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Evaluation of a multiparametric renal CT algorithm for diagnosis of clear-cell renal cell carcinoma among small (≤ 4 cm) solid renal masses

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Abstract

Objective

To evaluate a recently proposed CT-based algorithm for diagnosis of clear-cell renal cell carcinoma (ccRCC) among small (≤ 4 cm) solid renal masses diagnosed by renal mass biopsy.

Methods

This retrospective study included 51 small renal masses in 51 patients with renal-mass CT and biopsy between 2014 and 2021. Three radiologists independently evaluated corticomedullary phase CT for the following: heterogeneity and attenuation ratio (mass:renal cortex), which were used to inform the CT score (1–5). CT score ≥ 4 was considered positive for ccRCC. Diagnostic accuracy was calculated for each reader and overall using fixed effects logistic regression modelling.

Results

There were 51% (26/51) ccRCC and 49% (25/51) other masses. For diagnosis of ccRCC, area under curve (AUC), sensitivity, specificity, and positive predictive value (PPV) were 0.69 (95% confidence interval 0.61–0.76), 78% (68–86%), 59% (46–71%), and 67% (54–79%), respectively. CT score ≤ 2 had a negative predictive value 97% (92–99%) to exclude diagnosis of ccRCC. For diagnosis of papillary renal cell carcinoma (pRCC), CT score ≤ 2, AUC, sensitivity, specificity, and PPV were 0.89 (0.81–0.98), 81% (58–94%), 98% (93–99%), and 85% (62–97%), respectively. Pooled inter-observer agreement for CT scoring was moderate (Fleiss weighted kappa = 0.52).

Conclusion

The CT scoring system for prediction of ccRCC was sensitive with a high negative predictive value and moderate agreement. The CT score is highly specific for diagnosis of pRCC.

Clinical relevance statement

The CT score algorithm may help guide renal mass biopsy decisions in clinical practice, with high sensitivity to identify clear-cell tumors for biopsy to establish diagnosis and grade and high specificity to avoid biopsy in papillary tumors.

Key Points

• A CT score ≥ 4 had high sensitivity and negative predictive value for diagnosis of clear-cell renal cell carcinoma (RCC) among solid ≤ 4-cm renal masses.

• A CT score ≤ 2 was highly specific for diagnosis of papillary RCC among solid ≤ 4-cm renal masses.

• Inter-observer agreement for CT score was moderate.

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Abbreviations

AS :

Active surveillance

ccLS :

Clear-cell likelihood score

ccRCC:

Clear-cell renal cell carcinoma

CIs:

Confidence intervals

ISUP:

International Society of Urogenital Pathology

MDCT:

Multi-detector computed tomography

Mp:

Multi-parametric

MRI:

Magnetic resonance imaging

NPV:

Negative predictive value

PPV:

Positive predictive value

pRCC:

Papillary renal cell carcinoma

SD:

Standard deviation

SEI:

Segmental enhancement inversion

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The authors state that this work has not received any funding.

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Authors and Affiliations

  1. Department of Medical Imaging, The Ottawa Hospital, 1053 Carling Avenue, Room C159, Ottawa, ON, K1Y 4E9, Canada

    Fatma Eldihimi, Cynthia Walsh, Rebecca M. Hibbert, Khalid Al Nasibi, Jana Sheinis Pickovsky & Nicola Schieda

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  1. Fatma Eldihimi
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  2. Cynthia Walsh
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  3. Rebecca M. Hibbert
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  4. Khalid Al Nasibi
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  5. Jana Sheinis Pickovsky
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  6. Nicola Schieda
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Corresponding author

Correspondence to Nicola Schieda.

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Guarantor

The scientific guarantor of this publication is Dr Nicola Schieda.

Conflict of interest

The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.

Statistics and biometry

Statistical analysis performed by Dr. Nicola Schieda.

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Written informed consent was waived by the Institutional Review Board.

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Institutional Review Board (Ottawa Hospital Research Ethics Board) approval was obtained.

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• retrospective

• cross-sectional study

• performed at one institution

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Eldihimi, F., Walsh, C., Hibbert, R.M. et al. Evaluation of a multiparametric renal CT algorithm for diagnosis of clear-cell renal cell carcinoma among small (≤ 4 cm) solid renal masses. Eur Radiol 34, 3992–4000 (2024). https://doi.org/10.1007/s00330-023-10434-4

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