Jeffrey A. Cadeddu, MD, presented “Mutliparametric MRI for Solid Masses: Accurate Detection of Clear Cell Renal Cell Carcinoma to Direct Patient Care” during the 41st Annual Ralph E. Hopkins Urology Seminar on February 3, 2022, in Jackson Hole, Wyoming.
How to cite: Cadeddu, Jeffrey A. “Mutliparametric MRI for Solid Masses: Accurate Detection of Clear Cell Renal Cell Carcinoma to Direct Patient Care” February 3, 2022. Accessed Apr 2024. https://grandroundsinurology.com/mutliparametric-mri-for-solid-masses-accurate-detection-of-clear-cell-renal-cell-carcinoma-to-direct-patient-care/
Mutliparametric MRI for Solid Masses: Accurate Detection of Clear Cell Renal Cell Carcinoma to Direct Patient Care – Summary
Jeffrey A. Cadeddu, MD, Ralph C. Smith, MD, Distinguished Chair in Minimally Invasive Urologic Surgery, Director of The University of Texas (UT) Southwestern Clinical Center for Minimally Invasive Treatment of Urologic Cancer, and Professor of Urology and Radiology at UT Southwestern Medical Center in Dallas, Texas, discusses multiparametric magnetic resonance imaging (mpMRI) for small renal masses (SRM). Dr. Cadeddu provides context, explaining a significant rise in the incidental identification of SRM with cross-sectional imaging but explaining the pathology of these masses is unknown. Many will remain indolent with no growth or slow growth, with many being candidates for active surveillance. He points out that the treatment recommendations do not distinguish histology and the guidance assumption that all SRM subtypes are the same is incorrect. Dr. Cadeddu then displays a chart distinguishing prognosis by tumor histology, demonstrating the vast differences among SRM subtypes and how these relate to patient outcomes. Dr. Cadeddu explains that while biopsy is an accepted means of tumor evaluation, he does not biopsy all patients. He lists pros (e.g., reducing the number of benign nephrectomies) and cons (e.g., invasiveness, diagnostic performance) of biopsy and highlights a challenge—that 37 percent of those with benign biopsy actually have malignant disease. Dr. Cadeddu posits that mpMRI provides a better way and explains the protocol and algorithm involved, citing examples. He demonstrates how mpMRI can assist in differentiating fat-poor renal angiomyolipoma (AML) and clear cell renal cell carcinoma (ccRCC). Dr. Cadeddu displays the diagnostic performance of mpMRI by pathologic subtype and explains that while the numbers are not perfect, they are a reasonable means to identify ccRCC. He then explains the clear cell likelihood score (ccLS) before turning to the diagnostic accuracy of mpMRI to identify ccRCC in cT1a SRM, sharing data and explaining that mpMRI outperforms biopsy in terms of negative predictive value (NPV), since the NPV for a biopsy is only 63 percent. Dr. Cadeddu explains data from UT for cT1 lesions, ccLS 4-5 detecting ccRCC with a positive predictive value (PPV) of 84 percent and a NPV of 86 percent; ccLS 1-2 detecting non-ccRCC, the PPV is 100 percent and the NPV is 80 percent. He presents data from a multi-institutional assessment of ccLS that are consistent with the UT data and explains that the ccLS score also helps predict tumor growth rates, with ccLS of 4 and 5 indicating higher growth rates. Dr.Cadeddu displays cost data demonstrating that mpMRI is less costly than biopsy before turning to a proposed MRI evaluation and treatment algorithm for T1a SRM based on the ccLS. Dr. Cadeddu then concludes, emphasizing that using mpMRI and ccLS is a promising, reliable, non-invasive, and cost-effective means of renal tumor characterization.
About The 41st Annual Ralph E. Hopkins Urology Seminar:
The Ralph E. Hopkins Urology Seminar is a multi-day meeting focused on training urologists in the latest in assessing, diagnosing, and treating urologic conditions in the clinical setting. Updates are provided on urologic cancers, stone disease, urologic reconstruction, female urology, infertility, emerging surgical techniques, and general urology. Dr. Stoffel presented this lecture during the 41st iteration of the meeting on February 3rd, 2022 in Jackson Hole, Wyoming.
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