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Minerva Urology and Nephrology 2021 February;73(1):17-31

DOI: 10.23736/S2724-6051.20.04073-4

Copyright © 2020 EDIZIONI MINERVA MEDICA

language: English

Computed tomography features predicting aggressiveness of malignant parenchymal renal tumors suitable for partial nephrectomy

Vincenzo FICARRA 1 , Simona CALOGGERO 2, Marta ROSSANESE 1, Gianluca GIANNARINI 3, Alessandro CRESTANI 4, Giorgio ASCENTI 2, Giacomo NOVARA 5, Francesco PORPIGLIA 6

1 Unit of Urology, Department of Human and Pediatric Pathology “Gaetano Barresi”, G. Martino University Hospital, University of Messina, Messina, Italy; 2 Department of Radiology, University of Messina, Messina, Italy; 3 Unit of Urology, Academic Medical Center “Santa Maria della Misericordia”, Udine, Italy; 4 Oncological Urology, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy; 5 Unit of Urology, Department of Oncological, Surgical and Gastrointestinal Sciences, University of Padua, Padua, Italy; 6 Division of Urology, Department of Oncology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy



The aim of this study was to identify and standardize computed tomography (CT) features having a potential role in predicting aggressiveness of malignant parenchymal renal tumors suitable for partial nephrectomy (PN). We performed a non-systematic review of the recent literature to evaluate the potential impact of CT variables proposed by the Society of Abdominal Radiology Disease-Focused Panel on Renal Cell Carcinoma in predicting aggressiveness of newly diagnosed malignant parenchymal renal tumors. The analyzed variables were clinical tumor size, tumor growth rate, enhancement characteristics, amount of cystic component, polar and capsular location, tumor margins and distance between tumor and renal sinus. Unfavorable behavior was defined as: 1) renal cell carcinoma (RCC) with stage ≥pT3; 2) nuclear grade 3 or 4; 3) presence of sarcomatoid de-differentiation; or 4) non-clear cell subtypes with unfavorable prognosis (type 2 papillary RCC, collecting duct or renal medullary carcinoma, unclassified RCC). Beyond clinical tumor size, tumor growth rate, enhancement characteristics, amount of cystic component, tumor margins and distance between tumor and renal sinus are highly relevant features predicting an unfavorable behavior. Moreover, several studies supported the role of necrosis as preoperative predictor of tumor aggressiveness. Peritumoral and intratumoral vasculature as well as capsule status are emerging variables that need to be further evaluated. Tumor size, enhancement characteristics, tumor margins and distance to the renal sinus are highly relevant CT features predicting biological aggressiveness of malignant parenchymal renal tumors. Combination of these parameters might be useful to generate tools to predict the unfavorable behavior of renal tumors suitable for PN.


KEY WORDS: Kidney neoplasms; Carcinoma, renal cell; Nephrectomy; Tomography, X-Ray computed; Margins of excision; Necrosis

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