Division of Urologic Surgery, Department of Surgery, Washington University School of Medicine and Barnes Jewish Hospital, St Louis, Missouri 63110 , USA.
J Urol. 2010 Feb;183(2):455-8. doi: 10.1016/j.juro.2009.10.045. Epub 2009 Dec 14.
The incidence of benign renal tumors has increased in recent years. This trend is commonly attributed to the increased use of cross-sectional imaging and minimally invasive surgical approaches. An alternative hypothesis is that recent changes in histological classification are responsible for the increasing incidence. To further investigate the impact of histological reclassification we reexamined all excised renal masses using the 2004 WHO criteria and compared this histological classification to the prior criteria.
We identified 1,101 consecutive partial and radical nephrectomy cases managed at our institution from 1989 to 2003. All histopathological sections were rereviewed by a single pathologist and reclassified according to 2004 WHO criteria. The percentages of benign lesions per year according to the prior histological and current WHO 2004 histological criteria were compared.
Of the 1,101 renal masses 132 (12.0%) and 165 (15.0%) were classified as benign using prior and current WHO criteria, respectively. On average the WHO criteria diagnosed more benign tumors per year than the prior criteria (p = 0.004). Linear regression demonstrated a similar, persistent increase in benign diagnoses per year of 0.69% (WHO) and 1.22% (prior) during the 14-year period (p = 0.33). All masses reclassified as benign were oncocytoma (33).
Implementation of the 2004 WHO criteria is contributing to the increase in diagnosis of benign renal lesions, specifically oncocytoma. Changes in histological classification do not account for the entire increase. Other factors, which remain to be delineated, are also contributing to the increase in the diagnosis of benign renal lesions.
近年来，良性肾肿瘤的发病率有所增加。这种趋势通常归因于横断面成像和微创外科方法的广泛应用。另一种假设是，组织学分类的最近变化是导致发病率上升的原因。为了进一步研究组织学重新分类的影响，我们使用 2004 年 WHO 标准重新检查了所有切除的肾肿块，并将这种组织学分类与以前的标准进行了比较。
我们确定了 1989 年至 2003 年在我们机构接受部分和根治性肾切除术的连续 1101 例病例。所有组织病理学切片均由一位病理学家重新审查，并根据 2004 年 WHO 标准重新分类。根据以前的组织学和当前的 2004 年 WHO 组织学标准，每年良性病变的百分比进行了比较。
在 1101 个肾肿块中，分别有 132 个（12.0%）和 165 个（15.0%）根据以前和当前的 WHO 标准被归类为良性。平均而言，与以前的标准相比，WHO 标准每年诊断出更多的良性肿瘤（p = 0.004）。线性回归显示，在 14 年期间，每年良性诊断的比例以相似的方式持续增加，分别为 0.69%（WHO）和 1.22%（以前）（p = 0.33）。所有重新分类为良性的肿块均为嗜酸细胞瘤（33 个）。
实施 2004 年 WHO 标准导致良性肾病变，特别是嗜酸细胞瘤的诊断增加。组织学分类的变化并不是导致全部增加的原因。其他仍有待阐明的因素也导致了良性肾病变诊断的增加。
