Category: Clinical Oncology: Outcomes & Complications

MP18-2 - Imaging based scoring system to predict the sub-types of renal cell carcinoma

Sat, Sep 22
10:00 AM - 12:00 PM

Introduction & Objective :

The classification of renal cell carcinoma into subtypes has become area of interest because of their association with prognosis. CT has been widely used for the evaluation of RCC and only few studies has attempted differentiation of subtypes of RCC on basis of this. The purpose of our study was to predict histology of renal cell carcinoma on the basis of preoperative CT scan.


Methods :

We retrospectively reviewed CT scans of four subtypes of renal cell carcinoma – 88 clear cell, 36 papillary, 6 chromophobe, and 13 oncocytoma. A scoring system was formulated based on five components on CT scan – pre-contrast HU, post-contrast HU, contrast enhancement, presence/absence of necrosis, homogenous/heterogenous to predict the subtype of renal cell carcinoma. Score ranged from 5-13. Then score was applied prospectively for consecutive 100 patients of renal mass and accuracy of scoring system was validated.


Scoring system:










































 



1



2



3



Pre-contrast HU



>35



25-35



<25



Post-contrast HU



<70



70    – 100



>100



Contrast enhancement



<50



50 – 75



>75



Pattern of enhancement



Homogenous



Heterogenous



-



Necrosis



Absent



Present



-



Results :

Clear cell carcinoma showed stronger contrast enhancement than the papillary and chromophobe (p < 0.05). Score of 7 was 100 % sensitive and 51.42% specific to differentiate clear cell from papillary RCC whereas score of 9 was 89.23% sensitive and 91.42% specific for the same. Chromophobe RCC and oncocytoma were not considered in score calculation due to low number of patients in both groups<./p>


Conclusions :

This scoring system can be used to differentiate clear cell and papillary RCC accurately with clinical and prognostic implications. More multi-centric prospective studies are required for further validation of this scoring system.

Sudharsan Balaji

Fellow in Endourology, Laparoscopy and Robotics
Dr.
Nadiad, Gujarat, India

I am Dr. Sudharsan Balaji, MBBS MS MRCS DNB (Urology), working as a Fellow in Endourology, laparoscopy and Robotics in Muljibhai Patel Urological Hospital, Nadiad, India. I finished my Undergraduation and Postgraduation from Stanley Medical College, Chennai in 2009 and 2013 respectively. I finished ny Urological degree from my almamater MPUH, Nadiad in 2017 and was awarded the Endourological Society Fellowship on the same year. I have 15 publications to my credit, authored 3 book chapters and associate editor of a book titled "Monograph Series in Urology - Endourology and laparoscopy". I have so far 14 national and international presentations in various urological conferences till date. I was offered a visiting Scholarship in Pediatric Urology in Cincinnati Childrens' Hospital in 2015. I have specific interests in Endourology, Transplant and Minimally invasive pediatric urology. I see myself as laparoscopic/Robotic pediatric reconstruction in the future, which is my area of interest and expertise.

Rohit Maheshwari

Resident
Muljibhai Patel Urological Hospital
Nadiad, Gujarat, India

Mohankumar Vijayakumar

Fellow in Endourology, Laparoscopy and Robotics
Dr.
Nadiad, Gujarat, India

Abhishek Singh

Junior consultant
Muljibhai Patel Urological Hospital
Nadiad, Gujarat, India

Arvind Ganpule

Vice Chairman
Muljibhai Patel Urological Hospital
Nadiad, Gujarat, India

Ravindra Sabnis

Chairman
Muljibhai Patel Urological Hospital
Nadiad, Gujarat, India

Mahesh Desai

Consultant Urologist and Managing Trustee
Muljibhai Patel Urological Hospital
Nadiad, Gujarat, India