Pathologic and Clinical Outcomes in a Large Surveillance and Intervention Cohort of Radiographically Cystic Renal Masses.

We evaluated oncologic risks in a large cohort of patients with radiographic cystic renal masses who underwent active surveillance (AS) or intervention.

A single institutional database of 4,340 kidney lesions managed with either AS or intervention between 2000-2020 was queried for radiographically cystic renal masses. Association of radiographic tumor characteristics and high-grade (HG) pathology was evaluated.

We identified 387 radiographically confirmed cystic lesions in 367 patients. Of these, 247 were resected (n=240) or ablated (n=7) (n=247, 203 immediate vs 44 delayed intervention (DI)). Pathologically, 23% (n=56) demonstrated HG pathology. Cystic features were explicitly described by pathology in only 18% (n=33) of all lesions and in 7% (n=4) of HG lesions. Of the intervention cohort, African American race, male gender, and Bosniak score were associated with HG pathology (P < .05). On AS (n=184), Bosniak IV lesions demonstrated faster growth rates than IIF and III lesions (2.7 vs 0.6 and 0.5 mm/year, P≤0.001), however growth rates were not associated with HG pathology (P=.5). No difference in CSS was identified when comparing intervention vs AS at 5 years (99% vs 100%, P=.2). No difference in recurrence was observed between immediate intervention vs DI (P>.9).

A disconnect between "cystic" designation on imaging and pathology exists for renal lesions. Over 80% of radiographic Bosniak cystic lesions are not described as "cystic" on pathology reports. More than 1 in 5 resected cystic renal lesions demonstrated with HG disease. Despite this finding, judiciously managed AS ± DI is a safe and effective management option for most radiographic cystic renal masses.

The Journal of urology. 2023 Jan 11 [Epub ahead of print]

Randall A Lee, Robert G Uzzo, Jordan Anaokar, Ashanth Thomas, Shuanzeng Wei, Benjamin T Ristau, Andrew McIntosh, Matthew Lee, David Y T Chen, Richard E Greenberg, Rosalia Viterbo, Marc C Smaldone, Andres Correa, Jared Schober, Kevin Ginsburg, Laura Bukavina, Diana Magee, Phyllis Parkansky, Karen Ruth, Alexander Kutikov

Division of Urologic Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania., Department of Radiology, Fox Chase Cancer Center, Philadelphia, Pennsylvania., Department of Pathology, Fox Chase Cancer Center, Philadelphia, Pennsylvania., Department of Biostatistics, Fox Chase Cancer Center, Philadelphia, Pennsylvania.