Advertisement

International Journal of Clinical Oncology

, Volume 20, Issue 1, pp 150–155 | Cite as

Preoperative differentiation between benign and malignant renal masses smaller than 4 cm treated with partial nephrectomy

  • Masatomo Nishikawa
  • Hideaki Miyake
  • Kazuhiro Kitajima
  • Satoru Takahashi
  • Kazuro Sugimura
  • Masato Fujisawa
Original Article

Abstract

Background

The aim of this study is to accurately differentiate between benign and malignant small renal masses (SRMs) prior to surgery.

Methods

The study included 144 patients with SRMs <4 cm suspected to be renal cell carcinoma (RCC) based on several imaging examinations, who subsequently underwent partial nephrectomy. Clinicopathological data were analyzed based on the preoperative findings obtained from enhanced computed tomography (CT) as follows: group 1 showing a typical imaging pattern for clear cell RCC (CCRCC), and group 2 showing an imaging pattern atypical of CCRCC. We then evaluated the association between clinicopathological characteristics and pathological diagnosis in order to identify factors which can predict the pathological diagnosis.

Results

Based on the criteria, 102 (70.8 %) and 42 (29.2 %) patients were classified into group 1 and group 2, respectively. The only independent factor identified to predict the final pathological diagnosis of the 144 patients was preoperative CT findings. Only 7 (6.9 %) patients were pathologically diagnosed with benign tumors in group 1; however, 13 (31.0 %) of the 42 patients in group 2 appeared to have pathologically confirmed benign tumors. A younger age and lower body mass index (BMI) in group 2 were shown to be independently associated with benign histology on multivariate analysis.

Conclusions

The proportion of patients with benign tumors was comparatively high in those with CT findings atypical for CCRCC; therefore, other clinical parameters, such as age and BMI, should be considered when determining therapeutic strategies for patients with such SRMs.

Keywords

Small renal mass Enhanced computed tomography Age Body mass index 

Notes

Conflict of interest

The authors declare that they have no conflict of interest.

References

  1. 1.
    Hollingsworth JM, Miller DC, Daignault S et al (2006) Rising incidence of small renal masses: a need to reassess treatment effect. J Natl Cancer Inst 98:1331–1334PubMedCrossRefGoogle Scholar
  2. 2.
    Jeon HG, Lee SR, Kim KH et al (2010) Benign lesions after partial nephrectomy for presumed renal cell carcinoma in masses 4 cm or less: prevalence and predictors in Korean patients. Urology 76:574–579PubMedCrossRefGoogle Scholar
  3. 3.
    Kane CJ, Mallin K, Ritchey J et al (2008) Renal cell cancer stage migration: analysis of the National Cancer Data Base. Cancer 113:78–83PubMedCrossRefGoogle Scholar
  4. 4.
    Kutikov A, Fossett LK, Ramchandani P et al (2006) Incidence of benign pathologic findings at partial nephrectomy for solitary renal mass presumed to be renal cell carcinoma on preoperative imaging. Urology 68:737–740PubMedCrossRefGoogle Scholar
  5. 5.
    Dechet CB, Zincke H, Sebo TJ et al (2003) Prospective analysis of computerized tomography and needle biopsy with permanent sectioning to determine the nature of solid renal masses in adults. J Urol 169:71–74PubMedCrossRefGoogle Scholar
  6. 6.
    Snyder ME, Bach A, Kattan MW et al (2006) Incidence of benign lesions for clinically localized renal masses smaller than 7 cm in radiological diameter: influence of sex. J Urol 176:2391–2395PubMedCrossRefGoogle Scholar
  7. 7.
    Gill IS, Matin SF, Desai MM et al (2003) Comparative analysis of laparoscopic versus open partial nephrectomy for renal tumors in 200 patients. J Urol 170:64–68PubMedCrossRefGoogle Scholar
  8. 8.
    McKiernan J, Yossepowitch O, Kattan MW et al (2002) Partial nephrectomy for renal cortical tumors: pathologic findings and impact on outcome. Urology 60:1003–1009PubMedCrossRefGoogle Scholar
  9. 9.
    Murphy AM, Buck AM, Benson MC et al (2009) Increasing detection rate of benign renal tumors: evaluation of factors predicting for benign tumor histologic features during past two decades. Urology 73:1293–1297PubMedCrossRefGoogle Scholar
  10. 10.
    Millet I, Doyon FC, Hoa D et al (2011) Characterization of small solid renal lesions: can benign and malignant tumors be differentiated with CT? AJR Am J Roentgenol 197:887–896PubMedCrossRefGoogle Scholar
  11. 11.
    Pierorazio PM, Hyams ES, Tsai S et al (2013) Multiphasic enhancement patterns of small renal masses (≤4 cm) on preoperative computed tomography: utility for distinguishing subtypes of renal cell carcinoma, angiomyolipoma, and oncocytoma. Urology 81:1265–1271PubMedCrossRefGoogle Scholar
  12. 12.
    Go AS, Chertow GM, Fan D et al (2004) Chronic kidney disease and the risks of death, cardiovascular events, and hospitalization. N Engl J Med 351:1296–1305PubMedCrossRefGoogle Scholar
  13. 13.
    Kim JK, Kim TK, Ahn HJ et al (2002) Differentiation of subtypes of renal cell carcinoma on helical CT scans. AJR Am J Roentgenol 178:1499–1506PubMedCrossRefGoogle Scholar
  14. 14.
    Ruppert-Kohlmayr AJ, Uggowitzer M, Meissnitzer T et al (2004) Differentiation of renal clear cell carcinoma and renal papillary carcinoma using quantitative CT enhancement parameters. AJR Am J Roentgenol 183:1387–1391PubMedCrossRefGoogle Scholar

Copyright information

© Japan Society of Clinical Oncology 2014

Authors and Affiliations

  • Masatomo Nishikawa
    • 1
  • Hideaki Miyake
    • 1
  • Kazuhiro Kitajima
    • 2
  • Satoru Takahashi
    • 2
  • Kazuro Sugimura
    • 2
  • Masato Fujisawa
    • 1
  1. 1.Division of UrologyKobe University Graduate School of MedicineKobeJapan
  2. 2.Division of RadiologyKobe University Graduate School of MedicineKobeJapan

Personalised recommendations