Rationale and Objectives
Prediction of growth, in particular knowing the possibility of aggressive cancer in
small renal masses on active surveillance, remains poorly understood. The study was
designed to determine whether serial nephrometry score measurements could predict
possibility of aggressive malignancy (grade of cancer) in patients with small renal
masses opting for active surveillance initially.
Materials and Methods
One hundred sixteen patients between January 2000 and December 2016 undergoing partial
nephrectomy were recruited. Out of these, 97 were analyzed using different nephrometry
scoring systems. Measurement of nephrometry scores (Radius of tumors, Exo/Endophytic;
Nearness of tumors to the collecting system or sinus; Anterior/posterior; Location
in relation to polar lines, Preoperative Aspects and Dimensions Used for Anatomical,
Centrality Index) was performed by two researchers. Among the patients opting for
partial nephrectomy, 40 were on active surveillance for at least 12 months (mean 32;
12–60 months) before partial nephrectomy. Computed tomography scan images of these
patients were retrieved and analyzed including comparison to histopathology.
Results
Nephrometry scores measured on serial computed tomography scan images showed a significant
correlation between change in score and grade of cancer on multivariate analysis (P value .001). Addition of multivariate analysis to nomogram based on change in size
alone did not improve predictive value of area under the curve significantly.
Conclusions
Change in nephrometry scoring measurements correlates with grade of cancer in small
renal masses but falls short of significantly predicting presence of malignancy or
grade of cancer on nomogram in patients opting for active surveillance for small renal
masses. At present, this approach may be inadequate for decision-making.
Key Words
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Article info
Publication history
Published online: March 06, 2018
Accepted:
February 1,
2018
Received in revised form:
January 25,
2018
Received:
January 10,
2018
Footnotes
Ethics approval and consent to participate: Institutional permission was obtained through NHS Tayside Research and Development with Cadicott number Caldicott/CSAppGN021211; Caldicott/IGTCAL2973.
Availability of data and material: For transparency and sharing, data is available on (http://www.nisg.scot.nhs.uk/currently-supporting/pacs-and-ris).
Khan H. Mohammed and Zhang Wanzhe had equal contribution.
Identification
Copyright
© 2018 The Association of University Radiologists. Published by Elsevier Inc. All rights reserved.
