DeRoche Tom, Walker Esteban, Magi-Galluzzi Cristina, Zhou Ming
Department of Anatomic Pathology, Cleveland Clinic, Cleveland, OH, USA.
Am J Clin Pathol. 2008 Oct;130(4):560-4. doi: 10.1309/YR7P42XUVQHPHDWL.
We studied the pathologic features and whether clinical features could predict pathologic outcomes in small renal masses. The study included all adult patients with solitary, nonmetastatic renal masses 4 cm or smaller confirmed by nephrectomy or needle biopsy between 2004 and 2006. Tumor size, histologic type, Fuhrman nuclear grade, and stage were obtained from surgical pathology reports. Clinical variables included age, sex, tumor size, and symptomatology. The study included 290 men and 198 women (mean age, 59.3 years). Median tumor size was 2.6 cm (range, 0.5-4.0 cm). Approximately 84% of masses were incidentally detected. Nonneoplastic entities, benign neoplasms, and low- and high-grade carcinoma accounted for 1.6%, 18.0%, 49.0%, and 31.4% of masses, respectively. Women were more likely to have a benign mass (27.3% vs 14.5% of men, P < .001). Age (P = .56), tumor size (mean, 2.63 vs 2.46 cm for benign; P = .08), and symptomatology (P = .46) were not associated with malignancy. Multivariate analyses using sex, age, tumor size, and symptomatology failed to produce a model useful to predict the pathology of individual tumors. This inability may argue for an increased role for needle biopsy in their evaluation.
我们研究了小肾肿块的病理特征以及临床特征是否能够预测病理结果。该研究纳入了2004年至2006年间所有经肾切除术或穿刺活检确诊为孤立性、非转移性且直径4 cm或更小的成年肾肿块患者。肿瘤大小、组织学类型、福尔曼核分级和分期均来自手术病理报告。临床变量包括年龄、性别、肿瘤大小和症状。该研究包括290名男性和198名女性（平均年龄59.3岁）。肿瘤中位大小为2.6 cm（范围0.5 - 4.0 cm）。约84%的肿块是偶然发现的。非肿瘤性病变、良性肿瘤以及低级别和高级别癌分别占肿块的1.6%、18.0%、49.0%和31.4%。女性更有可能患有良性肿块（27.3%对男性的14.5%，P <.001）。年龄（P =.56）、肿瘤大小（良性肿块平均为2.63 cm对2.46 cm；P =.08）和症状（P =.46）与恶性肿瘤无关。使用性别、年龄、肿瘤大小和症状进行多变量分析未能得出一个可用于预测个体肿瘤病理的模型。这种情况可能表明穿刺活检在其评估中的作用应有所增加。
