Change in Nephrometry Scoring in Small Renal Masses (<4cm) on Active Surveillance: Preliminary Observations from Tayside Active Surveillance Cohort (TASC) Study

Khan H. Hassan, Zhang Wanzhe, Catherine Paterson, Magdalena Szewczyk-Bieda, Stephen Lang, Ghulam Nabi (Lead / Corresponding author)

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    Abstract

    Rationale and Objectives: Prediction of growth, in particular knowing the possibility of aggressive cancer in small renal masses on active surveillance, remains poorly understood. The study was designed to determine whether serial nephrometry score measurements could predict possibility of aggressive malignancy (grade of cancer) in patients with small renal masses opting for active surveillance initially. Materials and Methods: One hundred sixteen patients between January 2000 and December 2016 undergoing partial nephrectomy were recruited. Out of these, 97 were analyzed using different nephrometry scoring systems. Measurement of nephrometry scores (Radius of tumors, Exo/Endophytic; Nearness of tumors to the collecting system or sinus; Anterior/posterior; Location in relation to polar lines, Preoperative Aspects and Dimensions Used for Anatomical, Centrality Index) was performed by two researchers. Among the patients opting for partial nephrectomy, 40 were on active surveillance for at least 12 months (mean 32; 12–60 months) before partial nephrectomy. Computed tomography scan images of these patients were retrieved and analyzed including comparison to histopathology. Results: Nephrometry scores measured on serial computed tomography scan images showed a significant correlation between change in score and grade of cancer on multivariate analysis (P value.001). Addition of multivariate analysis to nomogram based on change in size alone did not improve predictive value of area under the curve significantly. Conclusions: Change in nephrometry scoring measurements correlates with grade of cancer in small renal masses but falls short of significantly predicting presence of malignancy or grade of cancer on nomogram in patients opting for active surveillance for small renal masses. At present, this approach may be inadequate for decision-making.

    Original languageEnglish
    Pages (from-to)1381-1387
    Number of pages7
    JournalAcademic Radiology
    Volume25
    Issue number11
    Early online date6 Mar 2018
    DOIs
    Publication statusPublished - Nov 2018

    Keywords

    • Kidney
    • complications
    • nephrometry score
    • partial nephrectomy

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