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Trovato P, Simonetti I, Morrone A, Fusco R, Setola SV, Giacobbe G, Brunese MC, Pecchi A, Triggiani S, Pellegrino G, Petralia G, Sica G, Petrillo A, Granata V. Scientific Status Quo of Small Renal Lesions: Diagnostic Assessment and Radiomics. J Clin Med 2024; 13:547. [PMID: 38256682 PMCID: PMC10816509 DOI: 10.3390/jcm13020547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Revised: 01/05/2024] [Accepted: 01/16/2024] [Indexed: 01/24/2024] Open
Abstract
Background: Small renal masses (SRMs) are defined as contrast-enhanced renal lesions less than or equal to 4 cm in maximal diameter, which can be compatible with stage T1a renal cell carcinomas (RCCs). Currently, 50-61% of all renal tumors are found incidentally. Methods: The characteristics of the lesion influence the choice of the type of management, which include several methods SRM of management, including nephrectomy, partial nephrectomy, ablation, observation, and also stereotactic body radiotherapy. Typical imaging methods available for differentiating benign from malignant renal lesions include ultrasound (US), contrast-enhanced ultrasound (CEUS), computed tomography (CT), and magnetic resonance imaging (MRI). Results: Although ultrasound is the first imaging technique used to detect small renal lesions, it has several limitations. CT is the main and most widely used imaging technique for SRM characterization. The main advantages of MRI compared to CT are the better contrast resolution and tissue characterization, the use of functional imaging sequences, the possibility of performing the examination in patients allergic to iodine-containing contrast medium, and the absence of exposure to ionizing radiation. For a correct evaluation during imaging follow-up, it is necessary to use a reliable method for the assessment of renal lesions, represented by the Bosniak classification system. This classification was initially developed based on contrast-enhanced CT imaging findings, and the 2019 revision proposed the inclusion of MRI features; however, the latest classification has not yet received widespread validation. Conclusions: The use of radiomics in the evaluation of renal masses is an emerging and increasingly central field with several applications such as characterizing renal masses, distinguishing RCC subtypes, monitoring response to targeted therapeutic agents, and prognosis in a metastatic context.
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Affiliation(s)
- Piero Trovato
- Radiology Division, Istituto Nazionale Tumori-IRCCS-Fondazione G. Pascale, 80131 Naples, Italy; (P.T.); (I.S.); (S.V.S.); (A.P.); (V.G.)
| | - Igino Simonetti
- Radiology Division, Istituto Nazionale Tumori-IRCCS-Fondazione G. Pascale, 80131 Naples, Italy; (P.T.); (I.S.); (S.V.S.); (A.P.); (V.G.)
| | - Alessio Morrone
- Division of Radiology, Università degli Studi della Campania Luigi Vanvitelli, 80138 Naples, Italy;
| | - Roberta Fusco
- Medical Oncology Division, Igea SpA, 80013 Naples, Italy
- Italian Society of Medical and Interventional Radiology (SIRM), SIRM Foundation, Via della Signora 2, 20122 Milan, Italy
| | - Sergio Venanzio Setola
- Radiology Division, Istituto Nazionale Tumori-IRCCS-Fondazione G. Pascale, 80131 Naples, Italy; (P.T.); (I.S.); (S.V.S.); (A.P.); (V.G.)
| | - Giuliana Giacobbe
- General and Emergency Radiology Department, “Antonio Cardarelli” Hospital, 80131 Naples, Italy;
| | - Maria Chiara Brunese
- Diagnostic Imaging Section, Department of Medical and Surgical Sciences & Neurosciences, University of Molise, 86100 Campobasso, Italy;
| | - Annarita Pecchi
- Department of Radiology, University of Modena and Reggio Emilia, 41121 Modena, Italy;
| | - Sonia Triggiani
- Postgraduate School of Radiodiagnostics, University of Milan, 20122 Milan, Italy; (S.T.); (G.P.)
| | - Giuseppe Pellegrino
- Postgraduate School of Radiodiagnostics, University of Milan, 20122 Milan, Italy; (S.T.); (G.P.)
| | - Giuseppe Petralia
- Department of Medical Imaging and Radiation Sciences, IEO European Institute of Oncology IRCCS, Via Ripamonti 435, 20141 Milan, Italy;
| | - Giacomo Sica
- Radiology Unit, Monaldi Hospital, Azienda Ospedaliera dei Colli, 80131 Naples, Italy;
| | - Antonella Petrillo
- Radiology Division, Istituto Nazionale Tumori-IRCCS-Fondazione G. Pascale, 80131 Naples, Italy; (P.T.); (I.S.); (S.V.S.); (A.P.); (V.G.)
| | - Vincenza Granata
- Radiology Division, Istituto Nazionale Tumori-IRCCS-Fondazione G. Pascale, 80131 Naples, Italy; (P.T.); (I.S.); (S.V.S.); (A.P.); (V.G.)
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2
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Boddy AM. The need for evolutionary theory in cancer research. Eur J Epidemiol 2023; 38:1259-1264. [PMID: 36385398 PMCID: PMC10757905 DOI: 10.1007/s10654-022-00936-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Accepted: 10/16/2022] [Indexed: 11/18/2022]
Abstract
Sir Richard Peto is well known for proposing puzzling paradoxes in cancer biology-some more well-known than others. In a 1984 piece, Peto proposed that after decades of molecular biology in cancer research, we are still ignorant of the biology underpinning cancer. Cancer is a product of somatic mutations. How do these mutations arise and what are the mechanisms? As an epidemiologist, Peto asked if we really need to understand mechanisms in order to prevent cancer? Four decades after Peto's proposed ignorance in cancer research, we can simply ask, are we still ignorant? Did the great pursuit to uncover mechanisms of cancer eclipse our understanding of causes and preventions? Or can we get closer to treating and preventing cancer by understanding the underlying mechanisms that make us most vulnerable to this disease?
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Affiliation(s)
- Amy M Boddy
- Department of Anthropology, University of California Santa Barbara, Santa Barbara, CA, USA.
- Arizona Cancer and Evolution Center, Arizona State University, Tempe, AZ, USA.
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3
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Baio R, Molisso G, Caruana C, Di Mauro U, Intilla O, Pane U, D'Angelo C, Campitelli A, Pentimalli F, Sanseverino R. "Could Patient Age and Gender, along with Mass Size, Be Predictive Factors for Benign Kidney Tumors?": A Retrospective Analysis of 307 Consecutive Single Renal Masses Treated with Partial or Radical Nephrectomy. Bioengineering (Basel) 2023; 10:794. [PMID: 37508821 PMCID: PMC10376757 DOI: 10.3390/bioengineering10070794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 05/29/2023] [Accepted: 06/25/2023] [Indexed: 07/30/2023] Open
Abstract
Due to the increased use of common and non-invasive abdominal imaging techniques over the last few decades, the diagnosis of about 60% of renal tumors is incidental. Contrast-enhancing renal nodules on computed tomography are diagnosed as malignant tumors, which are often removed surgically without first performing a biopsy. Most kidney nodules are renal cell carcinoma (RCC) after surgical treatment, but a non-negligible rate of these nodules may be benign on final pathology; as a result, patients undergo unnecessary surgery with an associated significant morbidity. Our study aimed to identify a subgroup of patients with higher odds of harboring benign tumors, who would hence benefit from further diagnostic examinations (such as renal biopsy) or active surveillance. We performed a retrospective review of the medical data, including pathology results, of patients undergoing surgery for solid renal masses that were suspected to be RCCs (for a total sample of 307 patients). Owing to the widespread use of common and non-invasive imaging techniques, the incidental diagnosis of kidney tumors has become increasingly common. Considering that a non-negligible rate of these tumors is found to be benign after surgery at pathological examination, it is crucial to identify features that can correctly diagnose a mass as benign or not. According to our study results, female sex and tumor size ≤ 3 cm were independent predictors of benign disease. Contrary to that demonstrated by other authors, increasing patient age was also positively linked to a greater risk of malign pathology.
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Affiliation(s)
- Raffaele Baio
- Department of Medicine and Surgery "Scuola Medica Salernitana", University of Salerno, 84081 Salerno, Italy
| | - Giovanni Molisso
- Department of Urology, Umberto I, Nocera Inferiore, 84014 Salerno, Italy
| | | | - Umberto Di Mauro
- Department of Urology, Umberto I, Nocera Inferiore, 84014 Salerno, Italy
| | - Olivier Intilla
- Department of Urology, Umberto I, Nocera Inferiore, 84014 Salerno, Italy
| | - Umberto Pane
- Department of Urology, Umberto I, Nocera Inferiore, 84014 Salerno, Italy
| | - Costantino D'Angelo
- Department of Medical Biotechnologies, University of Siena, 53100 Siena, Italy
| | - Antonio Campitelli
- Department of Urology, Umberto I, Nocera Inferiore, 84014 Salerno, Italy
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Pedrosa I, Cadeddu JA. How We Do It: Managing the Indeterminate Renal Mass with the MRI Clear Cell Likelihood Score. Radiology 2021; 302:256-269. [PMID: 34904873 PMCID: PMC8805575 DOI: 10.1148/radiol.210034] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The widespread use of cross-sectional imaging has led to a continuous increase in the number of incidentally detected indeterminate renal masses. Frequently, these clinical scenarios involve an older patient with comorbidities and a small renal mass (≤4 cm). Despite aggressive treatment in early stages of the disease, a clear positive effect in reducing kidney cancer-specific mortality is lacking, indicating that many renal cancers exhibit an indolent oncologic behavior. Furthermore, in general, one in five small renal masses is histologically benign and may not benefit from aggressive treatment. Although active surveillance is increasingly recognized as a management option for some patients, the absence of reliable clinical and imaging predictive biologic markers of aggressiveness can contribute to patient anxiety and limit its use in clinical practice. A standardized approach to the image interpretation of solid renal masses has not been broadly implemented. The clear cell likelihood score (ccLS) derived from multiparametric MRI is useful in noninvasively identifying the clear cell subtype, the most common and aggressive form of kidney cancer. Herein, a review of the ccLS is presented, including a step-by-step guide for image interpretation and additional guidance for its implementation in clinical practice.
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Affiliation(s)
- Ivan Pedrosa
- From the Department of Radiology (I.P., J.A.C.), Department of Urology (I.P., J.A.C.), and Advanced Imaging Research Center (I.P.), University of Texas Southwestern, 5323 Harry Hines Blvd, Clements Imaging Bldg, Ste 2202, MC 9085, Dallas, TX 75390
| | - Jeffrey A. Cadeddu
- From the Department of Radiology (I.P., J.A.C.), Department of Urology (I.P., J.A.C.), and Advanced Imaging Research Center (I.P.), University of Texas Southwestern, 5323 Harry Hines Blvd, Clements Imaging Bldg, Ste 2202, MC 9085, Dallas, TX 75390
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5
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McAlpine K, Finelli A. Natural history of untreated kidney cancer. World J Urol 2021; 39:2825-2829. [PMID: 33591379 DOI: 10.1007/s00345-020-03578-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Accepted: 12/19/2020] [Indexed: 12/29/2022] Open
Affiliation(s)
- Kristen McAlpine
- Division of Urology, Department of Surgery, Princess Margaret Cancer Centre, University Health Network and the University of Toronto, Toronto, ON, Canada
| | - Antonio Finelli
- Division of Urology, Department of Surgery, Princess Margaret Cancer Centre, University Health Network and the University of Toronto, Toronto, ON, Canada.
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6
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Wei X, Ren X, Ding Y, Wang H, Li Y, Li X, Gao Y. Comparative outcomes of radio frequency ablation versus partial nephrectomy for T1 renal tumors: a systematic review. Transl Androl Urol 2020; 8:601-608. [PMID: 32038956 DOI: 10.21037/tau.2019.10.13] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Background The role of radio frequency ablation (RFA) in small renal tumors remains controversial. This systematic review was performed to compare clinical outcomes of RFA versus partial nephrectomy (PN) for the treatment of T1 renal tumors. Methods A total of 11 studies including 2,397 patients were analyzed in this systematic review after searching the databases of PubMed, EMBASE and Web of Science. P value and odds ratio (OR)/hazard ratio (HR) with 95% confidence interval (CI) were used to evaluate the strength of the association. Results A total of six studies (2,056 patients) provided either survival curves or HR and its 95% CI, demonstrating that the majority of the patients with RFA treatment tended to exhibit a similar long-term survival rate to those with PN treatment. In addition, according to four studies, no differences were found in the overall rate of complications between the two groups. Furthermore, there were significant differences in glomerular filtration rate (GFR) change between the two methods in four studies but no differences were observed in other two. Conclusions Our systematic review indicated that RFA is an effective treatment option which could provide comparable oncologic outcomes to PN. Moreover, it may present obvious advantages in renal function preservation.
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Affiliation(s)
- Xiyi Wei
- Department of Urology, Jiangsu Cancer Hospital & Jiangsu Institute of Cancer Research & Affiliated Cancer Hospital of Nanjing Medical University, Nanjing 210009, China.,First Clinical Medical College of Nanjing Medical University, Nanjing 210029, China
| | - Xiaohan Ren
- First Clinical Medical College of Nanjing Medical University, Nanjing 210029, China
| | - Yichao Ding
- School of Nursing of Nanjing Medical University, Nanjing 210029, China
| | - Hongye Wang
- First Clinical Medical College of Nanjing Medical University, Nanjing 210029, China
| | - Yunxin Li
- First Clinical Medical College of Nanjing Medical University, Nanjing 210029, China
| | - Xiao Li
- Department of Urology, Jiangsu Cancer Hospital & Jiangsu Institute of Cancer Research & Affiliated Cancer Hospital of Nanjing Medical University, Nanjing 210009, China
| | - Yang Gao
- Department of Radiology, Jiangsu Cancer Hospital & Jiangsu Institute of Cancer Research & Affiliated Cancer Hospital of Nanjing Medical University, Nanjing 210009, China
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7
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Soomro N, Lecouturier J, Stocken DD, Shen J, Hynes AM, Ainsworth HF, Breen D, Oades G, Rix D, Aitchison M. Surveillance versus ablation for incidentally diagnosed small renal tumours: the SURAB feasibility RCT. Health Technol Assess 2019; 21:1-68. [PMID: 29280434 DOI: 10.3310/hta21810] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND There is uncertainty around the appropriate management of small renal tumours. Treatments include partial nephrectomy, ablation and active surveillance. OBJECTIVES To explore the feasibility of a randomised trial of ablation versus active surveillance. DESIGN Two-stage feasibility study: stage 1 - clinician survey and co-design work; and stage 2 - randomised feasibility study with qualitative and economic components. METHODS Stage 1 - survey of radiologists and urologists, and development of patient information materials. Stage 2 - patients identified across eight UK centres with small renal tumours (< 4 cm) were randomised (1 : 1 ratio) to ablation or active surveillance in an unblinded manner. Randomisation was carried out by a central computer system. The primary objective was to determine willingness to participate and to randomise a target of 60 patients. The qualitative and economic data were collected separately. RESULTS The trial was conducted across eight centres, with a site-specific period of recruitment ranging from 3 to 11 months. Of the 154 patients screened, 36 were eligible and were provided with study details. Seven agreed to be randomised and one patient was found ineligible following biopsy results. Six patients (17% of those eligible) were randomised: three patients received ablation and no serious adverse events were recorded. The 3- and 6-month data were collected for four (67%) and three (50%) out of the six patients, respectively. The qualitative substudy identified factors directly impacting on the recruitment of this trial. These included patient and clinician preferences, organisational factors (variation in clinical pathway) and standard treatment not included. The health economic questionnaire was designed and piloted; however, the sample size of recruited patients was insufficient to draw a conclusion on the feasibility of the health economics. CONCLUSIONS The trial did not meet the criteria for progression and the recruitment rate was lower than hypothesised, demonstrating that a full trial is presently not possible. The qualitative study identified factors that led to variation in recruitment across the sites. Implementation of organisational and operational measures can increase recruitment in any future trial. There was insufficient information to conduct a full economic analysis. TRIAL REGISTRATION Current Controlled Trials ISRCTN31161700. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 21, No. 81. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Naeem Soomro
- The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Jan Lecouturier
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Deborah D Stocken
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK.,Newcastle Clinical Trials Unit, Newcastle University, Newcastle upon Tyne, UK
| | - Jing Shen
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Ann Marie Hynes
- Newcastle Clinical Trials Unit, Newcastle University, Newcastle upon Tyne, UK
| | - Holly F Ainsworth
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - David Breen
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | | | - David Rix
- The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
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8
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Vartolomei MD, Matei DV, Renne G, Tringali VM, Crișan N, Musi G, Mistretta FA, Russo A, Conti A, Cozzi G, Luzzago S, Catellani M, Cioffi A, Cordima G, Bianchi R, Di Trapani E, Serino A, Delor M, Bianco R, Bottero D, Ferro M, De Cobelli O. Long-term oncologic and functional outcomes after robot-assisted partial nephrectomy in elderly patients. MINERVA UROL NEFROL 2019; 71:31-37. [DOI: 10.23736/s0393-2249.18.03006-0] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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9
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Shahriyar SA, Woo SM, Seo SU, Min KJ, Kwon TK. Cepharanthine Enhances TRAIL-Mediated Apoptosis Through STAMBPL1-Mediated Downregulation of Survivin Expression in Renal Carcinoma Cells. Int J Mol Sci 2018; 19:ijms19103280. [PMID: 30360403 PMCID: PMC6214104 DOI: 10.3390/ijms19103280] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Revised: 10/19/2018] [Accepted: 10/20/2018] [Indexed: 12/16/2022] Open
Abstract
Cepharanthine (CEP) is a natural plant alkaloid, and has anti-inflammatory, antineoplastic, antioxidative and anticancer properties. In this study, we investigated whether CEP could sensitize renal carcinoma Caki cells to tumor necrosis factor-related apoptosis-inducing ligand (TRAIL)-induced apoptosis. CEP alone and TRAIL alone had no effect on apoptosis. However, combined CEP and TRAIL treatment markedly enhanced apoptotic cell death in cancer cells, but not in normal cells. CEP induced downregulation of survivin and cellular-FLICE inhibitory protein (c-FLIP) expression at post-translational levels. Ectopic expression of survivin blocked apoptosis by combined treatment with CEP plus TRAIL, but not in c-FLIP overexpression. Interestingly, CEP induced survivin downregulation through downregulation of deubiquitin protein of STAM-binding protein-like 1 (STAMBPL1). Overexpression of STAMBPL1 markedly recovered CEP-mediated survivin downregulation. Taken together, our study suggests that CEP sensitizes TRAIL-mediated apoptosis through downregulation of survivin expression at the post-translational levels in renal carcinoma cells.
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Affiliation(s)
- Sk Abrar Shahriyar
- Department of Immunology, School of Medicine, Keimyung University, Daegu 42601, Korea.
| | - Seon Min Woo
- Department of Immunology, School of Medicine, Keimyung University, Daegu 42601, Korea.
| | - Seung Un Seo
- Department of Immunology, School of Medicine, Keimyung University, Daegu 42601, Korea.
| | - Kyoung-Jin Min
- Department of Immunology, School of Medicine, Keimyung University, Daegu 42601, Korea.
| | - Taeg Kyu Kwon
- Department of Immunology, School of Medicine, Keimyung University, Daegu 42601, Korea.
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10
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Abstract
The increase in serendipitous detection of solid renal masses on imaging has not resulted in a reduction in mortality from renal cell carcinoma. Consequently, efforts for improved lesion characterization have been pursued and incorporated into management algorithms for distinguishing clinically significant tumors from those with favorable histology or benign conditions. Although diagnostic imaging strategies have evolved for optimized lesion detection, distinction between benign tumors and both indolent and aggressive malignant neoplasms remain an important diagnostic challenge. Recent advances in cross-sectional imaging have expanded the role of these tests in the noninvasive characterization of solid renal tumors.
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Affiliation(s)
- Fernando U Kay
- Department of Radiology; UT Southwestern Medical Center, 2201 Inwood Road, Suite 210, Dallas, TX 75390, USA
| | - Ivan Pedrosa
- Department of Radiology; UT Southwestern Medical Center, 2201 Inwood Road, Suite 210, Dallas, TX 75390, USA.
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11
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Tricard T, Tsoumakidou G, Lindner V, Garnon J, Albrand G, Cathelineau X, Gangi A, Lang H. Thérapies ablatives dans le cancer du rein : indications. Prog Urol 2017; 27:926-951. [DOI: 10.1016/j.purol.2017.07.245] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Accepted: 07/22/2017] [Indexed: 12/19/2022]
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12
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Trilla E, Konstantinidis C, Serres X, Lorente D, Planas J, Placer J, Salvador C, Celma A, Montealegre C, Morote J. Ultrasound-guided percutaneous radiofrequency ablation for treating small renal masses. Actas Urol Esp 2017; 41:497-503. [PMID: 28457496 DOI: 10.1016/j.acuro.2017.03.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2016] [Revised: 03/21/2017] [Accepted: 03/21/2017] [Indexed: 01/25/2023]
Abstract
INTRODUCTION The objective of this study was to analyse and assess the experience with radiofrequency ablation of small renal masses using a contrast-enhanced, ultrasound-guided percutaneous approach for patients who are not suitable for surgical resection and/or who refused surveillance or observation. MATERIAL AND METHOD From January 2007 to August 2015, 164 treatments were performed on a total of 148 patients. We present the patients' clinical-radiological characteristics, oncological and functional results in the short and medium term. RESULTS The overall technical success rate was 97.5%, with a successful outcome in 1 session in 100% of the lesions≤3cm and 92% in lesions measuring 3-5cm. The mean tumour diameter in the patients for whom the treatment was ultimately successful was 2.7cm, while the mean diameter of these in the unsuccessful operations was 3.9cm (P<.05). There were no statistically significant differences in the serum creatinine levels and estimated glomerular filtration rates. CONCLUSIONS Despite the low rate of positive renal biopsies in the series, ultrasound-guided percutaneous radiofrequency ablation for treating small renal lesions appears to be an effective and safe procedure with a minimum impact on renal function, an acceptable oncologic control in the short and medium term and a low rate of complications.
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Affiliation(s)
- E Trilla
- Servicio de Urología, Hospital Universitari Vall d'Hebron, Universitat Autònoma, Barcelona, España.
| | - C Konstantinidis
- Servicio de Urología, Hospital Universitari Vall d'Hebron, Universitat Autònoma, Barcelona, España
| | - X Serres
- Servicio de Radiodiagnóstico, Hospital Universitari Vall d'Hebron, Universitat Autònoma, Barcelona, España
| | - D Lorente
- Servicio de Urología, Hospital Universitari Vall d'Hebron, Universitat Autònoma, Barcelona, España
| | - J Planas
- Servicio de Urología, Hospital Universitari Vall d'Hebron, Universitat Autònoma, Barcelona, España
| | - J Placer
- Servicio de Urología, Hospital Universitari Vall d'Hebron, Universitat Autònoma, Barcelona, España
| | - C Salvador
- Servicio de Urología, Hospital Universitari Vall d'Hebron, Universitat Autònoma, Barcelona, España
| | - A Celma
- Servicio de Urología, Hospital Universitari Vall d'Hebron, Universitat Autònoma, Barcelona, España
| | - C Montealegre
- Servicio de Radiodiagnóstico, Hospital Universitari Vall d'Hebron, Universitat Autònoma, Barcelona, España
| | - J Morote
- Servicio de Urología, Hospital Universitari Vall d'Hebron, Universitat Autònoma, Barcelona, España
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13
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Active Surveillance of Nonfatty Renal Masses in Patients With Lymphangioleiomyomatosis: Use of CT Features and Patterns of Growth to Differentiate Angiomyolipoma From Renal Cancer. AJR Am J Roentgenol 2017; 209:611-619. [PMID: 28678574 DOI: 10.2214/ajr.16.17530] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
OBJECTIVE The objective of this study was to report our experience with active surveillance of nonfatty renal masses in a large cohort of patients with lymphangioleiomyomatosis (LAM), correlate their CT features and patterns of growth with histopathology results, and provide guidelines for management. SUBJECTS AND METHODS Yearly CT examinations were performed of 367 women (age range, 21-75 years; mean age, 47 years). For the 31 patients with 37 nonfatty renal masses that were biopsied, excised, or followed for ≥ 5 years, CT enhancement characteristics and patterns of growth were compared with the histopathology results. RESULTS Four of 37 nonfatty renal masses were biopsied without follow-up CT examinations: Two were heterogeneous renal cell carcinomas (RCCs), one was a heterogeneous nonfatty angiomyolipoma (AML), and one was homogeneous nonfatty AML. In the remaining 33 nonfatty renal masses with multiple follow-up CT examinations, two growth patterns were identified. Four showed a continuous increase in size of > 0.5 cm/y in some years, and all four in this first group were heterogeneous and were biopsy-proven RCC. The second group was composed of the remaining 29 masses. These 29 masses showed yearly no change, increase, or decrease in diameter. Eight were heterogeneous, and 21 were homogeneous. Of the masses showing a yearly increase, the increase was < 0.5 cm/y in all except one. In the one exception, the increase followed a decrease. Nine of the 29 masses were biopsied, and all nine were nonfatty renal masses (five homogeneous, four heterogeneous). CONCLUSION Our data provide further evidence in a large prospective study with longterm follow-up that active surveillance is an appropriate strategy in the management of nonfatty renal masses in patients with LAM. Our analysis of the growth patterns reveals duration of growth in addition to growth rate as criteria for biopsy or excision. Biopsy should be reserved for nonfatty renal masses that show sustained growth or growth > 0.5 cm/y during follow-up.
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Abstract
Objective: To review hot issues and future direction of renal tumor biopsy (RTB) technique. Data Sources: The literature concerning or including RTB technique in English was collected from PubMed published from 1990 to 2015. Study Selection: We included all the relevant articles on RTB technique in English, with no limitation of study design. Results: Computed tomography and ultrasound were usually used for guiding RTB with respective advantages. Core biopsy is more preferred over fine needle aspiration because of superior accuracy. A minimum of two good-quality cores for a single renal tumor is generally accepted. The use of coaxial guide is recommended. For biopsy location, sampling different regions including central and peripheral biopsies are recommended. Conclusion: In spite of some limitations, RTB technique is relatively mature to help optimize the treatment of renal tumors.
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Affiliation(s)
- Lei Zhang
- Department of Urology, Peking University First Hospital, Beijing 100034, China
| | - Xue-Song Li
- Department of Urology, Peking University First Hospital, Beijing 100034, China
| | - Li-Qun Zhou
- Department of Urology, Peking University First Hospital, Beijing 100034, China
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Finelli A, Ismaila N, Bro B, Durack J, Eggener S, Evans A, Gill I, Graham D, Huang W, Jewett MAS, Latcha S, Lowrance W, Rosner M, Shayegan B, Thompson RH, Uzzo R, Russo P. Management of Small Renal Masses: American Society of Clinical Oncology Clinical Practice Guideline. J Clin Oncol 2017; 35:668-680. [PMID: 28095147 DOI: 10.1200/jco.2016.69.9645] [Citation(s) in RCA: 228] [Impact Index Per Article: 32.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Purpose To provide recommendations for the management options for patients with small renal masses (SRMs). Methods By using a literature search and prospectively defined study selection, we sought systematic reviews, meta-analyses, randomized clinical trials, prospective comparative observational studies, and retrospective studies published from 2000 through 2015. Outcomes included recurrence-free survival, disease-specific survival, and overall survival. Results Eighty-three studies, including 20 systematic reviews and 63 primary studies, met the eligibility criteria and form the evidentiary basis for the guideline recommendations. Recommendations On the basis of tumor-specific findings and competing risks of mortality, all patients with an SRM should be considered for a biopsy when the results may alter management. Active surveillance should be an initial management option for patients who have significant comorbidities and limited life expectancy. Partial nephrectomy (PN) for SRMs is the standard treatment that should be offered to all patients for whom an intervention is indicated and who possess a tumor that is amenable to this approach. Percutaneous thermal ablation should be considered an option if complete ablation can reliably be achieved. Radical nephrectomy for SRMs should only be reserved for patients who possess a tumor of significant complexity that is not amenable to PN or for whom PN may result in unacceptable morbidity even when performed at centers with expertise. Referral to a nephrologist should be considered if chronic kidney disease (estimated glomerular filtration rate < 45 mL/min/1.73 m2) or progressive chronic kidney disease occurs after treatment, especially if associated with proteinuria.
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Affiliation(s)
- Antonio Finelli
- Antonio Finelli and Michael A.S. Jewett, Princess Margaret Cancer Center; Andrew Evans, University Health Network, Toronto; Bobby Shayegan, St Joseph Hospital, Hamilton, Ontario, Canada; Nofisat Ismaila, American Society of Clinical Oncology, Alexandria; Mitchell Rosner, University of Virginia School of Medicine, Charlottesville, VA; Bill Bro, Kidney Cancer Association; Scott Eggener, University of Chicago, Chicago, IL; Jeremy Durack, Sheron Latcha, and Paul Russo, Memorial Sloan Kettering Cancer Center; William Huang, New York University Langone Medical Center, New York, NY; Inderbir Gill, University of Southern California, Los Angeles, CA; David Graham, Levine Cancer Institute, Charlotte, NC; William Lowrance, University of Utah, Huntsman Cancer Institute, Salt Lake City, UT; R. Houston Thompson, Mayo Clinic, Rochester, MN; and Robert Uzzo, Fox Chase Cancer Center, Philadelphia, PA
| | - Nofisat Ismaila
- Antonio Finelli and Michael A.S. Jewett, Princess Margaret Cancer Center; Andrew Evans, University Health Network, Toronto; Bobby Shayegan, St Joseph Hospital, Hamilton, Ontario, Canada; Nofisat Ismaila, American Society of Clinical Oncology, Alexandria; Mitchell Rosner, University of Virginia School of Medicine, Charlottesville, VA; Bill Bro, Kidney Cancer Association; Scott Eggener, University of Chicago, Chicago, IL; Jeremy Durack, Sheron Latcha, and Paul Russo, Memorial Sloan Kettering Cancer Center; William Huang, New York University Langone Medical Center, New York, NY; Inderbir Gill, University of Southern California, Los Angeles, CA; David Graham, Levine Cancer Institute, Charlotte, NC; William Lowrance, University of Utah, Huntsman Cancer Institute, Salt Lake City, UT; R. Houston Thompson, Mayo Clinic, Rochester, MN; and Robert Uzzo, Fox Chase Cancer Center, Philadelphia, PA
| | - Bill Bro
- Antonio Finelli and Michael A.S. Jewett, Princess Margaret Cancer Center; Andrew Evans, University Health Network, Toronto; Bobby Shayegan, St Joseph Hospital, Hamilton, Ontario, Canada; Nofisat Ismaila, American Society of Clinical Oncology, Alexandria; Mitchell Rosner, University of Virginia School of Medicine, Charlottesville, VA; Bill Bro, Kidney Cancer Association; Scott Eggener, University of Chicago, Chicago, IL; Jeremy Durack, Sheron Latcha, and Paul Russo, Memorial Sloan Kettering Cancer Center; William Huang, New York University Langone Medical Center, New York, NY; Inderbir Gill, University of Southern California, Los Angeles, CA; David Graham, Levine Cancer Institute, Charlotte, NC; William Lowrance, University of Utah, Huntsman Cancer Institute, Salt Lake City, UT; R. Houston Thompson, Mayo Clinic, Rochester, MN; and Robert Uzzo, Fox Chase Cancer Center, Philadelphia, PA
| | - Jeremy Durack
- Antonio Finelli and Michael A.S. Jewett, Princess Margaret Cancer Center; Andrew Evans, University Health Network, Toronto; Bobby Shayegan, St Joseph Hospital, Hamilton, Ontario, Canada; Nofisat Ismaila, American Society of Clinical Oncology, Alexandria; Mitchell Rosner, University of Virginia School of Medicine, Charlottesville, VA; Bill Bro, Kidney Cancer Association; Scott Eggener, University of Chicago, Chicago, IL; Jeremy Durack, Sheron Latcha, and Paul Russo, Memorial Sloan Kettering Cancer Center; William Huang, New York University Langone Medical Center, New York, NY; Inderbir Gill, University of Southern California, Los Angeles, CA; David Graham, Levine Cancer Institute, Charlotte, NC; William Lowrance, University of Utah, Huntsman Cancer Institute, Salt Lake City, UT; R. Houston Thompson, Mayo Clinic, Rochester, MN; and Robert Uzzo, Fox Chase Cancer Center, Philadelphia, PA
| | - Scott Eggener
- Antonio Finelli and Michael A.S. Jewett, Princess Margaret Cancer Center; Andrew Evans, University Health Network, Toronto; Bobby Shayegan, St Joseph Hospital, Hamilton, Ontario, Canada; Nofisat Ismaila, American Society of Clinical Oncology, Alexandria; Mitchell Rosner, University of Virginia School of Medicine, Charlottesville, VA; Bill Bro, Kidney Cancer Association; Scott Eggener, University of Chicago, Chicago, IL; Jeremy Durack, Sheron Latcha, and Paul Russo, Memorial Sloan Kettering Cancer Center; William Huang, New York University Langone Medical Center, New York, NY; Inderbir Gill, University of Southern California, Los Angeles, CA; David Graham, Levine Cancer Institute, Charlotte, NC; William Lowrance, University of Utah, Huntsman Cancer Institute, Salt Lake City, UT; R. Houston Thompson, Mayo Clinic, Rochester, MN; and Robert Uzzo, Fox Chase Cancer Center, Philadelphia, PA
| | - Andrew Evans
- Antonio Finelli and Michael A.S. Jewett, Princess Margaret Cancer Center; Andrew Evans, University Health Network, Toronto; Bobby Shayegan, St Joseph Hospital, Hamilton, Ontario, Canada; Nofisat Ismaila, American Society of Clinical Oncology, Alexandria; Mitchell Rosner, University of Virginia School of Medicine, Charlottesville, VA; Bill Bro, Kidney Cancer Association; Scott Eggener, University of Chicago, Chicago, IL; Jeremy Durack, Sheron Latcha, and Paul Russo, Memorial Sloan Kettering Cancer Center; William Huang, New York University Langone Medical Center, New York, NY; Inderbir Gill, University of Southern California, Los Angeles, CA; David Graham, Levine Cancer Institute, Charlotte, NC; William Lowrance, University of Utah, Huntsman Cancer Institute, Salt Lake City, UT; R. Houston Thompson, Mayo Clinic, Rochester, MN; and Robert Uzzo, Fox Chase Cancer Center, Philadelphia, PA
| | - Inderbir Gill
- Antonio Finelli and Michael A.S. Jewett, Princess Margaret Cancer Center; Andrew Evans, University Health Network, Toronto; Bobby Shayegan, St Joseph Hospital, Hamilton, Ontario, Canada; Nofisat Ismaila, American Society of Clinical Oncology, Alexandria; Mitchell Rosner, University of Virginia School of Medicine, Charlottesville, VA; Bill Bro, Kidney Cancer Association; Scott Eggener, University of Chicago, Chicago, IL; Jeremy Durack, Sheron Latcha, and Paul Russo, Memorial Sloan Kettering Cancer Center; William Huang, New York University Langone Medical Center, New York, NY; Inderbir Gill, University of Southern California, Los Angeles, CA; David Graham, Levine Cancer Institute, Charlotte, NC; William Lowrance, University of Utah, Huntsman Cancer Institute, Salt Lake City, UT; R. Houston Thompson, Mayo Clinic, Rochester, MN; and Robert Uzzo, Fox Chase Cancer Center, Philadelphia, PA
| | - David Graham
- Antonio Finelli and Michael A.S. Jewett, Princess Margaret Cancer Center; Andrew Evans, University Health Network, Toronto; Bobby Shayegan, St Joseph Hospital, Hamilton, Ontario, Canada; Nofisat Ismaila, American Society of Clinical Oncology, Alexandria; Mitchell Rosner, University of Virginia School of Medicine, Charlottesville, VA; Bill Bro, Kidney Cancer Association; Scott Eggener, University of Chicago, Chicago, IL; Jeremy Durack, Sheron Latcha, and Paul Russo, Memorial Sloan Kettering Cancer Center; William Huang, New York University Langone Medical Center, New York, NY; Inderbir Gill, University of Southern California, Los Angeles, CA; David Graham, Levine Cancer Institute, Charlotte, NC; William Lowrance, University of Utah, Huntsman Cancer Institute, Salt Lake City, UT; R. Houston Thompson, Mayo Clinic, Rochester, MN; and Robert Uzzo, Fox Chase Cancer Center, Philadelphia, PA
| | - William Huang
- Antonio Finelli and Michael A.S. Jewett, Princess Margaret Cancer Center; Andrew Evans, University Health Network, Toronto; Bobby Shayegan, St Joseph Hospital, Hamilton, Ontario, Canada; Nofisat Ismaila, American Society of Clinical Oncology, Alexandria; Mitchell Rosner, University of Virginia School of Medicine, Charlottesville, VA; Bill Bro, Kidney Cancer Association; Scott Eggener, University of Chicago, Chicago, IL; Jeremy Durack, Sheron Latcha, and Paul Russo, Memorial Sloan Kettering Cancer Center; William Huang, New York University Langone Medical Center, New York, NY; Inderbir Gill, University of Southern California, Los Angeles, CA; David Graham, Levine Cancer Institute, Charlotte, NC; William Lowrance, University of Utah, Huntsman Cancer Institute, Salt Lake City, UT; R. Houston Thompson, Mayo Clinic, Rochester, MN; and Robert Uzzo, Fox Chase Cancer Center, Philadelphia, PA
| | - Michael A S Jewett
- Antonio Finelli and Michael A.S. Jewett, Princess Margaret Cancer Center; Andrew Evans, University Health Network, Toronto; Bobby Shayegan, St Joseph Hospital, Hamilton, Ontario, Canada; Nofisat Ismaila, American Society of Clinical Oncology, Alexandria; Mitchell Rosner, University of Virginia School of Medicine, Charlottesville, VA; Bill Bro, Kidney Cancer Association; Scott Eggener, University of Chicago, Chicago, IL; Jeremy Durack, Sheron Latcha, and Paul Russo, Memorial Sloan Kettering Cancer Center; William Huang, New York University Langone Medical Center, New York, NY; Inderbir Gill, University of Southern California, Los Angeles, CA; David Graham, Levine Cancer Institute, Charlotte, NC; William Lowrance, University of Utah, Huntsman Cancer Institute, Salt Lake City, UT; R. Houston Thompson, Mayo Clinic, Rochester, MN; and Robert Uzzo, Fox Chase Cancer Center, Philadelphia, PA
| | - Sheron Latcha
- Antonio Finelli and Michael A.S. Jewett, Princess Margaret Cancer Center; Andrew Evans, University Health Network, Toronto; Bobby Shayegan, St Joseph Hospital, Hamilton, Ontario, Canada; Nofisat Ismaila, American Society of Clinical Oncology, Alexandria; Mitchell Rosner, University of Virginia School of Medicine, Charlottesville, VA; Bill Bro, Kidney Cancer Association; Scott Eggener, University of Chicago, Chicago, IL; Jeremy Durack, Sheron Latcha, and Paul Russo, Memorial Sloan Kettering Cancer Center; William Huang, New York University Langone Medical Center, New York, NY; Inderbir Gill, University of Southern California, Los Angeles, CA; David Graham, Levine Cancer Institute, Charlotte, NC; William Lowrance, University of Utah, Huntsman Cancer Institute, Salt Lake City, UT; R. Houston Thompson, Mayo Clinic, Rochester, MN; and Robert Uzzo, Fox Chase Cancer Center, Philadelphia, PA
| | - William Lowrance
- Antonio Finelli and Michael A.S. Jewett, Princess Margaret Cancer Center; Andrew Evans, University Health Network, Toronto; Bobby Shayegan, St Joseph Hospital, Hamilton, Ontario, Canada; Nofisat Ismaila, American Society of Clinical Oncology, Alexandria; Mitchell Rosner, University of Virginia School of Medicine, Charlottesville, VA; Bill Bro, Kidney Cancer Association; Scott Eggener, University of Chicago, Chicago, IL; Jeremy Durack, Sheron Latcha, and Paul Russo, Memorial Sloan Kettering Cancer Center; William Huang, New York University Langone Medical Center, New York, NY; Inderbir Gill, University of Southern California, Los Angeles, CA; David Graham, Levine Cancer Institute, Charlotte, NC; William Lowrance, University of Utah, Huntsman Cancer Institute, Salt Lake City, UT; R. Houston Thompson, Mayo Clinic, Rochester, MN; and Robert Uzzo, Fox Chase Cancer Center, Philadelphia, PA
| | - Mitchell Rosner
- Antonio Finelli and Michael A.S. Jewett, Princess Margaret Cancer Center; Andrew Evans, University Health Network, Toronto; Bobby Shayegan, St Joseph Hospital, Hamilton, Ontario, Canada; Nofisat Ismaila, American Society of Clinical Oncology, Alexandria; Mitchell Rosner, University of Virginia School of Medicine, Charlottesville, VA; Bill Bro, Kidney Cancer Association; Scott Eggener, University of Chicago, Chicago, IL; Jeremy Durack, Sheron Latcha, and Paul Russo, Memorial Sloan Kettering Cancer Center; William Huang, New York University Langone Medical Center, New York, NY; Inderbir Gill, University of Southern California, Los Angeles, CA; David Graham, Levine Cancer Institute, Charlotte, NC; William Lowrance, University of Utah, Huntsman Cancer Institute, Salt Lake City, UT; R. Houston Thompson, Mayo Clinic, Rochester, MN; and Robert Uzzo, Fox Chase Cancer Center, Philadelphia, PA
| | - Bobby Shayegan
- Antonio Finelli and Michael A.S. Jewett, Princess Margaret Cancer Center; Andrew Evans, University Health Network, Toronto; Bobby Shayegan, St Joseph Hospital, Hamilton, Ontario, Canada; Nofisat Ismaila, American Society of Clinical Oncology, Alexandria; Mitchell Rosner, University of Virginia School of Medicine, Charlottesville, VA; Bill Bro, Kidney Cancer Association; Scott Eggener, University of Chicago, Chicago, IL; Jeremy Durack, Sheron Latcha, and Paul Russo, Memorial Sloan Kettering Cancer Center; William Huang, New York University Langone Medical Center, New York, NY; Inderbir Gill, University of Southern California, Los Angeles, CA; David Graham, Levine Cancer Institute, Charlotte, NC; William Lowrance, University of Utah, Huntsman Cancer Institute, Salt Lake City, UT; R. Houston Thompson, Mayo Clinic, Rochester, MN; and Robert Uzzo, Fox Chase Cancer Center, Philadelphia, PA
| | - R Houston Thompson
- Antonio Finelli and Michael A.S. Jewett, Princess Margaret Cancer Center; Andrew Evans, University Health Network, Toronto; Bobby Shayegan, St Joseph Hospital, Hamilton, Ontario, Canada; Nofisat Ismaila, American Society of Clinical Oncology, Alexandria; Mitchell Rosner, University of Virginia School of Medicine, Charlottesville, VA; Bill Bro, Kidney Cancer Association; Scott Eggener, University of Chicago, Chicago, IL; Jeremy Durack, Sheron Latcha, and Paul Russo, Memorial Sloan Kettering Cancer Center; William Huang, New York University Langone Medical Center, New York, NY; Inderbir Gill, University of Southern California, Los Angeles, CA; David Graham, Levine Cancer Institute, Charlotte, NC; William Lowrance, University of Utah, Huntsman Cancer Institute, Salt Lake City, UT; R. Houston Thompson, Mayo Clinic, Rochester, MN; and Robert Uzzo, Fox Chase Cancer Center, Philadelphia, PA
| | - Robert Uzzo
- Antonio Finelli and Michael A.S. Jewett, Princess Margaret Cancer Center; Andrew Evans, University Health Network, Toronto; Bobby Shayegan, St Joseph Hospital, Hamilton, Ontario, Canada; Nofisat Ismaila, American Society of Clinical Oncology, Alexandria; Mitchell Rosner, University of Virginia School of Medicine, Charlottesville, VA; Bill Bro, Kidney Cancer Association; Scott Eggener, University of Chicago, Chicago, IL; Jeremy Durack, Sheron Latcha, and Paul Russo, Memorial Sloan Kettering Cancer Center; William Huang, New York University Langone Medical Center, New York, NY; Inderbir Gill, University of Southern California, Los Angeles, CA; David Graham, Levine Cancer Institute, Charlotte, NC; William Lowrance, University of Utah, Huntsman Cancer Institute, Salt Lake City, UT; R. Houston Thompson, Mayo Clinic, Rochester, MN; and Robert Uzzo, Fox Chase Cancer Center, Philadelphia, PA
| | - Paul Russo
- Antonio Finelli and Michael A.S. Jewett, Princess Margaret Cancer Center; Andrew Evans, University Health Network, Toronto; Bobby Shayegan, St Joseph Hospital, Hamilton, Ontario, Canada; Nofisat Ismaila, American Society of Clinical Oncology, Alexandria; Mitchell Rosner, University of Virginia School of Medicine, Charlottesville, VA; Bill Bro, Kidney Cancer Association; Scott Eggener, University of Chicago, Chicago, IL; Jeremy Durack, Sheron Latcha, and Paul Russo, Memorial Sloan Kettering Cancer Center; William Huang, New York University Langone Medical Center, New York, NY; Inderbir Gill, University of Southern California, Los Angeles, CA; David Graham, Levine Cancer Institute, Charlotte, NC; William Lowrance, University of Utah, Huntsman Cancer Institute, Salt Lake City, UT; R. Houston Thompson, Mayo Clinic, Rochester, MN; and Robert Uzzo, Fox Chase Cancer Center, Philadelphia, PA
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Silverman SG, Israel GM, Trinh QD. Incompletely Characterized Incidental Renal Masses: Emerging Data Support Conservative Management. Radiology 2015; 275:28-42. [DOI: 10.1148/radiol.14141144] [Citation(s) in RCA: 88] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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Neal RE, Garcia PA, Kavnoudias H, Rosenfeldt F, Mclean CA, Earl V, Bergman J, Davalos RV, Thomson KR. In vivo irreversible electroporation kidney ablation: experimentally correlated numerical models. IEEE Trans Biomed Eng 2015; 62:561-9. [PMID: 25265626 DOI: 10.1109/tbme.2014.2360374] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Irreversible electroporation (IRE) ablation uses brief electric pulses to kill a volume of tissue without damaging the structures contraindicated for surgical resection or thermal ablation, including blood vessels and ureters. IRE offers a targeted nephron-sparing approach for treating kidney tumors, but the relevant organ-specific electrical properties and cellular susceptibility to IRE electric pulses remain to be characterized. Here, a pulse protocol of 100 electric pulses, each 100 μs long, is delivered at 1 pulse/s to canine kidneys at three different voltage-to-distance ratios while measuring intrapulse current, completed 6 h before humane euthanasia. Numerical models were correlated with lesions and electrical measurements to determine electrical conductivity behavior and lethal electric field threshold. Three methods for modeling tissue response to the pulses were investigated (static, linear dynamic, and asymmetrical sigmoid dynamic), where the asymmetrical sigmoid dynamic conductivity function most accurately and precisely matched lesion dimensions, with a lethal electric field threshold of 575 ± 67 V/cm for the protocols used. The linear dynamic model also attains accurate predictions with a simpler function. These findings can aid renal IRE treatment planning under varying electrode geometries and pulse strengths. Histology showed a wholly necrotic core lesion at the highest electric fields, surrounded by a transitional perimeter of differential tissue viability dependent on renal structure.
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Pomerri F, Opocher G, Dal Bosco C, Muzzio PC, Gennaro G. Optimal follow-up intervals in active surveillance of renal masses in patients with von Hippel-Lindau disease. Eur Radiol 2015; 25:2025-32. [PMID: 25636418 DOI: 10.1007/s00330-015-3591-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2014] [Revised: 12/17/2014] [Accepted: 01/12/2015] [Indexed: 10/24/2022]
Abstract
OBJECTIVES To estimate an optimal follow-up (FU) interval for von Hippel-Lindau (VHL) patients with renal masses (RMs) by determining tumour growth rates from growth curves. METHODS Thirty lesions (47.6%) were classified as solid tumours (STs) and 33 (52.4%) as complex cysts (CCs). Variations in lesion volume over time were analyzed. For 53 lesions, we calculated the growth rate during the period when the volume of the lesion changed most rapidly, and called this the fast growth rate (FGR). RESULTS The STs initially grew fast, followed by a period of slower growth. The CCs varied in volume over time, associated with variable amounts of their fluid component. The FGR correlated better with the latest volume for STs (r = 0.905) than for CCs (r = 0.780). An optimal FU interval between 3 and 12 months was derived by combining the FGR calculated from the curve with the latest volume measured. CONCLUSIONS Analyzing growth curves and related kinetic parameters for RMs in VHL patients could be useful with a view to optimizing the subsequent FU interval and improving the active surveillance program. KEY POINTS • Measuring volume changes over time enables tumour growth curves to be charted. • Renal solid tumours increase in volume with a typical sigmoidal curve. • Complex cysts may increase and decrease in volume spontaneously over time. • The fast growth rate of solid tumours correlates with their latest volume. • The fast growth rate can orient the scheduling of subsequent follow-ups.
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Affiliation(s)
- Fabio Pomerri
- Radiology Unit, Veneto Institute of Oncology IOV-IRCCS, via Gattamelata, 64, 35128, Padua, Italy
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Castañeda CV, Danzig MR, Finkelstein JB, RoyChoudhury A, Wagner AA, Chang P, Pierorazio PM, Allaf ME, McKiernan JM. The natural history of renal functional decline in patients undergoing surveillance in the DISSRM registry. Urol Oncol 2015; 33:166.e17-20. [PMID: 25601768 DOI: 10.1016/j.urolonc.2014.11.016] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2014] [Revised: 10/31/2014] [Accepted: 11/25/2014] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To describe the natural history of renal function in patients on active surveillance (AS) for small renal masses (SRM) in the Delayed Intervention and Surveillance for Small Renal Masses Registry. METHODS Delayed Intervention and Surveillance for Small Renal Masses is a prospective, multi-institutional registry of patients with SRM (≤ 4 cm) who choose intervention or AS. Of these, 64 patients on AS had longitudinal serum creatinine (sCr) values and underwent analysis of estimated glomerular filtration rate (eGFR). eGFR was calculated using the Modification of Diet in Renal Disease formula. The Kidney Disease Outcomes Quality Initiative chronic kidney disease (CKD) classification was used to categorize patients' eGFR values. RESULTS Median age was 74 (range: 34-88) years at onset of AS. Overall, 9% (6/64) of patients had CKD at baseline. Median initial tumor size was 2.1cm (range: 0.8-4.0). Median Charlson comorbidity index score was 4 (range: 0-8). Median baseline sCr was 1.0mg/dl (range: 0.4-2.1) and median baseline eGFR was 70.25 (range: 24.07-165.52). After a median follow-up of 17 (range: 2-46) months, 64% of patients experienced a decrease in eGFR, with average yearly decrease in eGFR of 1.82 ml/min/1.73 m(2) (P = 0.092) and average yearly increase in sCr of 0.046 (P = 0.012). A total of 15 (24%) patients experienced an upstaging in classification of CKD. DISCUSSION Nearly two-thirds of patients on AS experienced a decrease in eGFR and nearly one-fourth had upstaging of CKD classification. The annual eGFR decline experienced by patients on AS minimally exceeded the annual decline of 1.49 ± 0.3 ml/min/1.73 m(2) that an individual who was 70 to 79 years of age can expect from aging alone. Further follow-up is necessary to assess this in a more definitive manner, but this trend should be considered when evaluating AS as an alternative to interventional therapies for SRM.
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Affiliation(s)
- Crystal V Castañeda
- Department of Urology, Herbert Irving Cancer Center, Columbia University College of Physicians and Surgeons, New York, NY
| | - Matthew R Danzig
- Department of Urology, Herbert Irving Cancer Center, Columbia University College of Physicians and Surgeons, New York, NY
| | - Julia B Finkelstein
- Department of Urology, Herbert Irving Cancer Center, Columbia University College of Physicians and Surgeons, New York, NY
| | - Arindam RoyChoudhury
- Department of Biostatistics, Columbia University Mailman School of Public Health, New York, NY
| | - Andrew A Wagner
- Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Peter Chang
- Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Phillip M Pierorazio
- James Buchanan Brady Urological Institute and Department of Urology, The Johns Hopkins University School of Medicine, Baltimore, MD
| | - Mohamad E Allaf
- James Buchanan Brady Urological Institute and Department of Urology, The Johns Hopkins University School of Medicine, Baltimore, MD
| | - James M McKiernan
- Department of Urology, Herbert Irving Cancer Center, Columbia University College of Physicians and Surgeons, New York, NY.
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Chen DYT, Uzzo RG, Viterbo R. Thinking beyond surgery in the management of renal cell carcinoma: the risk to die from renal cell carcinoma and competing risks of death. World J Urol 2014; 32:607-13. [PMID: 24710683 DOI: 10.1007/s00345-014-1285-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2014] [Accepted: 03/17/2014] [Indexed: 11/27/2022] Open
Abstract
INTRODUCTION The presentation of renal cell carcinoma (RCC) has changed where it is most commonly identified when asymptomatic and incidental. Contemporary patients with renal tumors are often older in age and may have significant concurrent medical comorbidity, where proceeding with routine surgical treatment may not be of benefit. Traditional clinical assessments have not considered the impact of comorbidity on oncologic outcome, and recent studies have demonstrated the relationship between comorbidity and patient survival. We review the existing data examining the significance of medical comorbidity on RCC management and outcomes. MATERIALS AND METHODS The existing literature on this topic is reviewed, and validated measures of comorbidity are described. The available studies examining the relationship between comorbidity and RCC are summarized. RESULTS AND DISCUSSION The article reviews the growing body of literature supporting the importance of assessment of patient comorbidity, and we highlight novel prognostic instruments that can estimate the likelihood of several different patient outcomes following RCC treatment, and these nomograms can be accessed via a web-based portal ( www.cancernomograms.com ) to assist in patient education and clinical decision making.
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Affiliation(s)
- David Y T Chen
- Fox Chase Cancer Center-Temple Health, 333 Cottman Avenue, Philadelphia, PA, 19111, USA,
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Orton LP, Cohan RH, Davenport MS, Parker RA, Parameswaran A, Caoili EM, Kaza RK, Francis IR, Ellis JH, Wolf JS, Hafez K. Variability in computed tomography diameter measurements of solid renal masses. ACTA ACUST UNITED AC 2014; 39:533-42. [DOI: 10.1007/s00261-014-0088-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Volpe A, Jewett MAS. Current role, techniques and outcomes of percutaneous biopsy of renal tumors. Expert Rev Anticancer Ther 2014; 9:773-83. [DOI: 10.1586/era.09.48] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
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Abourbih S, Aldousari S, Brimo F, Omeroglu A, Kassouf W. Extensive renal infarction following percutaneous biopsy of a small renal mass: A case report. Can Urol Assoc J 2013; 7:E118-20. [PMID: 23671500 DOI: 10.5489/cuaj.252] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Percutaneous renal biopsy has become increasingly used particularly in patients undergoing active surveillance for small renal masses. We present a patient, who was recently diagnosed with laryngeal squamous cell carcinoma, with significant complication following biopsy of a solid renal mass. The patient was planned for nephron-sparing surgery that was converted to radical nephrectomy due to extensive renal infarction secondary to significant subcapsular hemorrhage inflicted by the biopsy.
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Affiliation(s)
- Samuel Abourbih
- Division of Urology, Department of Surgery, McGill University Health Centre, Montreal, QC
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Parker PA, Alba F, Fellman B, Urbauer DL, Li Y, Karam JA, Tannir N, Jonasch E, Wood CG, Matin SF. Illness uncertainty and quality of life of patients with small renal tumors undergoing watchful waiting: a 2-year prospective study. Eur Urol 2013; 63:1122-7. [PMID: 23419322 DOI: 10.1016/j.eururo.2013.01.034] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2012] [Accepted: 01/31/2013] [Indexed: 10/27/2022]
Abstract
BACKGROUND Few studies have examined factors associated with the quality of life (QOL) of patients with renal tumors. Illness uncertainty may influence QOL. OBJECTIVE To prospectively examine the influence of uncertainty on general and cancer-specific QOL and distress in patients undergoing watchful waiting (WW) for a renal mass. DESIGN, SETTING, AND PARTICIPANTS In 2006-2010, 264 patients were enrolled in a prospective WW registry. The decision for WW was based on patient, tumor, and renal function characteristics at the discretion of the urologist and medical oncologist in the context of the physician-patient interaction. Participants had suspected clinical stage T1-T2 disease, were aged ≥ 18 yr, and spoke and read English. The first 100 patients enrolled in the registry participated in this study. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Patients completed questionnaires on demographics, illness uncertainty (Mishel Uncertainty in Illness Scale), general QOL (Medical Outcomes Study 36-item short-form survey), cancer-specific QOL (Cancer Rehabilitation Evaluation System-Short Form), and distress (Impact of Events Scale) at enrollment and at 6, 12, and 24 mo. Age, gender, ethnicity, tumor size, estimated glomerular filtration rate, comorbidities, and assessment time point were controlled for in the models. RESULTS AND LIMITATIONS Among the sample, 27 patients had biopsies, and 17 patients had proven renal cell carcinoma. Growth rate was an average of 0.17 cm/yr (standard deviation: 0.35). Mean age was 72.5 yr, 55% of the patients were male, and 84% of the patients were Caucasian. Greater illness uncertainty was associated with poorer general QOL scores in the physical domain (p=0.008); worse cancer-related QOL in physical (p=0.001), psychosocial (p<0.001), and medical (p=0.034) domains; and higher distress (p<0.001). CONCLUSIONS This study is among the first to prospectively examine the QOL of patients with renal tumors undergoing WW and the psychosocial factors that influence QOL. Illness uncertainty predicted general QOL, cancer-specific QOL, and distress. These factors could be targeted in psychosocial interventions to improve the QOL of patients on WW.
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Affiliation(s)
- Patricia A Parker
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, TX 77230, USA.
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Abstract
Thermoablation (TA) has become an increasingly popular treatment for small renal masses (SRMs). Although long-term outcomes are not currently reported, TA may have a role in being an alternative to radical or partial nephrectomy. This review gives a broad overview of TA and discusses current controversies in the field.
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Affiliation(s)
- Phillip H Abbosh
- Division of Urology, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri
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Comparison of CT-Based Methodologies for Detection of Growth of Solid Renal Masses on Active Surveillance. AJR Am J Roentgenol 2012; 199:373-8. [DOI: 10.2214/ajr.11.7735] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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28
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Violette P, Abourbih S, Szymanski KM, Tanguay S, Aprikian A, Matthews K, Brimo F, Kassouf W. Solitary solid renal mass: can we predict malignancy? BJU Int 2012; 110:E548-52. [DOI: 10.1111/j.1464-410x.2012.11245.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Dodelzon K, Mussi TC, Babb JS, Taneja SS, Rosenkrantz AB. Prediction of Growth Rate of Solid Renal Masses: Utility of MR Imaging Features—Preliminary Experience. Radiology 2012; 262:884-93. [DOI: 10.1148/radiol.11111074] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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30
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Haramis G, Graversen JA, Mues AC, Korets R, Rosales JC, Okhunov Z, Badani KK, Gupta M, Landman J. Retrospective Comparison of Laparoscopic Partial Nephrectomy Versus Laparoscopic Renal Cryoablation for Small (<3.5 cm) Cortical Renal Masses. J Laparoendosc Adv Surg Tech A 2012; 22:152-7. [DOI: 10.1089/lap.2011.0246] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Affiliation(s)
- Georgios Haramis
- Department of Urology, Columbia University Medical Center, New York, New York
| | | | - Adam C. Mues
- Department of Urology, New York University School of Medicine, New York, New York
| | - Ruslan Korets
- Department of Urology, Columbia University Medical Center, New York, New York
| | - Juan Carlos Rosales
- Department of Urology, Columbia University Medical Center, New York, New York
| | - Zhamshid Okhunov
- Department of Urology, Columbia University Medical Center, New York, New York
| | - Ketan K. Badani
- Department of Urology, Columbia University Medical Center, New York, New York
| | - Mantu Gupta
- Department of Urology, Columbia University Medical Center, New York, New York
| | - Jaime Landman
- Department of Urology, University of California, Irvine, Irvine, California
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31
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Quelle place pour la surveillance active des petites tumeurs rénales ? Prog Urol 2011; 21:895-900. [DOI: 10.1016/j.purol.2011.08.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2010] [Revised: 08/28/2011] [Accepted: 08/29/2011] [Indexed: 11/24/2022]
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32
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Pahernik S, Huber J, Pfitzenmaier J, Haferkamp A, Hohenfellner M. Small renal cell carcinoma: oncological outcome with tumour size. ACTA ACUST UNITED AC 2011; 45:432-5. [DOI: 10.3109/00365599.2011.621143] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
| | - Johannes Huber
- Department of Urology,
University of Heidelberg, Germany
| | | | - Axel Haferkamp
- Department of Urology,
University of Heidelberg, Germany
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33
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Smaldone MC, Uzzo RG. Active surveillance: a potential strategy for select patients with small renal masses. Future Oncol 2011; 7:1133-47. [DOI: 10.2217/fon.11.97] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Increased abdominal imaging has led to the significant incidental detection of clinically localized renal masses. While the gold standard remains surgical excision, mortality rates from kidney cancer remain relatively unchanged implying that a proportion of small renal masses may be indolent tumors that do not require surgical intervention. As a result, active surveillance has emerged as an alternative management strategy in select patients with significant competing risks. Although the contemporary literature characterizing the natural history of untreated small renal masses is limited, recent data demonstrate that many incidental renal masses demonstrate slow growth kinetics with a low rate of progression to metastatic disease over an intermediate time period. Prospective trials are necessary to define entry and intervention criteria for active surveillance protocols.
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Affiliation(s)
- Marc C Smaldone
- Department of Surgery, Division of Urologic Oncology, Fox Chase Cancer Center, 333 Cottman Avenue, Philadelphia, PA 19111, USA
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34
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Kawaguchi S, Fernandes KA, Finelli A, Robinette M, Fleshner N, Jewett MA. Most Renal Oncocytomas Appear to Grow: Observations of Tumor Kinetics With Active Surveillance. J Urol 2011; 186:1218-22. [DOI: 10.1016/j.juro.2011.05.080] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2011] [Indexed: 11/16/2022]
Affiliation(s)
- Sarah Kawaguchi
- Division of Urology, Departments of Surgery and Surgical Oncology, Princess Margaret Hospital, University Health Network, Toronto, Ontario, Canada
- University of Toronto, Toronto, Ontario, Canada
| | - Kimberly A. Fernandes
- Department of Biostatistics, Princess Margaret Hospital and University Health Network, Toronto, Ontario, Canada
| | - Antonio Finelli
- Division of Urology, Departments of Surgery and Surgical Oncology, Princess Margaret Hospital, University Health Network, Toronto, Ontario, Canada
- University of Toronto, Toronto, Ontario, Canada
| | - Michael Robinette
- Division of Urology, Departments of Surgery and Surgical Oncology, Princess Margaret Hospital, University Health Network, Toronto, Ontario, Canada
- University of Toronto, Toronto, Ontario, Canada
| | - Neil Fleshner
- Division of Urology, Departments of Surgery and Surgical Oncology, Princess Margaret Hospital, University Health Network, Toronto, Ontario, Canada
- University of Toronto, Toronto, Ontario, Canada
| | - Michael A.S. Jewett
- Division of Urology, Departments of Surgery and Surgical Oncology, Princess Margaret Hospital, University Health Network, Toronto, Ontario, Canada
- University of Toronto, Toronto, Ontario, Canada
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35
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Wong JA, Rendon RA. Progression to metastatic disease from a small renal cell carcinoma prospectively followed with an active surveillance protocol. Can Urol Assoc J 2011; 1:120-2. [PMID: 18542777 DOI: 10.5489/cuaj.57] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
With the widespread use of abdominal imaging to evaluate other medical conditions, many renal tumours are being diagnosed at earlier stages. Older patients have experienced the most significant increase in the incidence of renal cell carcinoma (RCC). This age group frequently has significant medical comorbidities. This has led to the concept of active surveillance for select patients with renal lesions that may not affect their mortality. However, the ultimate risk of active surveillance is the potential for developing metastases. This case report presents the development of metastatic disease from a small, incidentally detected and prospectively followed RCC with asymptomatic progression.
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Affiliation(s)
- Jaime A Wong
- Department of Urology, Dalhousie University, and the Queen Elizabeth II Health Sciences Centre, Halifax, NS
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36
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Abstract
Objectives: To evaluate the role and feasibility of observation with regard to the small renal mass. Methods: We performed a literature search of MEDLINE, reviewing the world literature relevant to the natural history, role of percutaneous biopsy and surveillance of the small renal mass. Results: The average yearly growth rate of most small renal masses ranges from 0.1 to 0.70 cm/yr with obvious exceptions. Clinical predictors of growth such as radiographic size at presentation, age, gender and tumor characteristics are not reliable. Approximately 1% develops metastatic disease while under surveillance. Contemporary series of percutaneous biopsy of small renal masses report sensitivity for malignancy to be 90%-98%. However, false-negative results can occur. For the majority of patients, the gold standard remains surgical extirpation. Conclusions: Watchful waiting is an acceptable option for management of small renal masses in the surgically unfit and elderly population. More information regarding the natural history and metastatic potential of small renal masses is needed. Percutaneous needle biopsy can be successful in detecting malignancy in selected patients with small renal masses. The role of needle biopsy for the small renal mass continues to evolve
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Affiliation(s)
- K Clint Cary
- Department of Urology, Indiana University School of Medicine, Indianapolis, IN, USA
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Chen X, Summers R, Yao J. FEM-based 3-D tumor growth prediction for kidney tumor. IEEE Trans Biomed Eng 2011; 58:463-7. [PMID: 21342810 DOI: 10.1109/tbme.2010.2089522] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
It is important to predict the tumor growth so that appropriate treatment can be planned in the early stage. In this letter, we propose a finite-element method (FEM)-based 3-D tumor growth prediction system using longitudinal kidney tumor images. To the best of our knowledge, this is the first kidney tumor growth prediction system. The kidney tissues are classified into three types: renal cortex, renal medulla, and renal pelvis. The reaction-diffusion model is applied as the tumor growth model. Different diffusion properties are considered in the model: the diffusion for renal medulla is considered as anisotropic, while those of renal cortex and renal pelvis are considered as isotropic. The FEM is employed to solve the diffusion model. The model parameters are estimated by the optimization of an objective function of overlap accuracy using a hybrid optimization parallel search package. The proposed method was tested on two longitudinal studies with seven time points on five tumors. The average true positive volume fraction and false positive volume fraction on all tumors is 91.4% and 4.0%, respectively. The experimental results showed the feasibility and efficacy of the proposed method.
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Affiliation(s)
- Xinjian Chen
- Department of Radiology and Imaging Sciences, National Institute of Health, Bethesda, MD 20892 USA.
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39
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Quantitative Enhancement Washout Analysis of Solid Cortical Renal Masses Using Multidetector Computed Tomography. J Comput Assist Tomogr 2011; 35:337-42. [DOI: 10.1097/rct.0b013e318219f92b] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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40
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Graversen JA, Mues AC, Pérez-Lanzac de Lorca A, Landman J. Active surveillance of renal cortical neoplasms: a contemporary review. Postgrad Med 2011; 123:105-13. [PMID: 21293090 DOI: 10.3810/pgm.2011.01.2251] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
INTRODUCTION Over the past 2 decades, there has been a significant increase in the number of incidentally found small renal cortical neoplasms (RCNs). As more RCNs are being discovered in the elderly and infirmed patient populations, there has been a growing interest in the role of active surveillance (AS). Active surveillance is recommended for high surgical-risk patients and those with a reduced life expectancy. It is also an option for patients wishing to avoid surgery. We review the current literature on AS and highlight the natural history of disease, the important factors to evaluate during AS, and the contemporary role of biopsy. METHODS AND MATERIALS The MEDLINE database was searched using PubMed. Search terms included active surveillance, renal mass, natural history, and renal mass histology. From 1966 to present, 17 AS series were identified, all of which have been included in this summary. A summary was performed by compiling all available data and performing a weighted mean where applicable. RESULTS Initial tumor size does not correlate with growth rate or malignancy. The mean growth rate in large published series is low (0.28-0.34 cm/year). Tumors with high growth rates usually represent malignant lesions and typically undergo delayed intervention. Progression to metatatic disease is a low-probability event for tumors on AS (1.4%); however, this is still a risk that patients must be willing to accept. Larger tumors (cT1b and cT2) also demonstrate relatively low growth (0.57 cm/year); however, these tumors should be monitored carefully. Tumors followed for > 5 years demonstrate a low growth rate (0.15 cm/year), will not likely require intervention, and have a low chance of progression to metastatic disease. CONCLUSION For highly selected patients with RCN, AS is a reasonable treatment option. Age, surgical risk, comorbidities, and patient opinion must all factor into the final decision when considering a patient for AS.
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Affiliation(s)
- Joseph A Graversen
- Department of Urology, Columbia University Medical Center, New York, NY, USA
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41
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Kai F, Takayama T, Ito T, Hadano S, Ozono S. Natural history of renal cell carcinoma: a case with 18 years follow-up. Clin Exp Nephrol 2010; 15:312-5. [DOI: 10.1007/s10157-010-0383-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2010] [Accepted: 11/07/2010] [Indexed: 11/29/2022]
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42
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Samplaski MK, Zhou M, Lane BR, Herts B, Campbell SC. Renal mass sampling: an enlightened perspective. Int J Urol 2010; 18:5-19. [PMID: 21039914 DOI: 10.1111/j.1442-2042.2010.02641.x] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Renal mass sampling (RMS) can be carried out by core biopsy or fine needle aspiration with each presenting potential advantages and limitations. The literature about RMS is confounded by a lack of standardized techniques, ambiguous terminology, imprecise definitions of accuracy, substantial rates of non-informative biopsies, and recurrent diagnostic challenges with respect to eosinophilic neoplasms. Despite these concerns, RMS has an expanding role in the evaluation and treatment of renal masses, in order to stratify biological aggressiveness and guide management that can range from surgery to active surveillance. Non-informative biopsies can be managed with surgical excision or repeat biopsy, with the latter showing encouraging results in recent studies. We propose a new classification in which all biopsies are categorized as non-informative versus informative, with the latter being subclassified as confirmed accurate, presumed accurate or confirmed inaccurate. This terminology will facilitate the comparison of results from various studies and stimulate progress. Incorporation of novel biomarkers and molecular fingerprinting into RMS protocols will likely allow for more rational management of patients with renal masses in the near future.
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Affiliation(s)
- Mary K Samplaski
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio 44195, USA
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43
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Berland LL, Silverman SG, Gore RM, Mayo-Smith WW, Megibow AJ, Yee J, Brink JA, Baker ME, Federle MP, Foley WD, Francis IR, Herts BR, Israel GM, Krinsky G, Platt JF, Shuman WP, Taylor AJ. Managing Incidental Findings on Abdominal CT: White Paper of the ACR Incidental Findings Committee. J Am Coll Radiol 2010; 7:754-73. [DOI: 10.1016/j.jacr.2010.06.013] [Citation(s) in RCA: 512] [Impact Index Per Article: 36.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2010] [Accepted: 06/07/2010] [Indexed: 02/06/2023]
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44
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Mues AC, Haramis G, Badani K, Gupta M, Benson MC, McKiernan JM, Landman J. Active Surveillance for Larger (cT1bN0M0 and cT2N0M0) Renal Cortical Neoplasms. Urology 2010; 76:620-3. [DOI: 10.1016/j.urology.2010.04.021] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2010] [Revised: 04/10/2010] [Accepted: 04/10/2010] [Indexed: 10/19/2022]
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Abstract
The recent stage migration observed for renal tumours is contributing to a significant increase in the diagnosis of small renal masses. This evolution has led to a significant change in the approach to renal masses. New options such as observation or energy ablation are gaining popularity in a subset of this patient population. In addition, the observed changes directly contribute to the increased use of nephron-sparing surgery. A better understanding of the various characteristics of these masses will allow for a better understanding of the natural history of these masses and for selection of the optimal therapeutic approach.
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Affiliation(s)
| | - S. Tanguay
- Correspondence to: Simon Tanguay, Department of Surgery (Urology), McGill University Health Centre, 1650 Cedar Avenue, L8-318, Montreal, Quebec H3G 1A4. E-mail:
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del Cura JL, Zabala R, Iriarte JI, Unda M. Treatment of renal tumors by percutaneous ultrasound-guided radiofrequency ablation using a multitined electrode: effectiveness and complications. Eur Urol 2009; 57:459-65. [PMID: 19926208 DOI: 10.1016/j.eururo.2009.11.025] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2009] [Accepted: 11/03/2009] [Indexed: 11/15/2022]
Abstract
BACKGROUND Radiofrequency ablation (RFA) is a minimally aggressive, therapeutic alternative for renal tumors. It can be an alternative to nephrectomy in patients with previous nephrectomy, bilateral tumors, von Hippel-Lindau disease, or small renal carcinomas and in those with contraindications for surgery. OBJECTIVE To assess the effectiveness of the treatment of renal tumors by RFA in the short and medium term and to identify the possible complications and the factors that determine therapeutic success. DESIGN, SETTING, AND PARTICIPANTS A retrospective review of patients with renal tumors treated with RFA between May 2005 and December 2008 was performed in a tertiary academic hospital. Patients were selected among those with previous nephrectomy, bilateral neoplasms, von Hippel-Lindau disease, surgical risk, comorbidity, advanced age, or patient's refusal to surgery. Tumors with evidence of extrarenal extension were excluded. Patients were followed up for 10-50 mo using computed tomography and magnetic resonance imaging. INTERVENTION Ultrasound-guided RFA was performed on 65 tumors (range: 1.2-5.3 cm) of 58 patients using multitined electrodes. MEASUREMENTS Incomplete ablation rate, therapeutic success rate, and complications rate. RESULTS AND LIMITATIONS Therapeutic success was achieved in 59 of 65 tumors (91%): 53 in a single session, 5 in two sessions, and 1 in three sessions. A significant relationship was observed between size and growth pattern of the tumor and both therapeutic success and incomplete ablation rates. Therapeutic success in tumors >5 cm was 60%. Complications were detected in 10 patients (13%); 5% were considered major complications. Limitations include the lack of pathologic studies to confirm a complete ablation and the lack of a control group to compare with the results of those who underwent nephrectomy. CONCLUSIONS RFA is safe and effective in renal tumors. Corticomedullary lesions and tumors >3 cm have greater possibility of incomplete ablation. In tumors >5 cm, RFA has a significant failure rate.
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Affiliation(s)
- Jose L del Cura
- Radiology Department, Basurto University Hospital, Bilbao, Spain.
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48
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Long JA, Neuzillet Y, Poissonnier L, Lang H, Paparel P, Escudier B, Rioux-Leclercq N, Correas JM, Mejean A, Baumert H, Soulié M, Patard JJ. Les traitements ablatifs modifient-ils la prise en charge des tumeurs du rein chez la personne âgée ? Prog Urol 2009; 19 Suppl 3:S116-23. [DOI: 10.1016/s1166-7087(09)73356-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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49
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Abstract
Improvements in imaging technology and the expanding use of imaging have led to a rapid increase in the discovery of incidental renal lesions. These can present both the radiologist and the referring clinician with diagnostic dilemmas. This article addresses the most frequently encountered lesions and provides a framework for the diagnostic and management pathways for both solid and cystic lesions.
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50
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José Iriarte Soldevilla I, Senarriaga Ruiz de la Illa N, Lacasa Viscasillas I, Loizaga Iriarte A, Zubiaur Libano C, Unda Urzaiz M. [Current treatment of small renal masses]. Actas Urol Esp 2009; 33:505-13. [PMID: 19658303 DOI: 10.1016/s0210-4806(09)74183-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
UNLABELLED Incidental diagnosis of renal carcinoma (RC) is increasingly common due to widespread use of radiodiagnostic techniques for other conditions. In developed countries, incidental tumor account for more than 40% of detected tumors, and 80% of solid kidney tumors less than 4 cm in size are malignant. Standard treatment for these tumors is partial nephrectomy, and their relapse rate is 1%-2% The higher increase in diagnosis of this disease has occurred in patients aged 70 to 90 years, a group where associated comorbidities are very common. In the past two decades, in parallel to development of radiographic techniques, two ablation procedures achieving tumor necrosis through cold, cryotherapy, and through heat, radiofrequency, have become established. These procedures achieve 95% short- and long-term remissions in tumors less than 4 cm in size. In addition, since these procedures may be performed percutaneously, both complications and hospital stay have decreased. As early as in 1995, Bosniak, based on observation of the growth and behavior of small RCs for longer than 8 years, advocated a watchful waiting or active surveillance attitude. This article reports cryotherapy, our radiofrequency series, and a literature review. CONCLUSIONS In the event of elderly patients, concomitant diseases advising against surgery, multiple renal tumors, a solitary kidney, or patients who reject surgery, ablation procedures may be safe and effective when performed by expert hands, achieving mid-term oncological results similar to partial nephrectomy. Active surveillance has also been shown to be safe in the mid-term in adequately informed patients. To improve indications, new diagnostic procedures that help us differentiate the potentially more aggressive tumors will be required. Larger series and longer follow-ups are neede to confirm current results.
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