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Use of RENAL nephrometry scores for predicting tumor upgrading between core biopsies and surgical specimens: a prospective ex vivo study.

Zhang GM, Zhu Y, Gan HL, Wang HK, Shi GH, Zhang HL, Dai B, Wang CF, Ye DW - Medicine (Baltimore) (2015)

Bottom Line: According to multivariate analyses, anatomical features R (radius) and L (location) scores correlated significantly with FG upgrading.With a threshold of 30%, our nomogram identified 92.4% of cases with upgrading; however, it overrated 26.8% of patients without upgrading.Our nomogram uses anatomical features to predict true FG from renal biopsies.

View Article: PubMed Central - PubMed

Affiliation: From the Department of Urology (GMZ, YZ, HKW, GHS, HLZ, BD, DWY); Department of Pathology (HLG, CFW, Fudan University Shanghai Cancer Center; and Department of Oncology (GMZ, YZ, DWY), Shanghai Medical College, Fudan University, Shanghai, China.

ABSTRACT
Determination of Fuhrman grade (FG) on biopsies of renal masses is relatively inaccurate, being prone to underestimating the true grade as ascertained from surgical specimens. This study evaluated whether anatomical features of tumors could predict tumor upgrading between core biopsies and surgical specimens. We prospectively enrolled 249 patients undergoing surgical resection of solid renal masses at our institution from 2012 to 2013. Tumor anatomical features were defined using RENAL nephrometry scores. Two peripheral and 1 central ex vivo core biopsies were taken from surgical specimens with an F18-gauge needle. Logistic regression was used to assess associations between covariates and FG upgrading. A comprehensive nomogram was constructed to quantitate the probability of tumor upgrading. The median tumor size was 4.75 cm and FG upgrading occurred in 43.6% of cases. In tumors of low, intermediate, and high complexity, the risk of FG upgrading was 22.0%, 47.6%, and 50.6%, respectively. According to multivariate analyses, anatomical features R (radius) and L (location) scores correlated significantly with FG upgrading. A combination of anatomical features and core biopsy findings predicted tumor upgrading with an accuracy of 0.884. With a threshold of 30%, our nomogram identified 92.4% of cases with upgrading; however, it overrated 26.8% of patients without upgrading. This ex vivo prospective study demonstrated that RENAL nephrometry score can aid prediction of FG upgrading between core biopsies and surgical specimens. Our nomogram uses anatomical features to predict true FG from renal biopsies.

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Nomogram for predicting the probability of tumor upgrading in patients with RCC undergoing core biopsy. RCC = renal cell carcinoma.
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Figure 1: Nomogram for predicting the probability of tumor upgrading in patients with RCC undergoing core biopsy. RCC = renal cell carcinoma.

Mentions: To achieve the goal of predicting FG upgrading, a multivariate model, which included clinical characteristics, individual anatomical features, and core biopsy results, was constructed. Using backward variable selection based on the “Akaike information criterion,” R, N, and L scores and biopsy grade remained in the final model. The predictive accuracy of the final model was 0.884 (0.841–0.928). The performance of the model in our patients was assessed according to a set of probability thresholds (Table 4 and Supplementary Figure, http://links.lww.com/MD/A219). For example, the nomogram (Figure 1) correctly identified tumor upgrading in 92.4% of patients with a predicted probability of tumor upgrading of ≥0.3 (AUC = 0.723), while overrating 26.8% of patients without upgrading.


Use of RENAL nephrometry scores for predicting tumor upgrading between core biopsies and surgical specimens: a prospective ex vivo study.

Zhang GM, Zhu Y, Gan HL, Wang HK, Shi GH, Zhang HL, Dai B, Wang CF, Ye DW - Medicine (Baltimore) (2015)

Nomogram for predicting the probability of tumor upgrading in patients with RCC undergoing core biopsy. RCC = renal cell carcinoma.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4554152&req=5

Figure 1: Nomogram for predicting the probability of tumor upgrading in patients with RCC undergoing core biopsy. RCC = renal cell carcinoma.
Mentions: To achieve the goal of predicting FG upgrading, a multivariate model, which included clinical characteristics, individual anatomical features, and core biopsy results, was constructed. Using backward variable selection based on the “Akaike information criterion,” R, N, and L scores and biopsy grade remained in the final model. The predictive accuracy of the final model was 0.884 (0.841–0.928). The performance of the model in our patients was assessed according to a set of probability thresholds (Table 4 and Supplementary Figure, http://links.lww.com/MD/A219). For example, the nomogram (Figure 1) correctly identified tumor upgrading in 92.4% of patients with a predicted probability of tumor upgrading of ≥0.3 (AUC = 0.723), while overrating 26.8% of patients without upgrading.

Bottom Line: According to multivariate analyses, anatomical features R (radius) and L (location) scores correlated significantly with FG upgrading.With a threshold of 30%, our nomogram identified 92.4% of cases with upgrading; however, it overrated 26.8% of patients without upgrading.Our nomogram uses anatomical features to predict true FG from renal biopsies.

View Article: PubMed Central - PubMed

Affiliation: From the Department of Urology (GMZ, YZ, HKW, GHS, HLZ, BD, DWY); Department of Pathology (HLG, CFW, Fudan University Shanghai Cancer Center; and Department of Oncology (GMZ, YZ, DWY), Shanghai Medical College, Fudan University, Shanghai, China.

ABSTRACT
Determination of Fuhrman grade (FG) on biopsies of renal masses is relatively inaccurate, being prone to underestimating the true grade as ascertained from surgical specimens. This study evaluated whether anatomical features of tumors could predict tumor upgrading between core biopsies and surgical specimens. We prospectively enrolled 249 patients undergoing surgical resection of solid renal masses at our institution from 2012 to 2013. Tumor anatomical features were defined using RENAL nephrometry scores. Two peripheral and 1 central ex vivo core biopsies were taken from surgical specimens with an F18-gauge needle. Logistic regression was used to assess associations between covariates and FG upgrading. A comprehensive nomogram was constructed to quantitate the probability of tumor upgrading. The median tumor size was 4.75 cm and FG upgrading occurred in 43.6% of cases. In tumors of low, intermediate, and high complexity, the risk of FG upgrading was 22.0%, 47.6%, and 50.6%, respectively. According to multivariate analyses, anatomical features R (radius) and L (location) scores correlated significantly with FG upgrading. A combination of anatomical features and core biopsy findings predicted tumor upgrading with an accuracy of 0.884. With a threshold of 30%, our nomogram identified 92.4% of cases with upgrading; however, it overrated 26.8% of patients without upgrading. This ex vivo prospective study demonstrated that RENAL nephrometry score can aid prediction of FG upgrading between core biopsies and surgical specimens. Our nomogram uses anatomical features to predict true FG from renal biopsies.

Show MeSH
Related in: MedlinePlus