Avoidable Benign Kidney Tumor Resections—Data from a Tertiary Care Cancer Institute
Main Article Content
Keywords
benign kidney tumor, kidney cancer, nephrectomy, overtreatment, renal tumor
Abstract
Enhancing renal masses are conventionally treated as malignant unless proven otherwise due to the difficulty distinguishing between malignant and benign tumors based on imaging. Data from the Western registries suggests overtreatment of renal tumors with a Benign Kidney Tumor Resection Rate (BKTRR) ranging from 10 to 33%, with an increasing trend. Since robust, population-based data from India was unavailable, we sought to determine BKTRR in an apex cancer institute, which would provide insight into the rates in the community. The institutional kidney tumor database was queried for all patients aged ≥18 years with renal neoplasms between January 2000 and December 2022. Patients who underwent surgery, either radical or partial nephrectomy, with intent to cure were analyzed and the BKTRR during the study period was evaluated. A total of 330 patients underwent surgery for renal tumors presumed to be malignant. A final pathologic diagnosis of the benign tumor was made in 16 (4.8%) patients, comprising 7.2, 7.2, and 3.7% of resections with LTD ≤4, 4–7, and >7 cm, respectively. Asymptomatic benign tumors ≤7 cm comprised 3.0% of all resections, and these were potentially unnecessary surgeries. A multivariable analysis suggested that no patient or imaging characteristic could predict a final benign extirpative pathology. Our study suggests a lower rate of BKTRR compared to the published international literature but is likely to be the lower limit of that in the community. Population-based studies are required to determine the true BKTRR and the quantum of potentially unnecessary surgeries for benign kidney tumors.
References
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20. Kava BR, Eldefrawy A, Ayyathurai R, Manoharan M, Aziz M, Bird VG, et al. Impact of body mass index and tumor location on the incidence of benign histology at the time of nephron-sparing surgery. Int Urol Nephrol. 2012;44(5):1319–24. 10.1007/s11255-012-0207-z
21. Zisman A, Patard JJ, Raz O, Klatte T, Haifler M, Mendlovic S, et al. Sex, age, and surgeon decision on nephron-sparing surgery are independent predictors of renal masses with benign histologic findings—A multicenter survey. Urology. 2010;76(3): 541–6. 10.1016/j.urology.2010.01.089
22. Lane BR, Babineau D, Kattan MW, Novick AC, Gill IS, Zhou M, et al. A preoperative prognostic nomogram for solid enhancing renal tumors 7 cm or less amenable to partial nephrectomy. J Urol. 2007;178(2):429–34. 10.1016/j.juro.2007.03.106
23. Bauman TM, Potretzke AM, Wright AJ, Knight BA, Vetter JM, Figenshau RS. Partial nephrectomy for presumed renal-cell carcinoma: Incidence, predictors, and perioperative outcomes of benign lesions. J Endourol. 2017;31(4):412–7. 10.1089/end.2016.0667
24. Lane BR, Samplaski MK, Herts BR, Zhou M, Novick AC, Campbell SC. Renal mass biopsy—A renaissance? J Urol. 2008;179(1):20–7. 10.1016/j.juro.2007.08.124
25. Renshaw AA, Powell A, Caso J, Gould EW. Needle track seeding in renal mass biopsies. Cancer Cytopathol. 2019;127(6): 358–61. 10.1002/cncy.22147
26. Dechet CB, Zincke H, Sebo TJ, King BF, LeRoy AJ, Farrow GM, et al. Prospective analysis of computerized tomography and needle biopsy with permanent sectioning to determine the nature of solid renal masses in adults. J Urol. 2003;169(1):71–4. 10.1016/S0022-5347(05)64038-4
27. Patel HD, Johnson MH, Pierorazio PM, Sozio SM, Sharma R, Iyoha E, et al. Diagnostic accuracy and risks of biopsy in the diagnosis of a renal mass suspicious for localized renal cell carcinoma: Systematic review of the literature. J Urol. 2016;195(5):1340–7. 10.1016/j.juro.2015.11.029
28. Patel RM, Safiullah S, Okhunov Z, Meller D, Osann K, Kaler K, et al. Pretreatment diagnosis of the small renal mass: Status of renal biopsy in the United States of America. J Endourol. 2018;32(9):884–90. 10.1089/end.2018.0175
29. Simpfendorfer C, Herts BR, Motta-Ramirez GA, Lockwood DS, Zhou M, Leiber M, et al. Angiomyolipoma with minimal fat on MDCT: Can counts of negative-attenuation pixels aid diagnosis? AJR Am J Roentgenol. 2009;192(2):438–43. 10.2214/AJR.08.1180
30. Park BK. Renal angiomyolipoma based on new classification: How to differentiate it from renal cell carcinoma. AJR Am J Roentgenol. 2019;212(3):582–8. 10.2214/AJR.18.20408
31. Wilson MP, Patel D, Murad MH, McInnes MDF, Katlariwala P, Low G. Diagnostic performance of MRI in the detection of renal lipid-poor angiomyolipomas: A systematic review and meta-analysis. Radiology. 2020;296(3):511–20. 10.1148/radiol.2020192070
32. Gorin MA, Rowe SP, Baras AS, Solnes LB, Ball MW, Pierorazio PM, et al. Prospective evaluation of (99m)Tc-sestamibi SPECT/CT for the diagnosis of renal oncocytomas and hybrid oncocytic/chromophobe tumors. Eur Urol. 2016;69(3):413–6. 10.1016/j.eururo.2015.08.056
33. Nassiri N, Maas M, Cacciamani G, Varghese B, Hwang D, Lei X, et al. A Radiomic-based machine learning algorithm to reliably differentiate benign renal masses from renal cell carcinoma. Eur Urol Focus. 2022;8(4):988–94. 10.1016/j.euf.2021.09.004
34. Menon AR, Hussein AA, Attwood KM, White T, James G, Xu B, et al. Active surveillance for risk stratification of all small renal masses lacking predefined clinical criteria for intervention. J Urol. 2021;206(2):229–39. 10.1097/JU.0000000000001714
35. Menon A, Aly A, White T, James G, May P, Kauffman E. Prevention of benign kidney tumor resection using a combination of routine biopsy and tumor: Cortex PEER evaluation. J Urol. 2019;201(Supplement 4):e188. 10.1097/01.JU.0000555302.69849.d1
2. Johnson DC, Vukina J, Smith AB, Meyer AM, Wheeler SB, Kuo TM, et al. Preoperatively misclassified, surgically removed benign renal masses: A systematic review of surgical series and United States population level burden estimate. J Urol. 2015;193(1):30–5. 10.1016/j.juro.2014.07.102
3. Patel HD, Semerjian A, Gupta M, Pavlovich CP, Johnson MH, Gorin MA, et al. Surgical removal of renal tumors with low metastatic potential based on clinical radiographic size: A systematic review of the literature. Urol Oncol. 2019;37(8):519–24. 10.1016/j.urolonc.2019.05.013
4. Corcoran AT, Russo P, Lowrance WT, Asnis-Alibozek A, Libertino JA, Pryma DA, et al. A review of contemporary data on surgically resected renal masses—Benign or malignant? Urology. 2013;81(4):707–13. 10.1016/j.urology.2013.01.009
5. Nandanan N, Veccia A, Antonelli A, Derweesh I, Mottrie A, Minervini A, et al. Outcomes and predictors of benign histology in patients undergoing robotic partial or radical nephrectomy for renal masses: A multicenter study. Cent European J Urol. 2020;73(1):33–8. 10.5173/ceju.2020.0019
6. Shah PH, Alom MA, Leibovich BC, Thompson RH, Uzzo RG, Kavoussi LR, et al. The temporal association of robotic surgical diffusion with overtreatment of the small renal mass. J Urol. 2018;200(5):981–8. 10.1016/j.juro.2018.05.081
7. Sohlberg EM, Metzner TJ, Leppert JT. The harms of overdiagnosis and overtreatment in patients with small renal masses: A mini review. Eur Urol Focus. 2019;5(6):943–5. 10.1016/j.euf.2019.03.006
8. Nguyen KA, Brito J, Hsiang W, Nolte A, Syed JS, Suarez-Sarmiento A, et al. National trends and economic impact of surgical treatment for benign kidney tumors. Urol Oncol. 2019;37(3):183.e9–e15. 10.1016/j.urolonc.2018.11.019
9. Joshi A, Anand A, Prabhash K, Noronha V, Shrirangwar S, Bakshi G, et al. Kidney cancer demographics and outcome data from 2013 at a tertiary cancer hospital in India. Indian J Cancer. 2017;54(4):601–4. 10.4103/ijc.IJC_644_17
10. Moch H, Cubilla AL, Humphrey PA, Reuter VE, Ulbright TM. The 2016 WHO classification of tumours of the urinary system and male genital organs-Part A: Renal, penile, and testicular tumours. Eur Urol. 2016;70(1):93–105. 10.1016/j.eururo.2016.02.029
11. Amin MB, editor. AJCC cancer staging manual. Eighth edition/American Joint Committee on Cancer. New York, NY: Springer; 2017.
12. Soga N, Nishikawa K, Takaki H, Yamada Y, Arima K, Hayashi N, et al. Low incidence of benign lesions in resected suspicious renal masses greater than 2 cm: Single-center experience from Japan. Int J Urol. 2012;19(8):729–34. 10.1111/j.1442-2042.2012.03030.x
13. Park SY, Jeon SS, Lee SY, Jeong BC, Seo SI, Lee HM, et al. Incidence and predictive factors of benign renal lesions in Korean patients with preoperative imaging diagnoses of renal cell carcinoma. J Korean Med Sci. 2011;26(3):360–4. 10.3346/jkms.2011.26.3.360
14. Xiong YH, Zhang ZL, Li YH, Liu ZW, Hou GL, Liu Q, et al. Benign pathological findings in 303 Chinese patients undergoing surgery for presumed localized renal cell carcinoma. Int J Urol. 2010;17(6):517–21. 10.1111/j.1442-2042.2010.02525.x
15. Lowrance WT, Yee DS, Savage C, Cronin AM, O’Brien MF, Donat SM, et al. Complications after radical and partial nephrectomy as a function of age. J Urol. 2010;183(5):1725–30. 10.1016/j.juro.2009.12.101
16. Mari A, Campi R, Schiavina R, Amparore D, Antonelli A, Artibani W, et al. Nomogram for predicting the likelihood of postoperative surgical complications in patients treated with partial nephrectomy: A prospective multicentre observational study (the RECORd 2 project). BJU Int. 2019;124(1):93–102. 10.1111/bju.14680
17. Fernando A, Fowler S, Van Hemelrijck M, O’Brien T. Who is at risk of death from nephrectomy? An analysis of thirty-day mortality after 21 380 nephrectomies in 3 years of the British Association of Urological Surgeons (BAUS) National Nephrectomy Audit. BJU Int. 2017;120(3):358–64. 10.1111/bju.13842
18. Weight CJ, Larson BT, Fergany AF, Gao T, Lane BR, Campbell SC, et al. Nephrectomy induced chronic renal insufficiency is associated with increased risk of cardiovascular death and death from any cause in patients with localized cT1b renal masses. J Urol. 2010;183(4):1317–23. 10.1016/j.juro.2009.12.030
19. Pierorazio PM, Patel HD, Johnson MH, Sozio SM, Sharma R, Iyoha E, et al. Distinguishing malignant and benign renal masses with composite models and nomograms: A systematic review and meta-analysis of clinically localized renal masses suspicious for malignancy. Cancer. 2016;122(21):3267–76. 10.1002/cncr.30268
20. Kava BR, Eldefrawy A, Ayyathurai R, Manoharan M, Aziz M, Bird VG, et al. Impact of body mass index and tumor location on the incidence of benign histology at the time of nephron-sparing surgery. Int Urol Nephrol. 2012;44(5):1319–24. 10.1007/s11255-012-0207-z
21. Zisman A, Patard JJ, Raz O, Klatte T, Haifler M, Mendlovic S, et al. Sex, age, and surgeon decision on nephron-sparing surgery are independent predictors of renal masses with benign histologic findings—A multicenter survey. Urology. 2010;76(3): 541–6. 10.1016/j.urology.2010.01.089
22. Lane BR, Babineau D, Kattan MW, Novick AC, Gill IS, Zhou M, et al. A preoperative prognostic nomogram for solid enhancing renal tumors 7 cm or less amenable to partial nephrectomy. J Urol. 2007;178(2):429–34. 10.1016/j.juro.2007.03.106
23. Bauman TM, Potretzke AM, Wright AJ, Knight BA, Vetter JM, Figenshau RS. Partial nephrectomy for presumed renal-cell carcinoma: Incidence, predictors, and perioperative outcomes of benign lesions. J Endourol. 2017;31(4):412–7. 10.1089/end.2016.0667
24. Lane BR, Samplaski MK, Herts BR, Zhou M, Novick AC, Campbell SC. Renal mass biopsy—A renaissance? J Urol. 2008;179(1):20–7. 10.1016/j.juro.2007.08.124
25. Renshaw AA, Powell A, Caso J, Gould EW. Needle track seeding in renal mass biopsies. Cancer Cytopathol. 2019;127(6): 358–61. 10.1002/cncy.22147
26. Dechet CB, Zincke H, Sebo TJ, King BF, LeRoy AJ, Farrow GM, et al. Prospective analysis of computerized tomography and needle biopsy with permanent sectioning to determine the nature of solid renal masses in adults. J Urol. 2003;169(1):71–4. 10.1016/S0022-5347(05)64038-4
27. Patel HD, Johnson MH, Pierorazio PM, Sozio SM, Sharma R, Iyoha E, et al. Diagnostic accuracy and risks of biopsy in the diagnosis of a renal mass suspicious for localized renal cell carcinoma: Systematic review of the literature. J Urol. 2016;195(5):1340–7. 10.1016/j.juro.2015.11.029
28. Patel RM, Safiullah S, Okhunov Z, Meller D, Osann K, Kaler K, et al. Pretreatment diagnosis of the small renal mass: Status of renal biopsy in the United States of America. J Endourol. 2018;32(9):884–90. 10.1089/end.2018.0175
29. Simpfendorfer C, Herts BR, Motta-Ramirez GA, Lockwood DS, Zhou M, Leiber M, et al. Angiomyolipoma with minimal fat on MDCT: Can counts of negative-attenuation pixels aid diagnosis? AJR Am J Roentgenol. 2009;192(2):438–43. 10.2214/AJR.08.1180
30. Park BK. Renal angiomyolipoma based on new classification: How to differentiate it from renal cell carcinoma. AJR Am J Roentgenol. 2019;212(3):582–8. 10.2214/AJR.18.20408
31. Wilson MP, Patel D, Murad MH, McInnes MDF, Katlariwala P, Low G. Diagnostic performance of MRI in the detection of renal lipid-poor angiomyolipomas: A systematic review and meta-analysis. Radiology. 2020;296(3):511–20. 10.1148/radiol.2020192070
32. Gorin MA, Rowe SP, Baras AS, Solnes LB, Ball MW, Pierorazio PM, et al. Prospective evaluation of (99m)Tc-sestamibi SPECT/CT for the diagnosis of renal oncocytomas and hybrid oncocytic/chromophobe tumors. Eur Urol. 2016;69(3):413–6. 10.1016/j.eururo.2015.08.056
33. Nassiri N, Maas M, Cacciamani G, Varghese B, Hwang D, Lei X, et al. A Radiomic-based machine learning algorithm to reliably differentiate benign renal masses from renal cell carcinoma. Eur Urol Focus. 2022;8(4):988–94. 10.1016/j.euf.2021.09.004
34. Menon AR, Hussein AA, Attwood KM, White T, James G, Xu B, et al. Active surveillance for risk stratification of all small renal masses lacking predefined clinical criteria for intervention. J Urol. 2021;206(2):229–39. 10.1097/JU.0000000000001714
35. Menon A, Aly A, White T, James G, May P, Kauffman E. Prevention of benign kidney tumor resection using a combination of routine biopsy and tumor: Cortex PEER evaluation. J Urol. 2019;201(Supplement 4):e188. 10.1097/01.JU.0000555302.69849.d1
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Oct 1, 2024
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Avoidable Benign Kidney Tumor Resections—Data from a Tertiary Care Cancer Institute. (2024). Journal of Kidney Cancer, 11(4), 1-9. https://doi.org/10.15586/jkcvhl.v11i4.286
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Kidney Cancer: Original Articles
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How to Cite
Avoidable Benign Kidney Tumor Resections—Data from a Tertiary Care Cancer Institute. (2024). Journal of Kidney Cancer, 11(4), 1-9. https://doi.org/10.15586/jkcvhl.v11i4.286