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Incidence of benign renal masses in a contemporary cohort of patients receiving partial nephrectomy for presumed renal cell carcinoma

Published:November 17, 2022DOI:https://doi.org/10.1016/j.clgc.2022.11.006

      Take Home Messages

      • Despite the rising use of renal mass biopsy, the incidence of benign renal masses resected for oncologic indications has remained stable
      • Oncocytoma poses the most significant diagnostic challenge in attempting to differentiate RCC from benign masses
      • Smaller tumor size is predictive of finding benign pathology after extirpative surgery

      Abstract

      Purpose

      Over the past decade and a half, advances in diagnostic imaging as well as an increased utilization of active surveillance (AS) and renal mass biopsy (RMB) have led to an improved ability to identify benign lesions prior to partial nephrectomy (PN). We seek to examine the incidence of benign pathology at the time of PN in a contemporary cohort of patients undergoing PN for presumed renal cell carcinoma (RCC).

      Patients and Methods

      We performed a chart review on a prospectively maintained database on a series of patients who underwent PN between January 1st 2006 and December 31st 2021 for solid renal masses concerning for RCC.

      Results

      1229 patients were included in the analysis, with 240 patients (19.2%) identified to have benign disease on final pathology. Of patients with benign disease, (23%) of patients had angiomyolipoma (AML) and 64% had oncocytoma. Between 2006 and 2021, there was a significant increase in the incidence of benign pathology after PN. When examining 3-year rolling averages over this same time period, the incidence of oncocytoma appeared to increase while the incidence of AML decreased.

      Conclusions

      Despite improvements in diagnostic tools and increased utilization of active surveillance, the overall incidence of benign pathology, particularly oncocytoma, did not decrease over time in this contemporary cohort of patients undergoing PN.
      Microabstract: The authors reviewed data on patients at a single institution, ultimately analyzing 1229 patients who underwent extirpative surgery for presumed RCC. They found that 236 (19.2%) patients had benign disease on final pathology. Despite advances in diagnostic technologies, the rate of benign pathology after presumed oncologic renal surgery remains high.

      MeSH Keywords

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      References

        • Hollingsworth John M.
        • et al.
        Rising incidence of small renal masses: a need to reassess treatment effect.
        Journal of the National Cancer Institute. 2006; 98: 1331-1334
        • Jayson Mary
        • Sanders Holt
        Increased incidence of serendipitously discovered renal cell carcinoma.
        Urology. 1998; 51: 203-205
        • Huang William C.
        • et al.
        Partial nephrectomy versus radical nephrectomy in patients with small renal tumors—is there a difference in mortality and cardiovascular outcomes?.
        The Journal of urology. 2009; 181: 55-62
        • Znaor Ariana
        • et al.
        International variations and trends in renal cell carcinoma incidence and mortality.
        European urology. 2015; 67: 519-530
        • Mason Ross J.
        • et al.
        Growth kinetics of renal masses: analysis of a prospective cohort of patients undergoing active surveillance.
        European urology. 2011; 59: 863-867
        • Ristau Benjamin T.
        • et al.
        Active surveillance for small renal masses: when less is more.
        European Urology Focus. 2016; 2: 660-668
        • Patel Nilay
        • et al.
        Active surveillance of small renal masses offers short-term oncological efficacy equivalent to radical and partial nephrectomy.
        BJU international. 2012; 110: 1270-1275
        • Danzig Matthew R.
        • et al.
        Active surveillance is superior to radical nephrectomy and equivalent to partial nephrectomy for preserving renal function in patients with small renal masses: results from the DISSRM registry.
        The Journal of urology. 2015; 194: 903-909
        • Kutikov Alexander
        • et al.
        Incidence of benign pathologic findings at partial nephrectomy for solitary renal mass presumed to be renal cell carcinoma on preoperative imaging.
        Urology. 2006; 68: 737-740
        • Kim Jae Heon
        • et al.
        Association of prevalence of benign pathologic findings after partial nephrectomy with preoperative imaging patterns in the United States from 2007 to 2014.
        JAMA surgery. 2019; 154: 225-231
        • Wilson Mitchell P.
        • et al.
        Diagnostic Performance of MRI in the Detection of Renal Lipid-Poor Angiomyolipomas: A Systematic Review and Meta-Analysis.
        Radiology. 2020; 296: 511-520
        • Choudhary S.
        • et al.
        Renal oncocytoma: CT features cannot reliably distinguish oncocytoma from other renal neoplasms.
        Clinical radiology. 2009; 64: 517-522
        • Rosenkrantz Andrew B.
        • et al.
        MRI features of renal oncocytoma and chromophobe renal cell carcinoma.
        American Journal of Roentgenology. 2010; 195: W421-W427
        • Shannon Beverley A.
        • et al.
        The value of preoperative needle core biopsy for diagnosing benign lesions among small, incidentally detected renal masses.
        The Journal of urology. 2008; 180: 1257-1261
        • Fujii Yasuhisa
        • et al.
        Incidence of benign pathologic lesions at partial nephrectomy for presumed RCC renal masses: Japanese dual-center experience with 176 consecutive patients.
        Urology. 2008; 72: 598-602
        • Bauman Tyler M.
        • et al.
        Partial nephrectomy for presumed renal-cell carcinoma: incidence, predictors, and perioperative outcomes of benign lesions.
        Journal of endourology. 2017; 31: 412-417
        • Jeon Hwang Gyun
        • et al.
        Benign lesions after partial nephrectomy for presumed renal cell carcinoma in masses 4 cm or less: prevalence and predictors in Korean patients.
        Urology. 2010; 76: 574-579
        • Oh Sang Woo
        • Yoon Yeong Sook
        • Shin Soon-Ae
        Effects of excess weight on cancer incidences depending on cancer sites and histologic findings among men: Korea National Health Insurance Corporation Study.
        Journal of Clinical Oncology. 2005; 23: 4742-4754
        • Murphy Alana M.
        • et al.
        Increasing detection rate of benign renal tumors: evaluation of factors predicting for benign tumor histologic features during past two decades.
        Urology. 2009; 73: 1293-1297
        • Snyder Mark E.
        • et al.
        Incidence of benign lesions for clinically localized renal masses smaller than 7 cm in radiological diameter: influence of sex.
        The Journal of urology. 2006; 176: 2391-2396
        • Akdogan Bulent
        • et al.
        Prevalence and predictors of benign lesions in renal masses smaller than 7 cm presumed to be renal cell carcinoma.
        Clinical genitourinary cancer. 2012; 10: 121-125
        • Lim Robert S.
        • et al.
        Renal angiomyolipoma without visible fat: Can we make the diagnosis using CT and MRI?.
        European Radiology. 2018; 28: 542-553
        • Jeong Chae Jin
        • et al.
        Unenhanced CT and MRI parameters that can be used to reliably predict fat-invisible angiomyolipoma.
        American Journal of Roentgenology. 2016; 206: 340-347
        • Yang Ching-Wei
        • et al.
        Are there useful CT features to differentiate renal cell carcinoma from lipid-poor renal angiomyolipoma?.
        American Journal of Roentgenology. 2013; 201: 1017-1028
        • Hafron Jason
        • et al.
        Imaging characteristics of minimal fat renal angiomyolipoma with histologic correlations.
        Urology. 2005; 66: 1155-1159
        • Hajdu Steven I.
        • Foote Frank W.
        Angiomyolipoma of the kidney: report of 27 cases and review of the literature.
        The Journal of urology. 1969; 102: 396-401
        • Remzi Mesut
        • et al.
        Are small renal tumors harmless? Analysis of histopathological features according to tumors 4 cm or less in diameter.
        The Journal of urology. 2006; 176: 896-899
        • Schachter Lee R.
        • et al.
        Second prize: frequency of benign renal cortical tumors and histologic subtypes based on size in a contemporary series: what to tell our patients.
        Journal of endourology. 2007; 21: 819-823
        • DECHET CHRISTOPHER B.
        • et al.
        Renal oncocytoma: multifocality, bilateralism, metachronous tumor development and coexistent renal cell carcinoma.
        The Journal of urology. 1999; 162: 40-42
        • Johnson NB
        • Johnson MM
        • Selig MK
        • Nielsen GP.
        Use of electron microscopy in core biopsy diagnosis of oncocytic renal tumors.
        Ultrastruct Pathol. 2010; l34: 189-194
        • Carvalho PA
        • Chiu ML
        • Kronauge JF.
        Subcellar distribution and analysis of technetium-99m0MIBI in isolated perfused rat hearts.
        J Nuc Med. 1992; 33: 1516-1522
        • Wilson Mitchell P.
        • et al.
        Diagnostic accuracy of 99mTc-sestamibi SPECT/CT for detecting renal oncocytomas and other benign renal lesions: a systematic review and meta-analysis.
        Abdominal Radiology. 2020; 45: 2532-2541
        • Schieda N
        • Al-Subhi M
        • Flood TA
        • El-Khodary M
        • McInnes MD.
        Diagnostic accuracy of segmental enhancement inversion for the diagnosis of renal oncocytoma using biphasic computed tomography (CT) and multiphase contrast-enhanced magnetic resonance imaging (MRI).
        Eur Radiol. 2014; 24: 2787-2794