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Minerva Urologica e Nefrologica 2020 Nov 17

DOI: 10.23736/S0393-2249.20.04073-4

Copyright © 2020 EDIZIONI MINERVA MEDICA

lingua: Inglese

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

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


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PURPOSE: 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).
METHODS: 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. 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).
RESULTS: 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.
CONCLUSIONS: 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: Renal neoplasms; Renal cell carcinoma; Partial nephrectomy; Radical nephrectomy; Computed tomography; Tumor size; Enhancement; Surgical margins; Tumor/parenchyma interface; Necrosis; Nephrometry systems

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