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World Congress of Endourology October 22-26, 2013 PowerPoint Presentation
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World Congress of Endourology October 22-26, 2013 - PowerPoint PPT Presentation


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Can Renal Mass F eatures on CT Predict Positive Margins? Nick N. Tadros , MD, Brian D. Duty, MD, Michael J. Conlin MD: Portland, OR Oregon Health Sciences University, Portland VA Medical Center. World Congress of Endourology October 22-26, 2013. Introduction

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Can Renal Mass Features on CT Predict Positive Margins?

Nick N. Tadros, MD, Brian D. Duty, MD, Michael J. Conlin MD: Portland, OR

Oregon Health Sciences University, Portland VA Medical Center

World Congress of Endourology

October 22-26, 2013

Introduction

The C-Index, PADUA, and RENAL nephrometry scores are three standardized scoring systems commonly used to quantify renal mass complexity, primarily for the purpose of surgical planning. These scoring systems are based upon tumor size and location. They do not take into account tumor characteristics such as heterogeneity and shape. The purpose of our study was to determine if renal mass features on computed tomography (CT) can predict margin status in patients undergoing partial nephrectomy.

1.0

1.6

2.4

Tumor Heterogeneity

  • Methods
  • This is a case-control study of patients treated by partial nephrectomy comparing patients with positive margins (cases) to those with negative margins (controls). Patients were identified from the Oregon Health & Science University tumor registry. OsiriX, an open source medical imaging application, was used to measure:
  • tumor heterogeneity(standard deviation of Hounsfiled units)
  • perinephricfat stranding
  • distinctness of the tumor/kidney interface(subjective scale)
  • tumor geometric complexity (measured surface area/calculated surface area of a sphere of the same volume)
  • percentage of visceral fat
  • Imaging characteristics of 15 individuals with positive margins were compared to 15 patients with negative margins.  

Geometric Complexity Index

Low Complexity

Higher Complexity

Visceral

Subcutaneous

Results

Baseline demographics (age, gender), tumor size, RENAL nephrometry score, treatment modality (open versus laparoscopic) did not differ between the two groups. On univariable (Table 1) and multivariable (Table 2) analysis, no difference was found between the two groups with regard to tumor heterogeneity, perinephric fat stranding, distinctness of the tumor/kidney interface, tumor geometric complexity and percentage of visceral fat.

Conclusions

Although no difference was found in tumor characteristics between patients with and without positive surgical margins, there was a trend towards significance for tumor geometric complexity (p= 0.099). We plan on expanding our sample size and evaluating geometric complexity as a predictor of pathologic (benign versus malignant, tumor subtype, tumor grade, and tumor stage) and surgical outcomes.