Division of Urology, Department of Surgery, Fox Chase Cancer Center, Philadelphia, PA.
Division of Urology, Department of Surgery, Fox Chase Cancer Center, Philadelphia, PA.
Urol Oncol. 2023 Apr;41(4):208.e9-208.e14. doi: 10.1016/j.urolonc.2023.01.008. Epub 2023 Feb 18.
To validate the "overflowing beer sign" (OBS) for distinguishing between lipid-poor angiomyolipoma (AML) and renal cell carcinoma, and to determine whether it improves the detection of lipid-poor AML when added to the angular interface sign, a previously-validated morphologic feature associated with AML.
Retrospective nested case-control study of all 134 AMLs in an institutional renal mass database matched 1:2 with 268 malignant renal masses from the same database. Cross-sectional imaging from each mass was reviewed and the presence of each sign was identified. A random selection of 60 masses (30 AML and 30 benign) was used to measure interobserver agreement.
Both signs were strongly associated with AML in the total population (OBS: OR 17.4 95% CI 8.0-42.5, p < 0.001; angular interface: OR 12.6, 95% CI 5.9-29.7, p < 0.001) and the population of patients excluding those with visible macroscopic fat (OBS: OR 11.2, 95% CI 4.8-28.7, p < 0.001; angular interface: 8.5, 95% CI 3.7-21.1, p < 0.001). In the lipid-poor population, the specificity of both signs was excellent (OBS: 95.6%, 95% CI 91.9%-98%; angular interface: 95.1%, 95% CI 91.3%-97.6%). Sensitivity was low for both signs (OBS: 31.4%, 95% CI 24.0-45.4%; angular interface: 30.5%, 95% CI 20.8%-41.6%). Both signs showed high levels of inter-rater agreement (OBS 90.0% 95% CI 80.5 - 95.9; angular interface 88.6, 95% CI 78.7-94.9) Testing for AML using the presence of either sign in this population improved sensitivity (39.0%, 95% CI 28.4%-50.4%, p = 0.023) without significantly reducing specificity (94.2%, 95% CI 90%-97%, p = 0.2) relative to the angular interface sign alone.
Recognition of the OBS increases the sensitivity of detection of lipid-poor AML without significantly reducing specificity.
验证“溢出啤酒征”（OBS）是否可用于区分乏脂性血管平滑肌脂肪瘤（AML）和肾细胞癌，并确定在添加到已验证的与 AML 相关的形态特征“角状界面征”后，该征象是否可提高对乏脂性 AML 的检出率。
回顾性嵌套病例对照研究，纳入了机构肾肿块数据库中所有 134 例 AML，并按 1:2 比例与来自同一数据库的 268 例恶性肾肿块进行匹配。对每个肿块的横断面影像学进行了回顾，并确定了每个征象的存在。随机选择 60 个肿块（30 个 AML 和 30 个良性）用于测量观察者间的一致性。
在总人群中，这两个征象均与 AML 密切相关（OBS：比值比 17.4，95%置信区间 8.0-42.5，p<0.001；角状界面：比值比 12.6，95%置信区间 5.9-29.7，p<0.001），在排除了可见肉眼脂肪的患者人群中也是如此（OBS：比值比 11.2，95%置信区间 4.8-28.7，p<0.001；角状界面：比值比 8.5，95%置信区间 3.7-21.1，p<0.001）。在乏脂性人群中，两个征象的特异性均非常高（OBS：95.6%，95%置信区间 91.9%-98%；角状界面：95.1%，95%置信区间 91.3%-97.6%）。两个征象的敏感性均较低（OBS：31.4%，95%置信区间 24.0-45.4%；角状界面：30.5%，95%置信区间 20.8%-41.6%）。两个征象的观察者间一致性水平均较高（OBS：90.0%，95%置信区间 80.5%-95.9%；角状界面：88.6%，95%置信区间 78.7%-94.9%）。在该人群中，使用任一征象检测 AML 可提高敏感性（39.0%，95%置信区间 28.4%-50.4%，p=0.023），而特异性（94.2%，95%置信区间 90%-97%，p=0.2）无显著降低。
识别 OBS 可提高乏脂性 AML 的检出率，而特异性无显著降低。
