Predicting the Histology of Renal Masses Using Preoperative Doppler Ultrasonography
ABSTRACT Traditional imaging techniques cannot differentiate among benign, indolent and malignant renal neoplasms. Since conventional clear cell carcinomas are highly vascular, we used preoperative color and/or power Doppler ultrasonography to evaluate the association between vascular flow in a renal mass and surgical pathology.
Nephrectomies performed at our institution between January 2001 and December 2004 were retrospectively evaluated. Any detection of flow in the renal mass on color Doppler ultrasonography was defined as vascular flow. A prospective validation study was then performed from January 2005 to October 2005 and a nomogram was constructed to predict clear cell histology.
Of 299 renal lesions in the retrospective cohort 210 (70%) had evidence of vascular flow, including 156 of 169 conventional clear cell carcinomas (92%) (p <0.0001). On logistic regression analysis vascular flow was associated with conventional clear cell histology (OR 16.9, 95% CI 8.7-32.8; p <0.0001). This finding was validated prospectively in 97 patients. Vascular flow was detected in 54 of 65 renal masses (83%) with conventional clear cell histology (p <0.0001), which was associated with an OR of 10.8 (95% CI 4.0-29.0; p <0.0001). A nomogram incorporating vascular flow along with clinical variables (clinical size, patient sex and age) to predict conventional clear cell histology was constructed on the retrospective cohort and validated on the prospective data set (concordance index 0.82 and 0.76, respectively).
Vascular flow detected by color Doppler ultrasonography is strongly associated with conventional clear cell histology. A nomogram incorporating vascular flow on color Doppler ultrasonography and clinical parameters may aid in the preoperative characterization of renal lesions.
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ABSTRACT: Of all the malignant tumors, 3.5% correspond to renal cell carcinoma and its mortality rate is near 40%. The overall survival rate for localized renal tumors is of 90% at 5 years and 82% at 10 years and the incidence raises 2% to 2.5% per year. Between 60% and 70% of new cases, the RCC are asymptomatic and incidental. The surveillance of renal masses smaller than 4 cm is accepted as an active process that requires to focus on human and administrative resources to give to the patient the best therapeutical option. This is the reason why the small renal masses (less than 4 cm) with defined characteristics can benefit of the active surveillance. El carcinoma de células renales corresponde al 3.5% de de todos los tumores malignos y tiene una mortalidad cercana al 40%. La tasa de sobrevida relativa para tumores localizados en el riñón es del 90% a los 5 años y de 82% a los 10 años y la incidencia de aumenta a una tasa de 2% a 2,5% por año. Entre 60% y 70% de los nuevos casos de CCR diagnosticados son asintomáticos y de descubrimiento incidental. La observación de masas renales menores de 4 cm de diámetro es aceptada en pacientes como un proceso activo que requiere la focalización del recurso humano y administrativo, con una inversión económica importante, para dar a estos pacientes la mejor opción terapéutica según su condición. Por esta razón los pacientes con masas renales pequeñas (<4cm.) con características definidas, pueden beneficiarse en algún momento de la observación activa teniendo en cuenta que durante el seguimiento se pueden encontrar diferentes resultados y de acuerdo a estos cambiar la observación por otra opción terapeútica.
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ABSTRACT: Secondary to the widespread use of the modern imaging techniques of computed tomography, magnetic resonance imaging, and ultrasound, 70% of renal tumors today are detected incidentally with a median tumor size of less than 4 cm. Twenty years ago, all renal tumors, regardless of size were treated with radical nephrectomy (RN). Elective partial nephrectomy (PN) has emerged as the treatment of choice for small renal tumors. The basis of this paradigm shift is three major factors: (1) cancer specific survival is equivalent for T1 tumors (7 cm or less) whether treated by PN or RN; (2) approximately 45% of renal tumors have indolent or benign pathology; and (3) PN prevents or delays the onset of chronic kidney disease, a condition associated with increased cardiovascular morbidity and mortality. Although PN can be technically demanding and associated with potential complications of bleeding, infection, and urinary fistula, the patient derived benefits of this operation far outweigh the risks. We have developed a "mini-flank" open surgical approach that is highly effective and, coupled with rapid recovery postoperative care pathways associated with a 2-day length of hospital stay.Nature Clinical Practice Urology 02/2006; 3(1):2-3. DOI:10.1038/ncpuro0382 · 4.07 Impact Factor
Article: Imaging of Kidney Cancer[Show abstract] [Hide abstract]
ABSTRACT: Advances in molecular genetics have expanded the understanding of renal cell tumors. Now it is understood that renal cortical tumors are a family of neoplasms with distinct cytogenetics and molecular defects, unique histopathologic features, and different malignant potentials. Imaging contributes to clinical management of patients with renal tumors in providing diagnostic information for tumor detection, characterization, staging, treatment planning, and follow-up.Radiologic Clinics of North America 02/2007; 45(1):119-47. DOI:10.1016/j.rcl.2006.10.011 · 1.83 Impact Factor