Small renal masses in the era of personalized medicine: Tumor heterogeneity, growth kinetics, and risk of metastasis

Conti, Alessandro; Santoni, Matteo; Sotte, Valeria; Burattini, Luciano; Scarpelli, Marina; Liu, Cheng; López-Beltrán, Antonio; Montironi, Rodolfo; Cascinu, Stefano; Muzzonigro, Giovanni; Lund, Lars

doi:10.1016/j.urolonc.2015.04.001

Cited by 17 publications

(7 citation statements)

References 58 publications

(62 reference statements)

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“…Tumor heterogeneity is a well-recognized factor for histology, grade, and mutation status, especially in CCRCC. [43][44][45] Grade agreement decreased with size (Table 4), suggesting intratumoral heterogeneity to be a dominant factor. The higher concordance rates in SRMs may also be influenced by their tendency to be low grade and lack intratumoral heterogeneity.…”

Section: Discussionmentioning

confidence: 99%

Improving Renal Tumor Biopsy Prognostication With BAP1 Analyses

Kapur

Setoodeh²,

Araj³

et al. 2021

Archives of Pathology &Amp; Laboratory Medicine

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Context.— Active surveillance of small renal masses highlights the need for accurate prognostication of biopsies. Objective.— To comprehensively evaluate the accuracy of biopsies in assessing known prognostic parameters including histologic subtype by comparison with subsequent nephrectomy samples. Design.— We retrospectively identified patients at University of Texas Southwestern Medical Center, Dallas, Texas, who had a biopsy for a renal mass between 2004–2018. Biopsy samples were evaluated for known prognostic factors such as tumor grade, necrosis, sarcomatoid/rhabdoid change, and BRCA1-associated protein-1 (BAP1) status, which we previously showed is an independent prognostic factor for clear cell renal cell carcinoma. Accuracy was determined by comparison with subsequent analyses of nephrectomy specimens. Statistical analyses were performed to assess biopsy accuracy and correlation with tumor size and pathologic stage. Results.— From 805 biopsies with a diagnosis of renal neoplasm, 178 had subsequent resection of the biopsied tumor. Concordance rate for histologic subtype was 96.9% (κ [w], 0.90; 95% CI, 0.82–0.99) and excellent for small renal masses (98.8%; κ [w], 0.97; 95% CI, 0.90–1). Amongst the prognostic variables evaluated, BAP1 immunohistochemistry in clear cell renal cell carcinoma had the highest agreement (94.8%; κ [w], 0.83; 95% CI, 0.66–0.99). The presence of 1 or more aggressive features (grade 3–4, tumor necrosis, BAP1 loss, sarcomatoid/rhabdoid change) in a biopsy significantly correlated with pT stage (P = .004). Conclusions.— Biopsy analyses showed high accuracy for subtyping renal tumors, but it underestimated several poor prognostic features. Addition of BAP1 for clear cell renal cell carcinoma may increase prognostic accuracy. If validated, routine incorporation of BAP1 immunohistochemistry in clear cell renal cell carcinoma biopsies may refine prognosis and aid in the selection of patients for active surveillance.

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Section: Discussionmentioning

confidence: 99%

Improving Renal Tumor Biopsy Prognostication With BAP1 Analyses

Kapur

Setoodeh²,

Araj³

et al. 2021

Archives of Pathology &Amp; Laboratory Medicine

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“…Multiple cores likely increase the accuracy of the biopsy beyond the 93%. New studies suggest that clear cell renal cell carcinomas (ccRCC) have intratumor heterogeneity and RMB may underestimate the grade that the mass truly presents [ 11 , 28 , 35 ]. A recent study showed that 93% of high-grade specimens (Fuhrman score 3-4) also had low-grade components (Fuhrman score 1-2) [ 11 ].…”

Section: Biopsymentioning

confidence: 99%

“…Although conservative management of suspected RCC is growing in popularity, it should be emphasized that progression is still a possibility and thus close follow-up is indicated, because the tumor may not be necessarily at a 100% secure tumor size and some SRMs may albergate high-grade necrosis or other unfavorable features [ 28 , 35 ]. While AS represents a reasonable alternative to primary curative intervention such as nephrectomy or ablation, this type of treatment still necessitates careful patient selection, careful management, patient compliance, and ongoing follow-up.…”

Section: Active Surveillancementioning

confidence: 99%

The Past, Present, and Future in Management of Small Renal Masses

Zlomke

Cost

et al. 2015

Journal of Oncology

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Management of small renal masses (SRMs) is currently evolving due to the increased incidence given the ubiquity of cross-sectional imaging. Diagnosing a mass in the early stages theoretically allows for high rates of cure but simultaneously risks overtreatment. New consensus guidelines and treatment modalities are changing frequently. The multitude of information currently available shall be summarized in this review. This summary will detail the historic surgical treatment of renal cell carcinoma with current innovations, the feasibility and utility of biopsy, the efficacy of ablative techniques, active surveillance, and use of biomarkers. We evaluate how technology may be used in approaching the small renal mass in order to decrease morbidity, while keeping rates of overtreatment to a minimum.

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“…Predictors of growth and progression in SRMs on active surveillance remain poorly defined mainly due to a dearth of good quality longitudinal observational data (1)(2)(3)(4). The universal healthcare model in the National Health Services (NHS) of the United Kingdom has the advantage of studying longitudinal observational data, especially through linkage methodology using a common identifier such as unique Community Health Care Index (CHI) number.…”

Section: Introductionmentioning

confidence: 99%