Michael Organ1, Landan P MacDonald2, Michael A S Jewett3, Henry Ajzenberg4, Ashraf Almatar5, Mohamed Abdolell6, Matthew R Acker7, Ricardo Rendon8. 1. Department of Urology, Memorial University, St. John's, NL, Canada. 2. School of Medicine, Dalhousie University, Saint John, NB, Canada. 3. Departments of Surgery (Urology) and Surgical Oncology, Princess Margaret Cancer Centre, University Health Network and University of Toronto, Toronto, ON, Canada. 4. School of Medicine, Queen's University, Kingston, ON, Canada. 5. Department of Urology, King Fahad Specialist Hospital-Dammam, Dammam, Saudi Arabia. 6. Department of Diagnostic Radiology, Dalhousie University, Halifax, NS, Canada. 7. Department of Urology, Dalhousie University, Saint John, NB, Canada. 8. Department of Urology, Dalhousie University, Halifax, NS, Canada.
Abstract
INTRODUCTION: Preoperative prediction of benign vs. malignant small renal masses (SRMs) remains a challenge. This study: 1) validates our previously published classification tree (CT) with an external cohort; 2) creates a new CT with the combined cohort; and 3) evaluates the RENAL and PADUA scoring systems for prediction of malignancy. METHODS: This study includes a total of 818 patients with renal masses; 395 underwent surgical resection and 423 underwent biopsy. A CT to predict benign disease was developed using patient and tumour characteristics from the 709 eligible participants. Our CT is based on four parameters: tumour volume, symptoms, gender, and symptomatology. CART modelling was also used to determine if RENAL and PADUA scoring could predict malignancy. RESULTS: When externally validated with the surgical cohort, the predictive accuracy of the old CT dropped. However, by combining the cohorts and creating a new CT, the predictive accuracy increased from 74% to 87% (95% confidence interval 0.84-0.89). RENAL and PADUA score alone were not predictive of malignancy. One limitation was the lack of available histological data from the biopsy series. CONCLUSIONS: The validated old CT and new combined-cohort CT have a predictive value greater than currently published nomograms and single-biopsy cohorts. Overall, RENAL and PADUA scores were not able to predict malignancy.
INTRODUCTION: Preoperative prediction of benign vs. malignant small renal masses (SRMs) remains a challenge. This study: 1) validates our previously published classification tree (CT) with an external cohort; 2) creates a new CT with the combined cohort; and 3) evaluates the RENAL and PADUA scoring systems for prediction of malignancy. METHODS: This study includes a total of 818 patients with renal masses; 395 underwent surgical resection and 423 underwent biopsy. A CT to predict benign disease was developed using patient and tumour characteristics from the 709 eligible participants. Our CT is based on four parameters: tumour volume, symptoms, gender, and symptomatology. CART modelling was also used to determine if RENAL and PADUA scoring could predict malignancy. RESULTS: When externally validated with the surgical cohort, the predictive accuracy of the old CT dropped. However, by combining the cohorts and creating a new CT, the predictive accuracy increased from 74% to 87% (95% confidence interval 0.84-0.89). RENAL and PADUA score alone were not predictive of malignancy. One limitation was the lack of available histological data from the biopsy series. CONCLUSIONS: The validated old CT and new combined-cohort CT have a predictive value greater than currently published nomograms and single-biopsy cohorts. Overall, RENAL and PADUA scores were not able to predict malignancy.
Authors: Charlie J Gillis; Ricardo Rendon; Landan P MacDonald; Michael A S Jewett; Christopher French; Henry Ajzenberg; Ashraf Almatar; Mohammed Abdolell; Michael Organ Journal: Can Urol Assoc J Date: 2019-11-29 Impact factor: 1.862