Tumour location as a predictor of benign disease in the management of renal masses

Abstract

Objective: To investigate the association between tumour location and the proportion of benign disease in renal masses presumed to be renal cell carcinoma (RCC) preoperatively. Methods: This Institutional Review Board approved study includes 196 patients who underwent surgical treatment for renal masses <5 cm at our institution by a single surgeon between January 2002 and June 2009. Based on preoperative imaging, each mass was designated as central (touching or encroaching upon the renal collecting system and/or renal sinus) or peripheral. The association between tumour location and benign pathology was determined using univariate and multiple logistic regression, including tumour size and patient sex in the model. Results: The proportion of histologically confirmed benign disease in this series was 11.2%. The proportion of benign disease by location was 5.9% and 19.5% for central and peripheral masses, respectively. The effect of location was found to have a significant prognostic value (p = 0.0273) with an adjusted odds ratio of 3.51 (95% CI = 1.38-19.62) for the odds of a benign diagnosis in peripheral compared to central tumours. Tumour size and patient sex were not significant predictors of benign pathology (p = 0.483 and 0.191, respectively). Conclusions: Peripherally located renal masses are more likely to be benign than centrally located renal masses. This information may be used when selecting strategies for the management of renal masses presumed to be RCC.

Masas renales pequeñas: predictores de malignidad en una serie de 10 años

“…Tanto el análisis univariado como multivariado no mostró variables predictoras, excepto el tamaño por TAC, sin embargo, al establecer los grupos de riesgo por tamaño histológico se pierde el valor predictivo de esta variable. En otros estudios se han asociado con benignidad en la biopsia definitiva variables como localización y tamaño (tumores periféricos ≤ 5 cm son más benignos) 20 , sexo del paciente (femenino se asocia con benignidad) 21 , entre otras. Por su parte, está descrito que el porcentaje de tumores benignos aumenta con la disminución del tamaño tumoral 1 .…”

Active surveillance as the preferred management option for small renal masses

“…We have recently demonstrated that in this era of smaller, incidentally detected renal masses, tumour location has replaced tumour size as a predictor of benign disease. 13 We hypothesized that Management of small renal masses prediction of benign versus malignant disease may be as important as prediction of prognosis in the presence of a renal malignancy.…”