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Urol Int. 2017;99(2):229-236. doi: 10.1159/000460303. Epub 2017 Mar 8.

Does Computed Tomography Still Have Limitations to Distinguish Benign from Malignant Renal Tumors for Radiologists?

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1
USC Institute of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.

Abstract

OBJECTIVES:

To evaluate the current accuracy of CT for diagnosing benign renal tumors.

MATERIALS AND METHODS:

We retrospectively reviewed 905 patients who underwent preoperative CT followed by surgical resection. The final pathology was benign in 156 patients (17%). After exclusions, 140 patients with 163 benign tumors were included and 3 sets of the CT interpretations by radiologists with varying levels of experience were analyzed.

RESULTS:

The histological breakdown was as follows: oncocytomas (54.6%), angiomyolipomas (AMLs; 30.7%), renal cysts (8.0%), other miscellaneous benign tumors (6.7%). The sensitivities of diagnosing oncocytomas were 3.4, 9.0, and 13.5% in primary radiological reports, second blinded reviews, and third non-blinded reviews, respectively (p = 0.055). The sensitivities of diagnosing AMLs were 46.0, 58.0, and 62.0% in the 3-sets of CT interpretations, respectively (p = 0.246). As for renal cysts, the sensitivities were 69.2, 92.3, and 100% in the 3-sets of CT interpretations, respectively (p = 0.051). In primary reports, the positive predictive values were 95.8% in lipid poor (lp)-AMLs, 60.0% in oncocytomas, 69.2% in renal cysts, respectively (p < 0.05).

CONCLUSIONS:

Current conventional CT imaging still has limitations in differentiating oncocytomas and lp-AMLs from renal cell carcinomas, even when images were re-examined by experienced radiologists.

KEYWORDS:

Angiomyolipoma; Benign tumor; CT; Oncocytoma; Renal tumor

PMID:
28268233
DOI:
10.1159/000460303
[Indexed for MEDLINE]

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