Small Renal Masses in Close Proximity to the Collecting System and Renal Sinus Are Enriched for Malignancy and High Fuhrman Grade and Should Be Considered for Early Intervention |
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Authors: | Andres F. Correa Amir Toussi Milon Amin Ronald L. Hrebinko Bishoy A. Gayed Anil V. Parwani Jodi K. Maranchie |
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Affiliation: | 1. Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, PA;2. Department of Urology, Mayo Clinic, Rochester, MN;3. Affiliated Pathologists Medical Group, Torrance, CA;4. Department of Urology, University of Pittsburgh Medical Center, Pittsburgh, PA;5. Department of Urology, University of Pittsburgh Medical Center, Pittsburgh, PA;6. Department of Pathology, Ohio State University, Wexner Medical Center, Columbus, OH |
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Abstract: | IntroductionRecent reports show a correlation between renal tumor radiographic characteristics and pathologic features. We hypothesize that a more central location within the relatively hypoxic renal medulla might confer a more aggressive tumor phenotype. To test this, radiographic tumor characteristics were compared with tumor grade and histology.Materials and MethodsWe retrospectively reviewed renal masses <4 cm in diameter that underwent resection between 2008 and 2013. Tumor location was recorded using standard R.E.N.A.L. Nephrometry Score. Multivariate logistic regression was performed to compare independent anatomic features with incidence of malignancy and high nuclear grade.ResultsA total of 334 renal tumors had information available for analysis. Univariate analysis showed that increasing endophycity and proximity to the collecting system (<4 mm) were predictors of malignancy and high-grade features. In multivariate analysis, proximity to the collecting system <4 mm remained the as the only anatomical variable predictive of malignancy (odds ratio [OR], 3.58; 95% confidence interval [CI], 1.06-12.05; P = .04) and high nuclear grade (OR, 2.81; 95% CI, 1.44-5.51; P = .003).ConclusionMalignancy and high tumor grade occur with much greater frequency when tumors are located deep in the kidney, in close proximity to the collecting system and renal sinus. Ninety-six percent of small renal masses in this region were cancers and nearly half were Fuhrman Grade 3 or 4, suggesting that these small centrally located tumors should be targeted for early intervention. |
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Keywords: | High Grade Histology Location Renal cell carcinoma Small renal mass |
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