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A practical imaging classification for the non-invasive differentiation of renal cell carcinoma into its main subtypes

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Abdominal Radiology Aims and scope Submit manuscript

Abstract

Aim

Renal cell carcinoma (RCC) is a heterogeneous disease which encompasses various subtypes that exhibit differing biologic behavior and imaging findings. Non-invasive subtype differentiation by imaging facilitates prognostication and treatment selection. The aim of the study was to evaluate the performance of a diagnostic imaging key based on tumor morphology, T2 signal intensity on MRI, and tumor vascularity for differentiating RCC into its subtypes.

Materials and methods

Using a custom-designed diagnostic imaging key, three blinded fellowship-trained abdominal radiologists independently evaluated the cross-sectional imaging of 50 histologically proven RCCs and categorized these into subtypes in two sessions. The diagnostic performance of the imaging key was evaluated and compared to the baseline performance without the key.

Results

The 50 RCCs comprised 20 (40%) clear cell, 17 (34%) papillary, and 13 (26%) chromophobe tumors. All expert readers demonstrated an improvement in diagnostic accuracy by an average of 5.3% with the use of the key. The readers showed good to excellent diagnostic performance for clear cell RCC (area under the receiver operating curve, AUROC of 0.86–0.91) and papillary RCC (AUROC of 0.82–0.87), and fair performance with chromophobe RCC (AUROC of 0.67–0.77). The Reader-to-SOR (standard of reference) agreement increased from 0.53 (moderate) to 0.67 (good) with the use of the key.

Conclusion

The diagnostic imaging key facilitates RCC subtype characterization and can be used as a decision support tool.

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Authors and Affiliations

  1. Department of Radiology and Diagnostic Imaging, University of Alberta Hospital, 2A2.41 Walter Mackenzie Center, 8440-112 Street, Edmonton, AB, T6G 2B7, Canada

    Brindley David Cupido, Medica Sam, Sean David Winters, Bilal Ahmed, Michael Seidler, Guan Huang & Gavin Low

Authors
  1. Brindley David Cupido
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  2. Medica Sam
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  3. Sean David Winters
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  4. Bilal Ahmed
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  5. Michael Seidler
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  6. Guan Huang
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  7. Gavin Low
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Corresponding author

Correspondence to Brindley David Cupido.

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Conflict of Interest

Drs. Brindley David Cupido, Medica Sam, Sean David Winters, Bilal Ahmed, Michael Seidler, Guan Huang, and Gavin Low declare that they have no conflict of interest.

Funding

No funding was required for this project.

Ethical approval

Ethical approval was obtained from the University of Alberta Health Research Ethics board-Health Panel (Pro00038008).

Informed consent

Informed consent was waived for this retrospective review by University ethics committee.

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Cupido, B.D., Sam, M., Winters, S.D. et al. A practical imaging classification for the non-invasive differentiation of renal cell carcinoma into its main subtypes. Abdom Radiol 42, 908–917 (2017). https://doi.org/10.1007/s00261-016-0940-3

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  • DOI: https://doi.org/10.1007/s00261-016-0940-3

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