Change in Nephrometry Scoring in Small Renal Masses (<4 cm) on Active Surveillance: Preliminary Observations From Tayside Active Surveillance Cohort (TASC) Study.

Prediction of growth, in particular knowing the possibility of aggressive cancer in small renal masses on active surveillance, remains poorly understood. The study was designed to determine whether serial nephrometry score measurements could predict possibility of aggressive malignancy (grade of cancer) in patients with small renal masses opting for active surveillance initially.

One hundred sixteen patients between January 2000 and December 2016 undergoing partial nephrectomy were recruited. Out of these, 97 were analyzed using different nephrometry scoring systems. Measurement of nephrometry scores (Radius of tumors, Exo/Endophytic; Nearness of tumors to the collecting system or sinus; Anterior/posterior; Location in relation to polar lines, Preoperative Aspects and Dimensions Used for Anatomical, Centrality Index) was performed by two researchers. Among the patients opting for partial nephrectomy, 40 were on active surveillance for at least 12 months (mean 32; 12-60 months) before partial nephrectomy. Computed tomography scan images of these patients were retrieved and analyzed including comparison to histopathology.

Nephrometry scores measured on serial computed tomography scan images showed a significant correlation between change in score and grade of cancer on multivariate analysis (P value .001). Addition of multivariate analysis to nomogram based on change in size alone did not improve predictive value of area under the curve significantly.

Change in nephrometry scoring measurements correlates with grade of cancer in small renal masses but falls short of significantly predicting presence of malignancy or grade of cancer on nomogram in patients opting for active surveillance for small renal masses. At present, this approach may be inadequate for decision-making.

Academic radiology. 2018 Mar 06 [Epub ahead of print]

Khan H Mohammed, Zhang Wanzhe, Paterson Catherine, Szewczyk-Bieda Magda, Stephen Lang, Nabi Ghulam

Academic Section of Urology, School of Medicine, Ninewells Hospital, Dundee, UK; Department of Urology, Airedale General Hospital, NHS Trust, UK., Academic Section of Urology, School of Medicine, Ninewells Hospital, Dundee, UK., Academic Section of Urology, School of Medicine, Ninewells Hospital, Dundee, UK; Robert Gordon University, School of Nursing and Midwifery, Garthdee, Aberdeen, AB10 7QG., Academic Section of Urology, School of Medicine, Ninewells Hospital, Dundee, UK. Electronic address: .

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