Clear cell renal cell carcinoma: discrimination from other renal cell carcinoma subtypes and oncocytoma at multiphasic multidetector CT.

doi:10.1148/RADIOL.13112617

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Clear cell renal cell carcinoma: discrimination from other renal cell carcinoma subtypes and oncocytoma at multiphasic multidetector CT.

Journal Article•DOI•

Clear cell renal cell carcinoma: discrimination from other renal cell carcinoma subtypes and oncocytoma at multiphasic multidetector CT.

Jonathan R. Young¹, Daniel Margolis¹, Steven Sauk¹, Allan J. Pantuck¹, James Sayre¹, Steven S. Raman¹ - Show less +2 more•Institutions (1)

University of California, Los Angeles¹

01 May 2013-Radiology (Radiological Society of North America Inc.)-Vol. 267, Iss: 2, pp 444-453

TL;DR: Enhancement at multiphasic multidetector CT, if prospectively validated, may assist in the discrimination of clear cell RCC from oncocytoma, papillary RCC, and chromophobe RCC.

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Abstract: Multiphasic multidetector CT, if validated in a large prospective trial, may assist in the discrimination of clear cell renal cell carcinoma (RCC) from oncocytoma, papillary RCC, and chromophobe RCC.

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Journal Article•DOI•

Renal Mass and Localized Renal Cancer: AUA Guideline

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Steven C. Campbell¹, Robert G. Uzzo¹, Mohamad E. Allaf¹, Eric B Bass¹, Jeffrey A. Cadeddu¹, Anthony Chang¹, Peter E. Clark¹, Brian J. Davis¹, Ithaar Derweesh¹, Leo Giambarresi¹, Debra A. Gervais¹, Susie L. Hu¹, Brian R. Lane¹, Bradley C. Leibovich¹, Philip M. Pierorazio¹ - Show less +11 more•Institutions (1)

American Urological Association¹

01 Sep 2017-The Journal of Urology

TL;DR: Several factors should be considered during counseling/management of patients with clinically localized renal masses, including general health/comorbidities, oncologic potential of the mass, pertinent functional issues and relative efficacy/potential morbidities of various management strategies.

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990 citations

Cites background from "Clear cell renal cell carcinoma: di..."

...34 Recent studies have been unable to confirm a survival benefit for LND for RCC. 35 If lymph node involvement is confirmed on final pathology, medical oncology consultation should be considered....
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...While papillary RCC is often hypo-enhancing, both malignant and benign masses can display heterogeneous avid contrast enhancement patterns.(98,137)...
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...(Moderate Recommendation; Evidence Level: Grade C) Absolute indications for nephron-sparing approaches include situations in which RN would render the patient anephric or high-risk for renal replacement therapy.1 These include patients with anatomic or functionally solitary kidney, bilateral tumors, or known familial RCC. 1 While patients with familial RCC have two functional kidneys, they are likely to experience tumor recurrence and require multiple renal interventions throughout their lifetime....
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...%) of kidney cancers are renal cortical tumors known as RCC....
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...In addition, significant overlap can exist in imaging characteristics of RCC and oncocytoma on cross sectional imaging, or between subtypes of papillary RCC.(97,98)...
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Journal Article•DOI•

Management of Renal Masses and Localized Renal Cancer: Systematic Review and Meta-Analysis

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Phillip M. Pierorazio¹, Michael H. Johnson¹, Hiten D. Patel¹, Stephen M. Sozio¹, Ritu Sharma¹, Emmanuel Iyoha¹, Eric B Bass¹, Mohamad E. Allaf¹ - Show less +4 more•Institutions (1)

Johns Hopkins University¹

01 Oct 2016-The Journal of Urology

TL;DR: Comparative studies demonstrated similar cancer specific survival across management strategies, with some differences in renal functional outcomes, perioperative outcomes and postoperative harms that should be considered when choosing a management strategy.

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303 citations

Cites background from "Clear cell renal cell carcinoma: di..."

...Medina-Polo, 2011108 174 78 (20) 116 76 (22) -...
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...Klatte, 2011123 82 64 (27) 41 64 (22) Archived: This report is greater than 3 years old....
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...Author, Year Biopsy n Surgery n (%) Nondiagnostic Biopsy Benign Biopsy Malignant Biopsy Sensitivity (%) Specificity (%) PPV (%) NPV (%) Surgery n Malignant n (%) True Negative False Negative True Positive False Positive Campbell, 199761 25 25(100) 9 9(100) 0 6 10 0 63 NA 100 0 Chyhrai, 201062 25 21(84) 1 1(100) 5 1 14 0 94 100 100 83 Halverson, 201363 151 151(100) NR NR 4 3 130 0 98 100 100 57 Harisinghani, 200364 28 16(57) 0 NR 1 0 16 0 100 100 100 100 Leveridge, 201165 345 74(21) 6 5(83) NR NR NR NR NA NA NA NA Londono, 201366 132 63(48) 2 2(100) 2 13 46 0 78 100 100 13 Menogue, 201267 250 129(52) 9 8(89) 6 0 114 0 100 100 100 100 Millet, 201268a 187 61(33) NR NR NR NR 61 0 NA NA 100 NA Neuzillet, 200369 88 62(70) 5 5(100) 1 0 56 0 100 100 100 100 Park, 201351 59 13(22) 2 2(100) 0 0 11 0 100 NA 100 NA Prince, 201579 565 NR NR NR NR NR NR NR NA NA NA NA Reichelt, 200776 30 22(73) 4 4(100) 4 0 14 0 100 100 100 100 Richard, 201578 529 171(32) 4 4(100) 3 0 163 1 100 75 99....
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...Shannon, 200871c 224 50(22) 132(59) 42(19) 85(38) 25(11) 11(5) 3(1)...
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...Overall median 7409 76 (18) 8437 75 (21) 1765 64 (22) 173 68 (16)...
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Journal Article•DOI•

CT Texture Analysis of Renal Masses : Pilot Study Using Random Forest Classification for Prediction of Pathology

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Siva P. Raman¹, Yifei Chen¹, James L. Schroeder¹, Peng Huang¹, Elliot K. Fishman¹ - Show less +1 more•Institutions (1)

Johns Hopkins University¹

01 Dec 2014-Academic Radiology

TL;DR: CTTA, in conjunction with random forest modeling, demonstrates promise as a tool to characterize lesions and various renal masses were accurately classified using quantitative information derived from routine scans.

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144 citations

Cites background from "Clear cell renal cell carcinoma: di..."

...Finally, although oncocytomas also tend to be relatively vascular masses that can often resemble clear cell RCCs, studies have suggested that these lesions may have slightly lesser degrees of enhancement compared to clear cell RCCs on both corticomedullary and excretory phase images (7,10)....
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Journal Article•DOI•

Iodine Quantification to Distinguish Clear Cell from Papillary Renal Cell Carcinoma at Dual-Energy Multidetector CT: A Multireader Diagnostic Performance Study

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Achille Mileto¹, Daniele Marin², Marcela Alfaro-Córdoba¹, Juan Carlos Ramirez-Giraldo³, Christian D. Eusemann, Emanuele Scribano, Alfredo Blandino, Silvio Mazziotti, Giorgio Ascenti - Show less +5 more•Institutions (3)

North Carolina State University¹, University of Messina², Siemens³

25 Aug 2014-Radiology

TL;DR: Dual-energy multidetector CT with iodine quantification can be used to distinguish between clear cell and papillary RCC renal cell carcinoma , and it provides insights regarding the tumor grade.

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Abstract: Our study shows that iodine quantification with dual-energy multidetector CT imaging can differentiate between clear cell and papillary renal cell carcinoma at a single imaging time point.

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135 citations

Journal Article•DOI•

Texture analysis as a radiomic marker for differentiating renal tumors.

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Hei Shun Yu¹, Hei Shun Yu², Jonathan Scalera², Maria Khalid², Anne-Sophie Touret², Nicolas Bloch², Baojun Li², Muhammad M. Qureshi², Jorge A. Soto², Stephan W. Anderson² - Show less +6 more•Institutions (2)

Harvard University¹, Boston Medical Center²

18 Apr 2017-Abdominal Radiology

TL;DR: Texture analysis is a promising non-invasive tool for distinguishing renal tumors on CT images, and results were further improved upon application of machine learning, and support the further development of texture analysis as a quantitative biomarker for distinguishing various renal tumors.

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Abstract: To evaluate the utility of texture analysis for the differentiation of renal tumors, including the various renal cell carcinoma subtypes and oncocytoma. Following IRB approval, a retrospective analysis was performed, including all patients with pathology-proven renal tumors and an abdominal computed tomography (CT) examination. CT images of the tumors were manually segmented, and texture analysis of the segmented tumors was performed. A support vector machine (SVM) method was also applied to classify tumor types. Texture analysis results were compared to the various tumors and areas under the curve (AUC) were calculated. Similar calculations were performed with the SVM data. One hundred nineteen patients were included. Excellent discriminators of tumors were identified among the histogram-based features noting features skewness and kurtosis, which demonstrated AUCs of 0.91 and 0.93 (p < 0.0001), respectively, for differentiating clear cell subtype from oncocytoma. Histogram feature median demonstrated an AUC of 0.99 (p < 0.0001) for differentiating papillary subtype from oncocytoma and an AUC of 0.92 for differentiating oncocytoma from other tumors. Machine learning further improved the results achieving very good to excellent discrimination of tumor subtypes. The ability of machine learning to distinguish clear cell subtype from other tumors and papillary subtype from other tumors was excellent with AUCs of 0.91 and 0.92, respectively. Texture analysis is a promising non-invasive tool for distinguishing renal tumors on CT images. These results were further improved upon application of machine learning, and support the further development of texture analysis as a quantitative biomarker for distinguishing various renal tumors.

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127 citations

Cites methods from "Clear cell renal cell carcinoma: di..."

...Numerous imaging strategies have been employed in an attempt to non-invasively differentiate tumors, including enhancement heterogeneity, degree of enhancement, and pattern of enhancement on CT [3, 7]....
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References

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Journal Article•DOI•

Renal-cell carcinoma.

[...]

Herbert T. Cohen¹, Francis J. McGovern•Institutions (1)

Boston University¹

08 Dec 2005-The New England Journal of Medicine

TL;DR: In the United States, renal cancer is the 7th leading malignant condition in men and the 12th in women, accounting for 2.6 percent of all cancers.

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Abstract: In the United States, renal cancer is the 7th leading malignant condition in men and the 12th in women, accounting for 2.6 percent of all cancers. This article discusses the evolving presentation, understanding, and treatment of this disease.

...read moreread less

1,376 citations

Journal Article•DOI•

The Heidelberg classification of renal cell tumours

[...]

Gyula Kovacs¹, Mohammed Akhtar, Bruce Beckwith², Peter Bugert¹, Colin Cooper³, Brett Delahunt⁴, John N. Eble, Stewart Fleming⁵, Börje Ljungberg⁶, L. Jeffrey Medeiros⁷, Holger Moch⁸, Victor E. Reuter⁹, Eberhard Ritz¹, Göran Roos⁶, Dietmar Schmidt, John R. Srigley¹⁰, Stephan Störkel, Eva van den Berg¹¹, Bert Zbar - Show less +15 more•Institutions (11)

Heidelberg University¹, Loma Linda University², Institute of Cancer Research³, Wellington Management Company⁴, University of Edinburgh⁵, Umeå University⁶, City of Hope National Medical Center⁷, University of Basel⁸, Memorial Sloan Kettering Cancer Center⁹, University of Toronto¹⁰, University of Groningen¹¹

01 Oct 1997-The Journal of Pathology

TL;DR: This paper presents the conclusions of a workshop entitled ‘Impact of Molecular Genetics on the Classification of Renal Cell Tumours’, which was held in Heidelberg in October 1996 and is applicable to routine diagnostic practice.

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Abstract: This paper presents the conclusions of a workshop entitled 'Impact of Molecular Genetics on the Classification of Renal Cell Tumours', which was held in Heidelberg in October 1996. The focus on 'renal cell tumours' excludes any discussion of Wilms' tumour and its variants, or of tumours metastatic to the kidneys. The proposed classification subdivides renal cell tumours into benign and malignant parenchymal neoplasms and, where possible, limits each subcategory to the most commonly documented genetic abnormalities. Benign tumours are subclassified into metanephric adenoma and adenofibroma, papillary renal cell adenoma, and renal oncocytoma. Malignant tumours are subclassified into common or conventional renal cell carcinoma; papillary renal cell carcinoma; chromophobe renal cell carcinoma; collecting duct carcinoma, with medullary carcinoma of the kidney; and renal cell carcinoma, unclassified. This classification is based on current genetic knowledge, correlates with recognizable histological findings, and is applicable to routine diagnostic practice.

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1,288 citations

Journal Article•DOI•

Comparisons of outcome and prognostic features among histologic subtypes of renal cell carcinoma.

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John C. Cheville¹, Christine M. Lohse¹, Horst Zincke¹, Amy L. Weaver¹, Michael L. Blute¹ - Show less +1 more•Institutions (1)

Mayo Clinic¹

01 May 2003-The American Journal of Surgical Pathology

TL;DR: It is demonstrated that there are significant differences in outcome and associations with outcome for the different histologic subtypes of RCC, highlighting the need for accurate subtyping.

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Abstract: Our objective was to compare cancer-specific survival and to examine associations with outcome among the histologic subtypes of renal cell carcinoma (RCC). We studied 2385 patients whose first surgery between 1970 and 2000 was a radical nephrectomy for sporadic, unilateral RCC. All RCC tumors were classified following the 1997 Union Internationale Contre le Cancer and American Joint Committee on Cancer guidelines. There were 1985 (83.2%) patients with clear cell, 270 (11.3%) with papillary, 102 (4.3%) with chromophobe, 6 (0.3%) with collecting duct, 5 (0.3%) with purely sarcomatoid RCC and no underlying histologic subtype, and 17 (0.7%) with RCC, not otherwise specified. Cancer-specific survival rates at 5 years for patients with clear cell, papillary, and chromophobe RCC were 68.9%, 87.4%, and 86.7%, respectively. Patients with clear cell RCC had a poorer prognosis compared with patients with papillary and chromophobe RCC (p <0.001). This difference in outcome was observed even after stratifying by 1997 tumor stage and nuclear grade. There was no significant difference in cancer-specific survival between patients with papillary and chromophobe RCC (p = 0.918). The 1997 TNM stage, tumor size, presence of a sarcomatoid component, and nuclear grade were significantly associated with death from clear cell, papillary, and chromophobe RCC. Histologic tumor necrosis was significantly associated with death from clear cell and chromophobe RCC, but not with death from papillary RCC. Our results demonstrate that there are significant differences in outcome and associations with outcome for the different histologic subtypes of RCC, highlighting the need for accurate subtyping.

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1,012 citations

Journal Article•DOI•

Prognostic utility of the recently recommended histologic classification and revised TNM staging system of renal cell carcinoma: a Swiss experience with 588 tumors.

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Holger Moch¹, Thomas Gasser¹, Mahul B. Amin², Joachim Torhorst¹, Guido Sauter¹, Michael J. Mihatsch¹ - Show less +2 more•Institutions (2)

University of Basel¹, Emory University Hospital²

01 Aug 2000-Cancer

TL;DR: A new, internationally accepted histologic classification of renal cell carcinoma (RCC) and a new edition of the TNM staging system were introduced in 1997 and there was a dramatic change in the pT classification of organ‐confined renal cancer.

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Abstract: BACKGROUND A new, internationally accepted histologic classification of renal cell carcinoma (RCC) and a new edition of the TNM staging system were introduced in 1997. In the latter, there was a dramatic change in the pT classification of organ-confined renal cancer in which the break point between category pT1 and pT2 was increased from 2.5 cm to 7 cm. METHODS To study the significance of the new pT classification and the new recommendations for histologic classification, 588 nephrectomy specimens were reevaluated to define morphologic prognostic parameters in RCC. pT classification (TNM 1997), histologic subtype, histologic tumor grade, presence of necrosis, and sarcomatoid differentiation were assessed. RESULTS The histopathologic review according to the new classification revealed 487 conventional (clear cell) (83%), 64 papillary (11%), 31 chromophobe (5%), and 6 collecting duct (1%) RCCs. Clinical follow-up was available for 470 RCCs. The new pT classification (1997) was strongly correlated with patient survival (P < 0.0001). Histologic grade, presence of necrosis, and sarcomatoid differentiation provided independent prognostic information on the clear cell subtype of renal cancer. Sarcomatoid differentiation, but not tumor necrosis, portended a dismal prognosis for patients with papillary RCC. Chromophobe RCC was associated with a significantly better prognosis than clear cell RCC (P = 0.05). Papillary RCC with scanty cytoplasm and small cells (type 1) behaved less aggressively than papillary tumors with eosinophilic cytoplasm and large cells (type 2; P < 0.001). CONCLUSIONS Accurate histologic classification according to the new recommendations has implications because the prognostic importance of other histologic features that are of independent significance varies with tumor subtype. The data suggest that the new pT classification allows good separation of prognostic groups of patients with renal cancer. Cancer 2000;89:604–14. © 2000 American Cancer Society.

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459 citations

Journal Article•DOI•

Differentiation of Subtypes of Renal Cell Carcinoma on Helical CT Scans

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Jeong Kon Kim¹, Tae Kyoung Kim, Han Jong Ahn, Chung Soo Kim, Kyu-Rae Kim, Kyoung-Sik Cho - Show less +2 more•Institutions (1)

Asan Medical Center¹

01 Jun 2002-American Journal of Roentgenology

TL;DR: For the differentiation of the subtypes of renal cell carcinoma, degree of enhancement is the most valuable parameter; enhancement pattern, the presence or absence of calcification, and tumor-spreading patterns can serve supplemental roles in the identification of a subtype of renal carcinoma.

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Abstract: OBJECTIVE. The purpose of our study was to differentiate subtypes of renal cell carcinoma on helical CT scans.MATERIALS AND METHODS. We reviewed CT scans of four subtypes of renal cell carcinoma: 76 conventional (clear cell), 19 papillary, 13 chromophobe, and two collecting duct. Biphasic CT scans (unenhanced, corticomedullary, and excretory phase scans) were obtained in 61 patients, and monophasic CT scans (unenhanced and excretory phase scans) in 49. We compared patient age and sex; tumor size; degree and pattern (homogeneous, heterogeneous, predominantly peripheral) of enhancement; presence or absence of calcification; and tumor-spreading patterns including perinephric change, venous invasion, and lymphadenopathy in four subtypes.RESULTS. Conventional renal carcinoma showed stronger enhancement than the other subtypes (p < 0.05): 106 ± 48 H (mean ± SD) in the corticomedullary phase and 62 ± 25 H in the excretory phase. The sensitivity and specificity for differentiating conventional renal carcinoma fro...

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371 citations