J Korean Med Sci.  2011 Mar;26(3):360-364. 10.3346/jkms.2011.26.3.360.

Incidence and Predictive Factors of Benign Renal Lesions in Korean Patients with Preoperative Imaging Diagnoses of Renal Cell Carcinoma

• Park SY
• Jeon SS
• Lee SY
• Jeong BC
• Seo SI
• Lee HM
• Choi HY

• KMID: 2157872
• DOI: http://doi.org/10.3346/jkms.2011.26.3.360

Abstract

The present study was performed to determine the incidence and predictive factors of benign renal lesions in Korean patients undergoing nephrectomy for presumed renal cell carcinoma on preoperative imaging. We analyzed the pathologic reports and medical records of 1,598 eligible patients with unilateral, nonmetastatic, and nonfamilial renal masses. Of the 1,598 renal masses, 114 (7.1%) were benign lesions, including angiomyolipoma in 47 (2.9%), oncocytoma in 23 (1.4%), and complicated cysts in 18 (1.1%) patients. On univariate analysis, the proportion of benign lesions was significantly higher in female patients, and in patients with smaller tumors, cystic renal masses, and without gross hematuria as a presenting symptom. When renal lesions were stratified by tumor size, the proportion of benign as opposed to malignant lesions decreased significantly as tumor size increased. On multivariate analysis, female gender, smaller tumor size, and cystic lesions were significantly associated with benign histological features. The findings in this large cohort of Korean patients show a lower incidence (7.1%) of benign renal lesions than those of previous Western reports. Female gender, cystic renal lesions, and smaller tumor size are independent predictors of benign histological features.

Keyword

Kidney Neoplasms; Pathology; Carcinoma, Renal Cell; Incidence; Benign

MeSH Terms

Adolescent
Adult
Aged
Aged, 80 and over
Angiomyolipoma/diagnosis/epidemiology/surgery
Carcinoma, Renal Cell/*diagnosis/epidemiology/surgery
Child
Cohort Studies
Cysts/diagnosis/epidemiology/surgery
Diagnostic Imaging
Female
Hematuria
Humans
Kidney Neoplasms/*diagnosis/epidemiology/surgery
Male
Middle Aged
Nephrectomy
Republic of Korea
Retrospective Studies

Reference

1. Hollingsworth JM, Miller DC, Daignault S, Hollenbeck BK. Rising incidence of small renal masses: a need to reassess treatment effect. J Natl Cancer Inst. 2006. 98:1331–1334.

2. Volpe A, Panzarella T, Rendon RA, Haider MA, Kondylis FI, Jewett MA. The natural history of incidentally detected small renal masses. Cancer. 2004. 100:738–745.

3. Murphy AM, Buck AM, Benson MC, McKiernan JM. Increasing detection rate of benign renal tumors: evaluation of factors predicting for benign tumor histologic features during past two decades. Urology. 2009. 73:1293–1297.

4. Silverman SG, Gan YU, Mortele KJ, Tuncali K, Cibas ES. Renal masses in the adult patient: the role of percutaneous biopsy. Radiology. 2006. 240:6–22.

5. Frank I, Blute ML, Cheville JC, Lohse CM, Weaver AL, Zincke H. Solid renal tumors: an analysis of pathological features related to tumor size. J Urol. 2003. 170:2217–2220.

6. Kutikov A, Fossett LK, Ramchandani P, Tomaszewski JE, Siegelman ES, Banner MP, Van Arsdalen KN, Wein AJ, Malkowicz SB. Incidence of benign pathologic findings at partial nephrectomy for solitary renal mass presumed to be renal cell carcinoma on preoperative imaging. Urology. 2006. 68:737–740.

7. Lane BR, Babineau D, Kattan MW, Novick AC, Gill IS, Zhou M, Weight CJ, Campbell SC. A preoperative prognostic nomogram for solid enhancing renal tumors 7 cm or less amenable to partial nephrectomy. J Urol. 2007. 178:429–434.

8. McKiernan J, Yossepowitch O, Kattan MW, Simmons R, Motzer RJ, Reuter VE, Russo P. Partial nephrectomy for renal cortical tumors: pathologic findings and impact on outcome. Urology. 2002. 60:1003–1009.

9. Pahernik S, Roos F, Hampel C, Gillitzer R, Melchior SW, Thüroff JW. Nephron sparing surgery for renal cell carcinoma with normal contralateral kidney: 25 years of experience. J Urol. 2006. 175:2027–2031.

10. Schlomer B, Figenshau RS, Yan Y, Venkatesh R, Bhayani SB. Pathological features of renal neoplasms classified by size and symptomatology. J Urol. 2006. 176:1317–1320.

11. Snyder ME, Bach A, Kattan MW, Raj GV, Reuter VE, Russo P. Incidence of benign lesions for clinically localized renal masses smaller than 7 cm in radiological diameter: influence of sex. J Urol. 2006. 176:2391–2395.

12. Fujii Y, Komai Y, Saito K, Iimura Y, Yonese J, Kawakami S, Ishikawa Y, Kumagai J, Kihara K, Fukui I. Incidence of benign pathologic lesions at partial nephrectomy for presumed RCC renal masses: Japanese dual-center experience with 176 consecutive patients. Urology. 2008. 72:598–602.

13. Xiong YH, Zhang ZL, Li YH, Liu ZW, Hou GL, Liu Q, Yun JP, Zhang XQ, Zhou FJ. Benign pathological findings in 303 Chinese patients undergoing surgery for presumed localized renal cell carcinoma. Int J Urol. 2010. 17:517–521.

14. Bosniak MA. Diagnosis and management of patients with complicated cystic lesions of the kidney. AJR Am J Roentgenol. 1997. 169:819–821.

15. Kovacs G, Akhtar M, Beckwith BJ, Bugert P, Cooper CS, Delahunt B, Eble JN, Fleming S, Ljungberg B, Medeiros LJ, Moch H, Reuter VE, Ritz E, Roos G, Schmidt D, Srigley JR, Storkel S, van den Berg E, Zbar B. The Heidelberg classification of renal cell tumours. J Pathol. 1997. 183:131–133.

16. Störkel S, Eble JN, Adlakha K, Amin M, Blute ML, Bostwick DG, Darson M, Delahunt B, Iczkowski K. Classification of renal cell carcinoma: Workgroup No 1 Union Internationale Contre le Cancer (UICC) and the American Joint Committee on Cancer (AJCC). Cancer. 1997. 80:987–989.

17. Schachter LR, Cookson MS, Chang SS, Smith JA Jr, Dietrich MS, Jayaram G, Herrell SD. Second prize: frequency of benign renal cortical tumors and histologic subtypes based on size in a contemporary series: what to tell our patients. J Endourol. 2007. 21:819–823.

18. Hélénon O, André M, Correas JM, Khairoune A, Merran S, Balleyguier C. Characterization of renal masses. J Radiol. 2002. 83:787–804.

19. Pallwein L, Mitterberger M, Aigner F, Pinggera GM, Gradl J, Klauser A, Halpern EJ, Strasser H, Bartsch G, Frauscher F. Small renal masses: the value of contrast-enhanced colour Doppler imaging. BJU Int. 2007. 99:579–585.

20. Roy C, Gengler L, Sauer B, Lang H. Role of contrast enhanced US in the evaluation of renal tumors. J Radiol. 2008. 89:1735–1744.

21. Tello R, Davison BD, O'Malley M, Fenlon H, Thomson KR, Witte DJ, Harewood L. MR imaging of renal masses interpreted on CT to be suspicious. AJR Am J Roentgenol. 2000. 174:1017–1022.

22. Kim SI, Choi YD, Kim SJ, Chung BH, Seong do H, Kim CI, Cheon SH, Cho JS, Song YS, Kim YS, Cho IR, Lee DH, Song KH, Kim HS, Lee JS, Yang WJ, Hong SJ. A multi-institutional study on histopathological characteristics of surgically treated renal tumors: the importance of tumor size. Yonsei Med J. 2008. 49:639–646.

23. Jeon HG, Lee SR, Kim KH, Oh YT, Cho NH, Rha KH, Yang SC, Han WK. Benign lesions after partial nephrectomy for presumed renal cell carcinoma in masses 4 cm or less: prevalence and predictors in Korean patients. Urology. 2010. 76:574–579.

24. Lang EK, Macchia RJ, Gayle B, Richter F, Watson RA, Thomas R, Myers L. CT-guided biopsy of indeterminate renal cystic masses (Bosniak 3 and 2F): accuracy and impact on clinical management. Eur Radiol. 2002. 12:2518–2524.

25. Marszalek M, Ponholzer A, Brössner C, Wachter J, Maier U, Madersbacher S. Elective open nephron-sparing surgery for renal masses: single-center experience with 129 consecutive patients. Urology. 2004. 64:38–42.

26. Warren KS, McFarlane J. The Bosniak classification of renal cystic masses. BJU Int. 2005. 95:939–942.

27. Ascenti G, Mazziotti S, Zimbaro G, Settineri N, Magno C, Melloni D, Caruso R, Scribano E. Complex cystic renal masses: characterization with contrast-enhanced US. Radiology. 2007. 243:158–165.

28. Quaia E, Bertolotto M, Cioffi V, Rossi A, Baratella E, Pizzolato R, Cov MA. Comparison of contrast-enhanced sonography with unenhanced sonography and contrast-enhanced CT in the diagnosis of malignancy in complex cystic renal masses. AJR Am J Roentgenol. 2008. 191:1239–1249.

29. Schlomer B, Figenshau RS, Yan Y, Bhayani SB. How does the radiographic size of a renal mass compare with the pathologic size? Urology. 2006. 68:292–295.

30. Yaycioglu O, Rutman MP, Balasubramaniam M, Peters KM, Gonzalez JA. Clinical and pathologic tumor size in renal cell carcinoma; difference, correlation, and analysis of the influencing factors. Urology. 2002. 60:33–38.