Imaging Characteristics of Nephrogenic Rests Versus Small Wilms Tumors: A Report From the Children's Oncology Group Study AREN03B2
Autor: | Conrad V. Fernandez, Jeffrey S. Dome, Peter F. Ehrlich, Fredric A. Hoffer, Elizabeth Mullen, Geetika Khanna, Sabah Servaes, Jesse K. Sandberg, Ethan A. Smith, Yueh-Yun Chi, Brett Tornwall, James I. Geller, Elizabeth J. Perlman, Paul E. Grundy |
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Rok vydání: | 2020 |
Předmět: |
Male
Oncology medicine.medical_specialty Kidney Wilms Tumor Article 030218 nuclear medicine & medical imaging Diagnosis Differential Perilobar nephrogenic rest 03 medical and health sciences symbols.namesake 0302 clinical medicine Internal medicine Humans Medicine Radiology Nuclear Medicine and imaging Nephrogenic rest Fisher's exact test Retrospective Studies Group study business.industry Perilobar nephroblastomatosis Infant Wilms' tumor Retrospective cohort study General Medicine medicine.disease Kidney Neoplasms Homogeneous Child Preschool 030220 oncology & carcinogenesis symbols Female business Precancerous Conditions |
Zdroj: | AJR Am J Roentgenol |
ISSN: | 1546-3141 0361-803X |
Popis: | OBJECTIVE. Distinguishing nephrogenic rests from small Wilms tumors can be challenging. This retrospective study was performed to determine if imaging characteristics can be used to distinguish nephrogenic rests from Wilms tumors. MATERIALS AND METHODS. All cases of pathologically confirmed nephrogenic rests and Wilms tumors smaller than 5 cm in maximum dimension on imaging in patients younger than 5 years old were identified from the Children’s Oncology Group AREN03B2 study (July 2006–August 2016). Exclusion criteria were chemotherapy before pathologic evaluation or more than 30 days between imaging and surgery; in addition, patients with nephrogenic rests occurring within or juxtaposed to a Wilms tumor and patients with diffuse hyperplastic perilobar nephroblastomatosis were excluded. Two radiologists who were blinded to pathology results assessed all lesions. The two-sample t test was used for continuous variables, and the Fisher exact test was used for categoric variables. ROC analysis was performed to determine the optimal size cutoff for distinguishing between nephrogenic rests and Wilms tumors. RESULTS. Thirty-one pathologically confirmed rests (20 perilobar, 11 intralobar) and 26 Wilms tumors smaller than 5 cm met the eligibility criteria for study inclusion. The median diameter of the nephrogenic rests was 1.3 cm (range, 0.7–3.4 cm) and the median diameter of the Wilms tumor was 3.2 cm (range, 1.8–4.9 cm) (p < 0.001). Imaging findings supportive of Wilms tumors were spherical (p < 0.001) and exophytic (p < 0.001) lesions. Perilobar rests (17/20) were more likely to be homogeneous than intralobar rests (3/11) or Wilms tumor (3/26) (p < 0.001). ROC analysis showed that the optimal size cutoff for distinguishing between nephrogenic rests and Wilms tumors was 1.75 cm. CONCLUSION. In children younger than 5 years old, the diagnosis of a Wilms tumor should be favored over a nephrogenic rest when a renal mass is spherical, exophytic, or larger than 1.75 cm. Homogeneity favors the diagnosis of perilobar nephrogenic rests, whereas intralobar rests and Wilms tumors are more likely to be inhomogeneous. |
Databáze: | OpenAIRE |
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