Preoperative prediction of benign vs. malignant small renal masses (SRMs) remains a challenge. This study 1) validates our classification tree (CT) with an external cohort; 2) creates a new CT with the combined cohort; and 3) evaluates the R. E.N.A.L. and PADUA scoring systems for prediction of malignancy.
This study includes 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. Our CT is based on four parameters: tumour volume, symptoms, gender, and symptomatology. CART modelling was also used to determine if R.E.N.A.L and PADUA scoring could predict malignancy.
When externally validated with the surgical resection cohort, the predictive accuracy of the original CT dropped. However, by combining the cohorts, the predictive accuracy increased from 74% to 87% (95% confidence interval [CI] 0.84-0.89). R.E.N.A.L. and PADUA score alone were not predictive of malignancy. One limitation was the lack of available histological data from the biopsy series.
The validated CT and combined cohort CT tree have a predictive value greater than currently published nomograms and single biopsy cohorts. Overall R.E.N.A.L. and PADUA scores were not able to predict malignancy.
Canadian Urological Association journal = Journal de l'Association des urologues du Canada. 2018 Jul 24 [Epub ahead of print]
Michael Organ, Landan P Macdonald, Michael A S Jewett, Henry Ajzenberg, Ashraf Almatar, Mohamed Abdolell, Matthew R Acker, Ricardo Rendon
Department of Urology, Memorial University, St. John's, NL, Canada., School of Medicine, Dalhousie University, Saint John, NB, Canada., Departments of Surgery (Urology) and Surgical Oncology, Princess Margaret Cancer Centre, University Health Network and University of Toronto, Toronto, ON, Canada., School of Medicine, Queen's University, Kingston, ON, Canada., Department of Urology, King Fahad Specialist Hospital-Dammam, Dammam, Saudi Arabia., Department of Diagnostic Radiology, Dalhousie University, Halifax, NS, Canada., Department of Urology, Dalhousie University, Saint John, NB, Canada., Department of Urology, Dalhousie University, Halifax, NS, Canada.