). The results were inconclusive or not significant for tumor characteristics, age, body mass index, and incidental presentation. In conclusion, composite models currently have a limited ability to distinguish malignant renal masses from benign renal masses, with increased tumor size and male sex associated with malignancy. Cancer 2016;122:3267-3276. © 2016 American Cancer Society.

Surgical histopathology for suspected oncocytoma on renal mass biopsy: a systematic review and meta‐analysis

“…The result of oncocytoma on RMB can lend support to a shared patient‐physician decision to pursue active surveillance with preserved quality of life, but careful follow‐up is needed given the rate of misclassification and similar growth rate of oncocytomas to RCC when on active surveillance . Other predictors of malignancy, beyond tumour size and sex, have not been shown to aid in this process . A recent in‐depth analysis of morphology and immunohistochemistry of renal oncocytic neoplasms on RMB by two expert genitourinary pathologists suggested the ability to categorise 67% of lesions as ‘favour oncocytoma’, a similar proportion as were confirmed on surgical pathology in the meta‐analysis .…”

Multiple growth periods predict unfavourable pathology in patients with small renal masses

“…These conflicting findings suggest that overall growth rates may not be as informative of malignant potential as previously thought. Baseline characteristics, such as patient sex and absolute tumour size, are the only variables that have been consistently associated with malignancy for clinically localized renal masses .…”

Trends in Percutaneous Thermal Ablation Therapies in the Treatment of T1a Renal Cell Carcinomas Rather than Partial Nephrectomy/Radical Nephrectomy

“…comparable therapeutic data to identify the potential efficacy differences among available multiple RCCs management modalities in long-term follow-up. 7,10,24,33,[42][43][44][45][46][47][48][49][50][51][52][53][54][55] In a 2019 study, Palumbo et al evaluated 3,946 patients using the Surveillance, Epidemiology and End Results database (SEER, 2004-2015) treated with cryosurgery for T1a lesions, reporting that tumor size greater than 3 cm is an independent predictor of higher 5-year cancer-specific mortality rate. Therefore, they suggested the local tumor ablation should be performed for tumors less than 3 cm.…”