703 ENHANCEMENT CHARACTERISTICS ON 4 PHASE DEDICATED RENAL PROTOCOL CT HELPS TO DISTINGUISH BENIGN FROM MALIGNANT TUMORS (2011)

You have accessJournal of UrologyKidney Cancer: Evaluation and Staging1 Apr 2011703 ENHANCEMENT CHARACTERISTICS ON 4 PHASE DEDICATED RENAL PROTOCOL CT HELPS TO DISTINGUISH BENIGN FROM MALIGNANT TUMORS Juan Ramos, Bruce Kava, Raymond Leveillee, Murugesan Manoharan, Vincent Bird, and Mark Soloway Juan RamosJuan Ramos Miami, FL More articles by this author , Bruce KavaBruce Kava Miami, FL More articles by this author , Raymond LeveilleeRaymond Leveillee Miami, FL More articles by this author , Murugesan ManoharanMurugesan Manoharan Miami, FL More articles by this author , Vincent BirdVincent Bird Gainesville, FL More articles by this author , and Mark SolowayMark Soloway Miami, FL More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2011.02.1670AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Benign tumors are found in approximately 20% of patients undergoing partial nephrectomy for presumed malignancy. Tumor size, patient age, gender, and smoking history have all been found to independently impact the risk of a tumor being benign or malignant. Whether the contrast enhancement characteristics on 4-phase computerized tomography could provide additional information in determining the benign or malignant nature of a renal tumor was assessed. METHODS Data was abstracted from a prospective, comprehensive database comprised of patients undergoing partial nephrectomy at our center. Only CT scans from patients undergoing 4-phase CT scan without and with iodinated contrast administration using our institutional protocol were evaluated independently by our radiology team and a urologist. Attenuation values were determined from the tumor in all phases of the computerized tomography study and compared between benign and malignant tumors. RESULTS CT scans were reviewed from a total of 91 renal masses in 88 patients. Histopathologically, there were 16 angiomyolipomas, 16 oncocytomas, and 59 renal cell carcinomas. The highest mean enhancement was shown by oncocytoma 83.37 HU (314%), followed by angiomyolipoma 77.25 HU (231%), clear cell RCC 62.60 HU (282%) and papillary RCC 28.65 HU (97%). Mean enhancement for benign tumors was significantly higher than for malignant tumors (45.91 HU benign versus 80.31 HU malignant tumors (p< 0.05). The mean decline in attenuation seen in delayed venous phase images was not different between benign and malignant tumors. Despite subtle differences noted in the dynamic contrast enhancement characteristics between clear cell and papillary renal cell carcinoma, there were no clear cut differences noted that could differentiate the various subtypes of renal cell carcinoma. CONCLUSIONS By preoperatively determining the benign nature of a renal tumor, patients may be spared from the attendant risks associated with surgery, which offers no therapeutic benefit. While age, gender, smoking history, and tumor size may impact the risk of having a benign tumor, additional pretreatment variables are needed in order to enhance the sensitivity of the existing models. In our study, 4-phase contrast enhanced CT scan attenuation of the mass may provide an additional parameter that may assist in determining the need for a preoperative biopsy. Corroboration of our findings in larger prospective cohorts is warranted. © 2011 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 185Issue 4SApril 2011Page: e282-e283 Advertisement Copyright & Permissions© 2011 by American Urological Association Education and Research, Inc.MetricsAuthor Information Juan Ramos Miami, FL More articles by this author Bruce Kava Miami, FL More articles by this author Raymond Leveillee Miami, FL More articles by this author Murugesan Manoharan Miami, FL More articles by this author Vincent Bird Gainesville, FL More articles by this author Mark Soloway Miami, FL More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...