Skip to main content

Advertisement

SpringerLink
Log in

Small (<4 cm) clear cell renal cell carcinoma: correlation between CT findings and histologic grade

  • Published:
Abdominal Radiology Aims and scope Submit manuscript

Abstract

Purpose

To evaluate the correlation between CT findings and histologic grade of small clear cell renal cell carcinoma (ccRCC).

Methods

CT scans of 101 patients with small ccRCC were reviewed independently by two radiologists for tumor size, shape, margin, encapsulation, enhancement pattern, and visual relative enhancement. Enhancement patterns were defined according to the percentage of uniform enhancement [pattern 1, homogeneous (≥90%); pattern 2, relatively homogeneous (≥75 and <90%); and pattern 3, heterogeneous (<75%)]. Quantitative parameters representing attenuation and degree of enhancement were calculated. Histologic grade was classified as low (Fuhrman grade I or II) and high (Fuhrman grade III or IV). CT imaging variables were analyzed using univariate and multivariate analyses.

Results

A total of 63 low-grade and 38 high-grade small ccRCCs were assessed. Low-grade tumors differed from high-grade tumors with respect to enhancement pattern 1 or 2 (p < 0.001 and p < 0.001), smaller size (p = 0.002 and p = 0.001), and lower attenuation on unenhanced scan (p < 0.001 and p = 0.008). In multivariate analysis, enhancement pattern 1 or 2 and low attenuation (≤30 HU) were identified as independent predictors of low-grade ccRCC. Accuracy derived from logistic regression analysis was 79.2% for reader 1 and 70.3% for reader 2.

Conclusions

CT imaging features including tumor attenuation and enhancement pattern can be useful to predict the biologic behavior of small ccRCC for adequate treatment strategy.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6

Similar content being viewed by others

References

  1. Ljungberg B, Bensalah K, Canfield S, et al. (2015) EAU guidelines on renal cell carcinoma: 2014 update. Eur Urol 67:913–924

    Article  PubMed  Google Scholar 

  2. Rendon RA, Jewett MA (2006) Expectant management for the treatment of small renal masses. Urol Oncol 24:62–67

    Article  PubMed  Google Scholar 

  3. Pahernik S, Ziegler S, Roos F, Melchior SW, Thüroff JW (2007) Small renal tumors: correlation of clinical and pathological features with tumor size. J Urol 178:414–417

    Article  PubMed  Google Scholar 

  4. Donat SM, Diaz M, Bishoff JT, et al. (2013) Follow-up for clinically localized renal neoplasms: AUA guideline. J Urol 190:407–416

    Article  PubMed  Google Scholar 

  5. Silverman SG, Israel GM, Trinh QD (2015) Incompletely characterized incidental renal masses: emerging data support conservative management. Radiology 275:28–42

    Article  PubMed  Google Scholar 

  6. Thompson RH, Hill JR, Babayev Y, et al. (2009) Metastatic renal cell carcinoma risk according to tumor size. J Urol 182:41–45

    Article  PubMed  PubMed Central  Google Scholar 

  7. Fuhrman SA, Lasky LC, Limas C (1982) Prognostic significance of morphologic parameters in renal cell carcinoma. Am J Surg Pathol 6:655–663

    Article  CAS  PubMed  Google Scholar 

  8. Ficarra V, Righetti R, Martignoni G, et al. (2001) Prognostic value of renal cell carcinoma nuclear grading: multivariate analysis of 333 cases. Urol Int 67:130–134

    Article  CAS  PubMed  Google Scholar 

  9. Volpe A, Mattar K, Finelli A, et al. (2008) Contemporary results of percutaneous biopsy of 100 small renal masses: a single center experience. J Urol 180:2333–2337

    Article  PubMed  Google Scholar 

  10. Leveridge MJ, Finelli A, Kachura JR, et al. (2011) Outcomes of small renal mass needle core biopsy, nondiagnostic percutaneous biopsy, and the role of repeat biopsy. Eur Urol 60:578–584

    Article  PubMed  Google Scholar 

  11. Harris CR, Whitson JM, Meng MV (2012) Under-grading of <4 cm renal masses on renal biopsy. BJU Int 110:794–797

    Article  PubMed  Google Scholar 

  12. Villalobos-Gollás M, Aguilar-Davidov B, Culebro-García C, et al. (2012) Pathological implications of areas of lower enhancement on contrast-enhanced computed tomography in renal-cell carcinoma: additional information for selecting candidates for surveillance protocols. Int Urol Nephrol 44:1369–1374

    Article  PubMed  Google Scholar 

  13. Vargas HA, Delaney HG, Delappe EM, et al. (2013) Multiphasic contrast-enhanced MRI: single-slice versus volumetric quantification of tumor enhancement for the assessment of renal clear-cell carcinoma fuhrman grade. J Magn Reson Imaging 37:1160–1167

    Article  PubMed  PubMed Central  Google Scholar 

  14. Kwon YK, Kim BH, Park CH, Kim CI, Chang HS (2009) Effectiveness of computed tomography for predicting the nuclear grade of renal cell carcinoma. Korean J Urol 50:942–946

    Article  Google Scholar 

  15. Ishigami K, Leite LV, Pakalniskis MG, et al. (2014) Tumor grade of clear cell renal cell carcinoma assessed by contrast-enhanced computed tomography. SpringerPlus . doi:10.1186/2193-1801-3-694

    PubMed  PubMed Central  Google Scholar 

  16. Zhu YH, Wang X, Zhang J, et al. (2014) Low enhancement on multiphase contrast-enhanced CT images: an independent predictor of the presence of high tumor grade of clear cell renal cell carcinoma. AJR Am J Roentgenol 203:W295–W300

    Article  PubMed  Google Scholar 

  17. Young JR, Margolis D, Sauk S, et al. (2013) Clear cell renal cell carcinoma: discrimination from other renal cell carcinoma subtypes and oncocytoma at multiphasic multidetector CT. Radiology 267:444–453

    Article  PubMed  Google Scholar 

  18. Halverson SJ, Kunju LP, Bhalla R, et al. (2013) Accuracy of determining small renal mass management with risk stratified biopsies: confirmation by final pathology. J Urol 189:441–446

    Article  PubMed  Google Scholar 

  19. Lebret T, Poulain JE, Molinie V, et al. (2007) Percutaneous core biopsy for renal masses: indications, accuracy and results. J Urol 178:1184–1188

    Article  PubMed  Google Scholar 

  20. Laguna MP, Kümmerlin I, Rioja J, de la Rosette JJ (2009) Biopsy of a renal mass: where are we now? Curr Opin Urol 19:447–453

    Article  PubMed  Google Scholar 

  21. Pablo C, Marcela G, Lía EA, María IA (2012) Correlation between MVD and two prognostic factors: Fuhrman grade and tumoral size, in clear cell renal cell carcinoma. J Cancer Sci Ther 4:313–316

    Article  Google Scholar 

  22. Wang JH, Min PQ, Wang PJ, et al. (2006) Dynamic CT evaluation of tumor vascularity in renal cell carcinoma. AJR Am J Roentgenol 186:1423–1430

    Article  PubMed  Google Scholar 

  23. Jinzaki M, Tanimoto A, Mukai M, et al. (2000) Double-phase helical CT of small renal parenchymal neoplasms: correlation with pathologic findings and tumor angiogenesis. J Comput Assist Tomogr 24:835–842

    Article  CAS  PubMed  Google Scholar 

  24. Birnbaum BA, Bosniak MA, Krinsky GA, et al. (1994) Renal cell carcinoma: correlation of CT findings with nuclear morphologic grading in 100 tumors. Abdom Imaging 19:262–266

    Article  CAS  PubMed  Google Scholar 

  25. Birnbaum BA, Bosniak MA, Megibow AJ, Lubat E, Gordon RB (1990) Observations on the growth of renal neoplasms. Radiology 176:695–701

    Article  CAS  PubMed  Google Scholar 

  26. Yu M, Wang H, Zhao J, et al. (2013) Expression of CIDE proteins in clear cell renal cell carcinoma and their prognostic significance. Mol Cell Biochem 378:145–151

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  27. Thoenes W, Störkel S, Rumpelt H (1986) Histopathology and classification of renal cell tumors (adenomas, oncocytomas and carcinomas). The basic cytological and histopathological elements and their use for diagnostics. Pathol Res Pract 181:125–143

    Article  CAS  PubMed  Google Scholar 

  28. Yao M, Tabuchi H, Nagashima Y, et al. (2005) Gene expression analysis of renal carcinoma: adipose differentiation-related protein as a potential diagnostic and prognostic biomarker for clear-cell renal carcinoma. J Pathol 205:377–387

    Article  CAS  PubMed  Google Scholar 

  29. Yao M, Huang Y, Shioi K, et al. (2007) Expression of adipose differentiation-related protein: a predictor of cancer-specific survival in clear cell renal carcinoma. Clin Cancer Res 13:152–160

    Article  CAS  PubMed  Google Scholar 

  30. Hsu RM, Chan DY, Siegelman SS (2004) Small renal cell carcinomas: correlation of size with tumor stage, nuclear grade, and histologic subtype. AJR Am J Roentgenol 182:551–557

    Article  PubMed  Google Scholar 

  31. Duffey BG, Choyke PL, Glenn G, et al. (2004) The relationship between renal tumor size and metastases in patients with von Hippel-Lindau disease. J Urol 172:63–65

    Article  PubMed  Google Scholar 

  32. Ro JY, Ayala AG, Sella A, Samuels ML, Swanson DA (1987) Sarcomatoid renal cell carcinoma: clinicopathologic. A study of 42 cases. Cancer 59:516–526

    Article  CAS  PubMed  Google Scholar 

  33. Jeldres C, Sun M, Liberman D, et al. (2009) Can renal mass biopsy assessment of tumor grade be safely substituted for by a predictive model? J Urol 182:2585–2589

    Article  PubMed  Google Scholar 

  34. Al-Aynati M, Chen V, Salama S, et al. (2003) Interobserver and intraobserver variability using the Fuhrman grading system for renal cell carcinoma. Arch Patholol Lab Med 127:593–596

    Google Scholar 

Download references

Acknowledgments

This study was financially supported and funded by a research grant (Grant Number I1404131) from Dongkook Pharmaceutical (Seoul, Korea). The authors were not employees of the company and had full control over the data and information submitted for publication.

Author information

Authors and Affiliations

  1. Department of Radiology, Anam Hospital, Korea University College of Medicine, Seoul, South Korea

    Soo Yeon Choi, Deuk Jae Sung, Ki Choon Sim, Na Yeon Han, Beom Jin Park, Min Ju Kim & Sung Bum Cho

  2. Department of Biostatistics, Korea University College of Medicine, Seoul, South Korea

    Kyung Sook Yang

  3. Department of Radiology, Guro Hospital, Korea University College of Medicine, Seoul, South Korea

    Kyeong Ah Kim

  4. Department of Radiology, Ansan Hospital, Korea University College of Medicine, Seoul, South Korea

    Suk Keu Yeom

  5. Department of Pathology, Anam Hospital, Korea University College of Medicine, Seoul, South Korea

    Jeong Hyeon Lee

Authors
  1. Soo Yeon Choi
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Deuk Jae Sung
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Kyung Sook Yang
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Kyeong Ah Kim
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Suk Keu Yeom
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Ki Choon Sim
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Na Yeon Han
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Beom Jin Park
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Min Ju Kim
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Sung Bum Cho
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Jeong Hyeon Lee
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Deuk Jae Sung.

Ethics declarations

Conflict of Interest

Author Deuk Jae Sung has received a research grant from Dongkook Pharmaceutical. The authors were not employees of the company and had full control of the data and information submitted for publication. All authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Written informed consent was waived by the institutional review board.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Choi, S.Y., Sung, D.J., Yang, K.S. et al. Small (<4 cm) clear cell renal cell carcinoma: correlation between CT findings and histologic grade. Abdom Radiol 41, 1160–1169 (2016). https://doi.org/10.1007/s00261-016-0732-9

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00261-016-0732-9

Keywords

Search

Navigation