Identification and Validation of Radiographic Enhancement for Reliable Differentiation of CD117(+) Benign Renal Oncocytoma and Chromophobe Renal Cell Carcinoma.

Autor:	Amin J; Department of Urology, Roswell Park Cancer Institute, Buffalo, New York., Xu B; Department of Pathology and Laboratory Medicine, Roswell Park Cancer Institute, Buffalo, New York., Badkhshan S; Department of Urology, Roswell Park Cancer Institute, Buffalo, New York., Creighton TT; Department of Urology, Roswell Park Cancer Institute, Buffalo, New York., Abbotoy D; Department of Urology, Roswell Park Cancer Institute, Buffalo, New York., Murekeyisoni C; Department of Urology, Roswell Park Cancer Institute, Buffalo, New York., Attwood KM; Department of Biostatistics and Bioinformatics, Roswell Park Cancer Institute, Buffalo, New York., Schwaab T; Department of Urology, Roswell Park Cancer Institute, Buffalo, New York.; Department of Immunology, Roswell Park Cancer Institute, Buffalo, New York.; Department of Urology, State University of New York at Buffalo, Buffalo, New York., Hendler C; Department of Diagnostic Radiology, Roswell Park Cancer Institute, Buffalo, New York., Petroziello M; Department of Diagnostic Radiology, Roswell Park Cancer Institute, Buffalo, New York., Roche CL; Department of Diagnostic Radiology, Roswell Park Cancer Institute, Buffalo, New York., Kauffman EC; Department of Urology, Roswell Park Cancer Institute, Buffalo, New York. eric.kauffman@roswellpark.org.; Department of Urology, State University of New York at Buffalo, Buffalo, New York.; Department of Cancer Genetics, Roswell Park Cancer Institute, Buffalo, New York.
Jazyk:	angličtina
Zdroj:	Clinical cancer research : an official journal of the American Association for Cancer Research [Clin Cancer Res] 2018 Aug 15; Vol. 24 (16), pp. 3898-3907. Date of Electronic Publication: 2018 May 11.
DOI:	10.1158/1078-0432.CCR-18-0252
Abstrakt:	Purpose: The diagnostic differential for CD117/KIT(+) oncocytic renal tumor biopsies is limited to benign renal oncocytoma versus chromophobe renal cell carcinoma (ChRCC); however, further differentiation is often challenging and requires surgical resection. We investigated clinical variables that might improve preoperative differentiation of CD117(+) renal oncocytoma versus ChRCC to avoid the need for benign tumor resection. Experimental Design: A total of 124 nephrectomy patients from a single institute with 133 renal oncocytoma or ChRCC tumors were studied. Patients from 2003 to 2012 comprised a retrospective cohort to identify clinical/radiographic variables associated with renal oncocytoma versus ChRCC. Prospective validation was performed among consecutive renal oncocytoma/ChRCC tumors resected from 2013 to 2017. Results: Tumor size and younger age were associated with ChRCC, and multifocality with renal oncocytoma; however, the most reliable variable for ChRCC versus renal oncocytoma differentiation was the tumor:cortex peak early-phase enhancement ratio (PEER) using multiphase CT. Among 54 PEER-evaluable tumors in the retrospective cohort [19 CD117(+), 13 CD117(-), 22 CD117-untested], PEER classified each correctly as renal oncocytoma (PEER >0.50) or ChRCC (PEER ≤0.50), except for four misclassified CD117(-) ChRCC variants. Prospective study of PEER confirmed 100% accuracy of renal oncocytoma/ChRCC classification among 22/22 additional CD117(+) tumors. Prospective interobserver reproducibility was excellent for PEER scoring (intraclass correlation coefficient, ICC = 0.97) and perfect for renal oncocytoma/ChRCC assignment (ICC = 1.0). Conclusions: In the largest clinical comparison of renal oncocytoma versus ChRCC to our knowledge, we identified and prospectively validated a reproducible radiographic measure that differentiates CD117(+) renal oncocytoma from ChRCC with potentially 100% accuracy. PEER may allow reliable biopsy-based diagnosis of CD117(+) renal oncocytoma, avoiding the need for diagnostic nephrectomy. Clin Cancer Res; 24(16); 3898-907. ©2018 AACR . (©2018 American Association for Cancer Research.)
Databáze:	MEDLINE
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