Presented by: Andrei Cumpanas MD
Department of Urology, University of California, Irvine,

Introduction

When pre-operative small renal mass (T1a) biopsy is not performed, up to 20% of surgically extracted tissues display benign histological features. However, up to 32% of urologists report that they would never perform a biopsy for T1a renal cortical neoplasms. Thus, we sought to evaluate the potential application of the Re-VASC retroperitoneal neovascularity score as an adjunct or potential replacement for renal biopsy in patients with T1a renal masses (Figure 1).

Materials

Patients who underwent surgical treatment of T1a renal cell carcinoma between 2014 and 2020, had pre-operative CT scans and post-operative pathology reports, were retrospectively included in our study. The population was divided into two-groups: the malignant group (pT1a) and the benign group (angiomyolipomas or oncocytomas). Re-VASC tumor scores were compared and analyzed between the two-groups. A multivariate logistic regression model was run to assess the effect of different covariates on predicting the malignancy of the tumor (age, gender, BMI, tumor size, tumor laterality, Re-VASC score of the tumor-bearing side as well as the contralateral kidney).

Results

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64 benign and 69 malignant T1a renal tumors were included in this study. Tumors in the malignant group had a statistically significantly higher Re-VASC score than the benign group (p<0.001). On the multivariate logistic regression analysis, only the tumor size (OR: 1.686, p=0.0245) and the Re-VASC score of the tumor-bearing kidney (OR: 2.737, p=0.0079) were found to be independent predictors of malignancy.

Conclusion

There is significant difference in the Re-VASC score between benign and malignant T1a renal masses. The Re-VASC score has the potential of being an adjunct or potential replacement of renal biopsy, contributing to the reduction in T1a renal mass over-treatment. Further, larger cohort multi-center studies are needed to validate the neovascularity system’s validity.

Funding

None.

Co-Authors

Cameron Fateri, BS
Department of Radiology, University of California Irvine

Bradley Roth, BS
Department of Radiology, University of California Irvine

Sriram Rao, BS
Department of Radiology, University of California Irvine

Akhil Peta, MD
Department of Urology, University of California Irvine

Luke Limfueco, BS
Department of Urology, University of California Irvine

Thahn-Lan Bui, BS
Department of Radiology, University of California Irvine

Andrei Cumpanas, MD
Department of Urology, University of California Irvine

Nina H. Kar, BS
Burrell College of Osteopathic Medicine, New Mexico State University

Justin Glavis-Bloom, MD
Department of Radiology, University of California Irvine

Jaime Landman, MD
Department of Urology, University of California Irvine

Roozbeh Houshyar, MD
Department of Radiology, University of California Irvine