Subtype differentiation of small renal cell carcinomas on three-phase MDCT: usefulness of the measurement of degree and heterogeneity of enhancement

2012 ◽  
Vol 53 (1) ◽  
pp. 112-118 ◽  
Author(s):  
Seung Chai Jung ◽  
Jeong Yeon Cho ◽  
Seung Hyup Kim
Keyword(s):  
Renal Cell ◽  
Clear Cell ◽  
Cell Types ◽  
Renal Tumors ◽  
Imaging Features ◽  
Renal Cell Carcinomas ◽  
Three Phase ◽  
Significant Difference ◽  
Subtype Differentiation ◽  
Papillary Type

Background Subtype differentiation of small renal cell carcinomas (RCCs) can provide more information to surgeons and patients and get more useful information about imaging features of small renal tumors. Purpose To evaluate the usefulness of the measurement of degree and heterogeneity of enhancement in subtype differentiation of small renal cell carcinomas (RCCs) by three-phase multidetector-row CT (MDCT). Material and Methods We reviewed 149 pathologically confirmed small (<4cm) RCCs in 143 patients: 114 (clear cell), 17 (chromophobe), and 18 papillary (8 papillary type 1 and 10 papillary type 2). Scans in pre-contrast, corticomedullary, and nephrographic phases were obtained. We assessed the mean and standard deviation of the Hounsfield units (HU) in a region of interest (ROI) for the degree of enhancement and the heterogeneity of enhancement, respectively. We compared the attenuation values, and the degree and heterogeneity of enhancement among the subtypes. Results The clear cell type showed the highest enhancement and heterogeneity of enhancement followed by chromophobe and papillary types. There was a significant difference in enhancement between the clear cell and papillary types in the corticomedullary phase ( P < 0.01), and between clear and non-clear cell types in the nephrographic phase ( P < 0.05). Heterogeneity of enhancement showed a significant difference between clear cell and non-clear cell types in the corticomedullary phase ( P < 0.05). Conclusion The measurement of degree and heterogeneity of enhancement on contrast-enhanced MDCT may be a simple and useful method to differentiate between the different types of small RCCs.

The Diagnostic Accuracy of Percutaneous Renal Needle Core Biopsy and Its Potential Impact on the Clinical Management of Renal Cortical Neoplasms

2014 ◽  
Vol 138 (12) ◽  
pp. 1673-1679 ◽  
Author(s):  
Lan L. Gellert ◽  
Rohit Mehra ◽  
Ying-Bei Chen ◽  
Anuradha Gopalan ◽  
Samson W. Fine ◽  
...  
Keyword(s):  
Clinical Management ◽  
Renal Cell ◽  
Core Biopsy ◽  
Clear Cell ◽  
Renal Tumors ◽  
Low Grade ◽  
Renal Cell Carcinomas ◽  
Biopsy Diagnosis ◽  
Potential Impact ◽  
Renal Cortical Neoplasms

Context While biopsies are now increasingly being performed for the diagnosis of renal cortical neoplasms, the influence of the rendered pathological diagnoses on the clinical management is only rarely documented. Objectives To report our experience with consecutively performed renal biopsies and the potential impact of the diagnosis on subsequent clinical management. Design Material from needle biopsies performed consecutively at our institution between 2006 and 2011 was reviewed. The influence of the reported pathology results on the clinical management was determined from patient follow-up medical record review. Results In total, 218 percutaneous biopsies for renal masses were performed during this period. Among them, 181 (83%) yielded neoplastic tissue, including 81 clear cell renal cell carcinomas, 29 low-grade oncocytic neoplasms, 7 papillary renal cell carcinomas, 5 clear cell papillary renal cell carcinomas, 5 angiomyolipomas, and 14 urothelial carcinomas. Fourteen additional cases (6%) contained lesional material from clinically known nonneoplastic processes, for a total diagnostic yield of 89%. Twenty-three (11%) were nonrepresentative of lesional tissue. In 10 of these, repeat biopsies or resections established the diagnosis of renal tumors. Biopsy diagnosis was confirmed in 29 of 30 cases (97%) on subsequent nephrectomy. Following the biopsy diagnosis, there were significant differences in the clinical management; overall, 79% of clear cell renal cell carcinomas received therapeutic interventions, and 17% were put on active surveillance. In contrast, 77% of the benign or low-grade lesions were put on active surveillance. Conclusions Accurate and specific diagnosis can be rendered on renal core biopsy in most renal tumors, and the biopsy diagnosis can have a definitive role in their clinical management.

Value of intravoxel incoherent motion for differential diagnosis of renal tumors

2018 ◽  
Vol 60 (3) ◽  
pp. 382-387 ◽  
Author(s):  
Qingqiang Zhu ◽  
Wenrong Zhu ◽  
Jing Ye ◽  
Jingtao Wu ◽  
Wenxin Chen ◽  
...  
Keyword(s):  
Renal Cell ◽  
Clear Cell ◽  
Threshold Value ◽  
Intravoxel Incoherent Motion ◽  
Renal Tumors ◽  
Threshold Values ◽  
Renal Cell Carcinomas ◽  
Perfusion Fraction ◽  
D Values ◽  
Tumor Types

Background Few studies have reported on the use of intravoxel incoherent motion (IVIM) for renal tumors. Purpose To investigate the value of IVIM for distinguishing renal tumors. Material and Methods Thirty-one patients with clear cell renal cell carcinomas (CCRCCs), 13 patients with renal angiomyolipomas with minimal fat (RAMFs), eight patients with chromophobe renal cell carcinomas (ChRCCs), and ten patients with papillary renal cell carcinomas (PRCCs) were examined. The tissue diffusivity (D), pseudodiffusivity (D*), and perfusion fraction (f) were calculated. Results The D and f values were highest for CCRCCs, lowest for PRCCs, and intermediate for ChRCCs and RAMFs ( P < 0.05). The D values of CCRCCs differed significantly from those of ChRCCs and PRCCs ( P < 0.05). The D* values were highest for RAMFs, lowest for ChRCCs, and intermediate for CCRCCs and PRCCs ( P < 0.05). Statistically significant differences were observed between the D* values of CCRCCs and RAMFs ( P < 0.05). The D* values of the CCRCCs differed significantly from the D* values of the ChRCCs ( P < 0.05). Using the D and f values of 1.10 and 0.41, respectively, as the threshold values for differentiating CCRCCs from RAMFs, ChRCCs, and PRCCs, the best results had sensitivities of 81.0% and 66.8% and specificities of 85.7% and 81.0%, respectively. Using the D* value of 0.038 as the threshold value for differentiating RAMFs from CCRCCs, ChRCCs, and PRCCs, the best result obtained had a sensitivity of 90.5% and specificity of 76.2%. Conclusion IVIM may provide information for differentiating renal tumor types.

scholarly journals Comprehensive Immunoprofiles of Renal Cell Carcinoma Subtypes

Cancers ◽  
2020 ◽  
Vol 12 (3) ◽  
pp. 602 ◽  
Author(s):  
Moonsik Kim ◽  
Jin Woo Joo ◽  
Seok Joo Lee ◽  
Yoon Ah Cho ◽  
Cheol Keun Park ◽  
...  
Keyword(s):  
Renal Cell Carcinoma ◽  
Cell Carcinoma ◽  
Renal Cell ◽  
Clear Cell ◽  
Collecting Duct ◽  
Cathepsin K ◽  
Renal Tumors ◽  
Duct Carcinoma ◽  
Epithelial Tumors ◽  
Papillary Type

In recent years, renal epithelial tumors have been among the fastest reclassifying tumors, requiring updates to the tumor classification system. Nonetheless, immunohistochemistry (IHC) remains the most widely used tool for renal epithelial tumors. In this proposal, we aimed to create the most efficient IHC panel for categorizing the diverse subtypes of renal tumors, and to find out more specific immunohistochemical results in each subtype or each antibody. A total of 214 renal tumors were analyzed using 10 possible IHC markers to differentiate subtypes, including three major renal cell carcinoma (RCC) subtypes, clear-cell type (50 cases), papillary type (50 cases), and chromophobe type (20 cases), and minor subtypes (MiT RCC, 13 cases; collecting duct carcinoma, 5 cases; and oncocytoma, 10 cases). A triple immunomarker (cytokeratin 7 (CK7)-carbonic anhydrase IX (CAIX)- alpha-methylacyl-CoA racemase (AMACR)) panel is useful in particular high-grade clear-cell tumors. If IHC remains ambiguous, the use of an adjunctive panel can be suggested, including CD10, epithelial membrane antigen, cathepsin K, c-kit, hepatocyte nuclear factor 1-β, and E-cadherin. For an efficient immunohistochemical strategy for subtyping of RCC, we conclude that the CK7-CAIX-AMACR panel is the best primary choice for screening subtyping.

scholarly journals Differentiation of Clear Cell Renal Cell Carcinoma from other Renal Cell Carcinoma Subtypes and Benign Oncocytoma Using Quantitative MDCT Enhancement Parameters

Medicina ◽  
2020 ◽  
Vol 56 (11) ◽  
pp. 569
Author(s):  
Claudia-Gabriela Moldovanu ◽  
Bianca Petresc ◽  
Andrei Lebovici ◽  
Attila Tamas-Szora ◽  
Mihai Suciu ◽  
...  
Keyword(s):  
Renal Cell Carcinoma ◽  
Cell Carcinoma ◽  
Renal Cell ◽  
Clear Cell ◽  
Renal Tumors ◽  
3D Analysis ◽  
Imaging Features ◽  
Enhancement Ratio ◽  
Cell Renal Cell Carcinoma ◽  
Renal Masses

Background and objectives: The use of non-invasive techniques to predict the histological type of renal masses can avoid a renal mass biopsy, thus being of great clinical interest. The aim of our study was to assess if quantitative multiphasic multidetector computed tomography (MDCT) enhancement patterns of renal masses (malignant and benign) may be useful to enable lesion differentiation by their enhancement characteristics. Materials and Methods: A total of 154 renal tumors were retrospectively analyzed with a four-phase MDCT protocol. We studied attenuation values using the values within the most avidly enhancing portion of the tumor (2D analysis) and within the whole tumor volume (3D analysis). A region of interest (ROI) was also placed in the adjacent uninvolved renal cortex to calculate the relative tumor enhancement ratio. Results: Significant differences were noted in enhancement and de-enhancement (diminution of attenuation measurements between the postcontrast phases) values by histology. The highest areas under the receiver operating characteristic curves (AUCs) of 0.976 (95% CI: 0.924–0.995) and 0.827 (95% CI: 0.752–0.887), respectively, were demonstrated between clear cell renal cell carcinoma (ccRCC) and papillary RCC (pRCC)/oncocytoma. The 3D analysis allowed the differentiation of ccRCC from chromophobe RCC (chrRCC) with a AUC of 0.643 (95% CI: 0.555–0.724). Wash-out values proved useful only for discrimination between ccRCC and oncocytoma (43.34 vs 64.10, p < 0.001). However, the relative tumor enhancement ratio (corticomedullary (CM) and nephrographic phases) proved useful for discrimination between ccRCC, pRCC, and chrRCC, with the values from the CM phase having higher AUCs of 0.973 (95% CI: 0.929–0.993) and 0.799 (95% CI: 0.721–0.864), respectively. Conclusions: Our observations point out that imaging features may contribute to providing prognostic information helpful in the management strategy of renal masses.

scholarly journals Multiple and Bilateral Sporadic Renal Cell Carcinomas: A Surgical Challenge

2018 ◽  
Vol 2018 ◽  
pp. 1-4
Author(s):  
Antonios Katsimantas ◽  
Spyridon Paparidis ◽  
Konstantinos Bouropoulos ◽  
Nikolaos Ferakis
Keyword(s):  
Renal Cell Carcinoma ◽  
Cell Carcinoma ◽  
Renal Cell ◽  
Clear Cell ◽  
Renal Tumors ◽  
High Grade ◽  
Lower Pole ◽  
Renal Cell Carcinomas ◽  
Cell Renal Cell Carcinoma ◽  
The Right

Sporadic, synchronous, bilateral, or unilateral Renal Cell Carcinomas constitute a rare clinical entity. We report the case of a 68-year-old male patient who presented in our department due to incidentally discovered multiple, bilateral renal tumors. Magnetic Resonance Imaging demonstrated cT1b renal tumors at the lower pole of each kidney and a cT1a renal tumor at the upper pole of the right kidney. The patient underwent transperitoneal, laparoscopic left partial nephrectomy with renal artery occlusion, histology revealed high-grade, pT1b, clear-cell renal cell carcinoma; however we observed decline of patient’s estimated glomerular filtration rate postoperatively. Forty days postoperatively, he underwent open partial nephrectomy for the right sided tumors with manual compression of the renal parenchyma and no use of ischemia. Histology revealed high-grade, pT1a, clear-cell renal cell carcinoma at the upper pole of the right kidney and low-grade, pT1b, clear-cell renal cell carcinoma at the lower pole of the right kidney. There was no additional decline in the serum creatinine value postoperatively. The patient avoided permanent or temporary dialysis and 6 months postoperatively he demonstrated no recurrence on imaging and his renal function remained stable.

scholarly journals Clinical Utility of Chromosome Genomic Array Testing for Unclassified and Advanced-Stage Renal Cell Carcinomas

2018 ◽  
Vol 143 (4) ◽  
pp. 494-504 ◽  
Author(s):  
Nicole K. Andeen ◽  
Xiaoyu Qu ◽  
Tatjana Antic ◽  
Scott S. Tykodi ◽  
Min Fang ◽  
...  
Keyword(s):  
Renal Cell ◽  
Clinical Utility ◽  
Clear Cell ◽  
Renal Tumors ◽  
Renal Cell Carcinomas ◽  
Duct Carcinoma ◽  
Clinical Scenarios ◽  
Genomic Array ◽  
Clear Cell Rcc ◽  
Array Testing

Context.— Cytogenomic analysis provides a useful adjunct to traditional pathology in the categorization of renal cell carcinomas (RCCs), particularly in morphologically ambiguous cases, but it has disadvantages, including cost. Objective.— To define the clinical scenarios in which this technology has direct clinical applications. Design.— DNA was isolated from paraffin-embedded tissue from 40 selected cases of RCC. Chromosome genomic array testing was performed using the OncoScan. Results.— Of 23 cases of unclassified renal tumors, 19 (83%) were reclassified with incorporation of cytogenetic and histologic features, including 10 as clear cell RCC, 2 as collecting duct carcinoma, 2 as papillary RCC, and 1 as novel TFEB-amplified tumor lacking TFEB translocation. Of 5 tumors with “hybrid” oncocytic features, 3 were reclassified as an eosinophilic variant of chromophobe RCC and 1 as oncocytoma. Appropriate staging in 2 patients was determined by identifying distinct, nonshared cytogenetic profiles. Of 11 cases of metastatic clear cell RCC, 7 (63%) had cytogenetic features associated with a poor prognosis. Conclusions.— We identified 5 scenarios in which chromosome genomic array testing has direct clinical utility: (1) to investigate unclassified RCCs, (2) to understand tumors with “hybrid” features and “collision” tumors, (3) to determine appropriate staging in questions of bilateral tumors and/or metastases, (4) to identify chromosomal aberrations in metastatic clear cell RCCs associated with a worse prognosis, and (5) to identify new entities. This has practical value in our institution, where a molecular profile diagnostically separating morphologically difficult to classify clear cell, papillary, chromophobe, and unclassified RCC influences treatment recommendations and clinical trial eligibility.

scholarly journals FLUORESCENT IN SITU HYBRIDIZATION AND IMMUNOHISTOCHEMISTRY FOR SUBTYPING “NON-CLASSIFIABLE” RENAL CELL CARCINOMAS

2019 ◽  
Vol 31 (4) ◽  
pp. 921-924
Author(s):  
Atanas Ivanov ◽  
Vili Stoyanova
Keyword(s):  
In Situ Hybridization ◽  
Genetic Analysis ◽  
Renal Cell ◽  
Clear Cell ◽  
Renal Tumors ◽  
Renal Cell Carcinomas ◽  
Trisomy 7 ◽  
Papillary Rcc ◽  
Clear Cell Rcc

Renal tumors account for about 3% of the malignancies in adults. Clear cell subtype renal cell carcinoma (RCC) and papillary RCC are the most common renal tubular epithelial carcinomas and their differentiation is important because they have a different prognosis and are associated with different treatment protocols. In most cases, histological features allow accurate diagnosis of renal cell carcinomas. There are also overlapping morphological findings between certain kidney neoplasms that make their subtyping extremely difficult. Some of them display papillary architecture but also have a clear cell component and it is not clear whether they should be classified as clear cell RCC or papillary RCC. In our study we performed an immunohistochemical and genetic analysis of 24 cases of RCC classified as non-classifiable with mixed papillary and clear cell components treated at Clinic of Urology in University Hospital "St. George "-Plovdiv. The mean age of patients was 54.5 years, and gender distribution: 60% male and 40% female. Based on the results of immunohistochemistry and fluorescence in situ hybridization (FISH), patients were stratified in 2 groups. The first group included 16 of the cases where strong immunoreactivity was found for alfa-methyl coenzyme A racemase (AMACR), with cytokeratin 7 (CK7) being present in 15 of these. In all cases in this group, FISH proved trisomy 7 and 17, in 4-9p deletion, and in 2- 3p deletion. The remaining 8 cases were stratified in the second group - all negative for CK7 and only one positive for AMACR. Genetic analysis showed a lack of trisomy 7 and 17 in all cases, as well as a deletion of 3p and 9p in 7 of them. The combination of immunohistochemical and genetic analyzes allows with a high accuracy to differentiate cases of papillary RCC from those with clear cell RCC.

scholarly journals CT-based multi-phase Radiomic models for differentiating clear cell renal cell carcinoma

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Menglin Chen ◽  
Fu Yin ◽  
Yuanmeng Yu ◽  
Haijie Zhang ◽  
Ge Wen
Keyword(s):  
Renal Cell ◽  
Clear Cell ◽  
Characteristic Curve ◽  
Treatment Options ◽  
Texture Features ◽  
Diagnostic Value ◽  
Renal Tumors ◽  
Diagnostic Model ◽  
Renal Cell Carcinomas ◽  
Cell Renal Cell Carcinoma

Abstract Background The aim of the study is to compare the diagnostic value of models that based on a set of CT texture and non-texture features for differentiating clear cell renal cell carcinomas(ccRCCs) from non-clear cell renal cell carcinomas(non-ccRCCs). Methods A total of 197 pathologically proven renal tumors were divided into ccRCC(n = 143) and non-ccRCC (n = 54) groups. The 43 non-texture features and 296 texture features that extracted from the 3D volume tumor tissue were assessed for each tumor at both Non-contrast Phase, NCP; Corticomedullary Phase, CMP; Nephrographic Phase, NP and Excretory Phase, EP. Texture-score were calculated by the Least Absolute Shrinkage and Selection Operator (LASSO) to screen the most valuable texture features. Model 1 contains the three most distinctive non-texture features with p < 0.001, Model 2 contains texture scores, and Model 3 contains the above two types of features. Results The three models shown good discrimination of the ccRCC from non-ccRCC in NCP, CMP, NP, and EP. The area under receiver operating characteristic curve (AUC)values of the Model 1, Model 2, and Model 3 in differentiating the two groups were 0.748–0.823, 0.776–0.887 and 0.864–0.900, respectively. The difference in AUC between every two of the three Models was statistically significant (p < 0.001). Conclusions The predictive efficacy of ccRCC was significantly improved by combining non-texture features and texture features to construct a combined diagnostic model, which could provide a reliable basis for clinical treatment options.

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