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      Imaging features of solid renal masses

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          Abstract

          <p class="first" id="d7563259e259">The widespread use of abdominal imaging techniques has increased the detection of solid renal masses over the past years. Imaging plays a crucial role in the management and surveillance and in determining which lesions need treatment. The “classical angiomyolipoma” is the only benign solid renal mass that can be characterized with confidence by imaging through the detection of a fat-containing lesion without calcifications. There is a large overlap of imaging features between benign and malignant renal masses that often makes difficult a correct characterization of these lesions. In this review, we discuss the imaging features of the main solid renal masses that may suggest a likely benign diagnosis. </p>

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          Rising incidence of small renal masses: a need to reassess treatment effect.

          John Hollingsworth, David C Miller, Stephanie Daignault … (2006)
          The incidence of kidney cancer has been rising over the last two decades, especially in cases where the disease is localized. Although rates of renal surgery parallel this trend, mortality rates have continued to rise. To investigate the basis of this "treatment disconnect" (i.e., increased rates of treatment accompanied by increased mortality rates), we analyzed patient data from nine registries of the National Cancer Institute's Surveillance, Epidemiology, and End Results Program. We assembled a cohort of 34,503 kidney cancer patients and derived incidence, treatment, and mortality trends for kidney cancer, overall and as a function of tumor size. From 1983 to 2002, the overall age-adjusted incidence rate for kidney cancer rose from 7.1 to 10.8 cases per 100,000 US population; tumors 7 cm. Our results demonstrate that the rising incidence of kidney cancer is largely attributable to an increase in small renal masses that are presumably curable. The fact that increased detection and treatment of small tumors is not reducing mortality argues for a reassessment of the current treatment paradigm.
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            Preoperative aspects and dimensions used for an anatomical (PADUA) classification of renal tumours in patients who are candidates for nephron-sparing surgery.

            Vincenzo Ficarra, Giacomo Novara, Silvia Secco … (2009)
            Besides clinical tumour size, other anatomical aspects of the renal tumour are routinely considered when evaluating the feasibility of elective nephron-sparing surgery (NSS). To propose an original, standardised classification of renal tumours suitable for NSS based on their anatomical features and size and to evaluate the ability of this classification to predict the risk of overall complications resulting from the surgery. We enrolled prospectively 164 consecutive patients who underwent NSS for renal tumours at a tertiary academic referral centre from January 2007 to December 2008. Open partial nephrectomy without vessel clamping. All tumours were classified by integrating size with the following anatomical features: anterior or posterior face, longitudinal, and rim tumour location; tumour relationships with renal sinus or urinary collecting system; and percentage of tumour deepening into the kidney. We generated an algorithm evaluating each anatomical parameter and tumour size (the preoperative aspects and dimensions used for an anatomical [PADUA] score) to predict the risk of complications. Overall rates of complication were significantly correlated to all the evaluated anatomical aspects, excluding clinical size and anterior or posterior location of the tumour. By multivariate analysis, PADUA scores were independent predictors of the occurrence of any grade complications (hazard ratio [HR] for score 8-9 vs 6-7: 14.535; HR for score ≥10 vs 6-7: 30.641). Potential limitations were the limited number of patients with T1b tumours included in the study and the lack of laparoscopically treated patients. Further external validation of the PADUA score is needed. The PADUA score is a simple anatomical system that can be used to predict the risk of surgical and medical perioperative complications in patients undergoing open NSS. The use of an appropriate score can help clinicians stratify patients suitable for NSS into subgroups with different complication risks and can help researchers evaluate the real comparability among patients undergoing NSS with different surgical approaches.
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              Renal angiomyolipoma: relationships between tumor size, aneurysm formation, and rupture.

              Kan Takeda, Tristan Nakagawa, Naoshi Tanaka … (2002)
              To evaluate the relationships between tumor size, aneurysm formation, and spontaneous rupture in renal angiomyolipomas. Twenty-three patients with renal angiomyolipoma were examined with angiography and computed tomography (CT). The single largest lesion in each kidney was evaluated. Tumor size was measured at CT, and aneurysm size was measured at renal angiography. Tumor and aneurysm sizes were compared between the group with ruptured angiomyolipoma and the group with unruptured angiomyolipoma. Multiple regression analysis was performed to identify factors affecting rupture. Twenty-nine kidneys with angiomyolipoma were identified. Eight angiomyolipomas were hemorrhagic; the remaining 21 were not hemorrhagic. Tumor size was larger than 4 cm and aneurysm size was 5 mm or larger in all hemorrhagic lesions. There were significant differences in mean tumor size (11.4 cm +/- 5.5 [SD] vs 5.0 cm +/- 3.1, P <.02) and mean aneurysm size (13.3 mm +/- 6.2 vs 2.4 mm +/- 2.9, P <.02) between the ruptured and unruptured tumor groups. When tumor size of 4 cm or larger and aneurysm size of 5 mm or larger were used as predictors of rupture, sensitivity and specificity, respectively, were 100% and 38% with the former criterion and 100% and 86% with the latter criterion. Multiple regression analysis indicated that aneurysm size was the most important factor linked to rupture. Aneurysm formation appears to be related to tumor size, and large aneurysms confer a higher probability of rupture.
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                Author and article information

                Journal
                Title: The British Journal of Radiology
                Abbreviated Title: BJR
                Publisher: British Institute of Radiology
                ISSN (Print): 0007-1285
                ISSN (Electronic): 1748-880X
                Publication date Created: August 2017
                Publication date (Print): August 2017
                Volume: 90
                Issue: 1077
                Page: 20170077
                Affiliations
                [1 ]Department of Radiology, DIBIMED, University of Palermo, Palermo, Italy
                [2 ]Department of General Surgery and Emergency, University of Palermo, Palermo, Italy
                Article
                DOI: 10.1259/bjr.20170077
                PMC ID: 5858810
                PubMed ID: 28590813
                SO-VID: 7a4bc8c1-5c7c-461d-abdd-3369229b1d3e
                Copyright © © 2017
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