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Early-stage clear cell tubulopapillary renal cell carcinoma: imaging features and distinction from clear cell and papillary subtypes

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Abstract

Purpose

Clear cell tubulopapillary renal cell carcinoma (CCTPRCC) is a recently described, low-grade subtype of renal cancer. We determined if imaging features could be used to distinguish early-stage CCTPRCC from stage-matched clear cell RCC (ccRCC) and papillary RCC (pRCC).

Methods

This IRB-approved retrospective study included 54 stage T1a patients with pathologically confirmed CCTPRCC (n = 18), ccRCC (n = 18), and pRCC (n = 18). CT (n = 48) and MRI (n = 27) exams were reviewed and imaging features compared. Continuous variables were evaluated using ANOVA and Tukey’s multiple comparison tests. Categorical variables were compared using Chi-square test or Fisher’s exact test.

Results

Compared to pRCC, CCTPRCC had a lower mean attenuation value on unenhanced CT (p < 0.017), was more often hyperintense on T2-weighted images (p < 0.0001), showed an ill-defined margin (p = 0.003), and demonstrated nonenhancing areas (p = 0.0003). The presence of all three of these statistically significant features [hypoattenuation (unenhanced attenuation ≤25 HU), ill-defined margin, nonenhancing areas] yielded an area under the receiver operator curve (ROC) of 0.92 (95% CI 0.83–0.99) for differentiating CCTPRCC from pRCC. There were no significant differences in the imaging features of CCTPRCC and ccRCC.

Conclusions

Early-stage clear cell tubulopapillary renal cell carcinoma can be distinguished from papillary RCC based on low attenuation on unenhanced CT, high intensity on T2-weighted images, an ill-defined margin, and presence of nonenhancing areas, but cannot be distinguished from clear cell RCC.

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Author notes

  1. Gevork N. Mnatzakanian

    Present address: Department of Medical Imaging, St. Michael’s Hospital, 3-141CC, 30 Bond St., Toronto, ON, M5B 1W8, Canada

  2. Atul B. Shinagare

    Present address: Dana-Farber Cancer Institute, 450 Brookline Ave, Boston, MA, 02215, USA

Authors and Affiliations

  1. Department of Radiology, Brigham and Women’s Hospital, 75 Francis St, Boston, MA, 02115, USA

    Gevork N. Mnatzakanian, Atul B. Shinagare, V. Anik Sahni & Stuart G. Silverman

  2. Department of Pathology, Brigham and Women’s Hospital, 75 Francis St., Amory-3, Boston, MA, 02115, USA

    Michelle S. Hirsch

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  1. Gevork N. Mnatzakanian
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Corresponding author

Correspondence to Gevork N. Mnatzakanian.

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Conflict of interest

The author declares that they have no competing interests.

Ethical approval

The study was approved by Hospital Institutional Review Board and this constitutes as ethical approval.

Additional information

This Health Insurance Portability and Accountability Act-compliant retrospective study was performed after approval of the Brigham and Women’s institutional review board.

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Mnatzakanian, G.N., Shinagare, A.B., Sahni, V.A. et al. Early-stage clear cell tubulopapillary renal cell carcinoma: imaging features and distinction from clear cell and papillary subtypes. Abdom Radiol 41, 2187–2195 (2016). https://doi.org/10.1007/s00261-016-0830-8

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  • DOI: https://doi.org/10.1007/s00261-016-0830-8

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