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KMID : 1011820170580040235
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Investigative and Clinical Urology
2017 Volume.58 No. 4 p.235 ~ p.240
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Patient and nonradiographic tumor characteristics predicting lipid-poor angiomyolipoma in small renal masses: Introducing the BEARS index
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Bauman Tyler M.
Potretzke Aaron M.
Wright Alec J.
Vetter Joel M.
Potretzke Theodora A.
Figenshau R. Sherburne
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Abstract
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Purpose: To create a simple model using clinical variables for predicting lipid-poor angiomyolipoma (AML) in patients with small renal masses presumed to be renal cell carcinoma (RCC) from preoperative imaging.
Materials and Methods: A series of patients undergoing partial nephrectomy (PN) for renal masses ≤4 cm was identified using a prospectively maintained database. Patients were excluded if standard preoperative imaging was not consistent with RCC. Chi square and Mann-Whitney U analyses were used to evaluate differences in characteristics between patients with AML and other types of pathology. A logistic regression model was constructed for multivariable analysis of predictors of lipid-poor AML.
Results: A total of 730 patients were identified that underwent PN for renal masses ≤4 cm between 2007?2015, including 35 with lipid-poor AML and 620 with RCC. In multivariable analysis, the following features predicted AML: female sex (odds ratio, 6.89; 95% confidence interval, 2.35?20.92; p<0.001), age <56 years (2.84; 1.21?6.66; p=0.02), and tumor size <2 cm (5.87; 2.70?12.77; p<0.001). Sex, age, and tumor size were used to construct the BEnign Angiomyolipoma Renal Susceptibility (BEARS) index with the following point values for each particular risk factor: female sex (2 points), age <56 years (1 point), and tumor size <2 cm (2 points). Within the study population, the BEARS index distinguished AML from malignant lesions with an area under the curve of 0.84.
Conclusions: Young female patients with small tumors are at risk for having lipid-poor AML despite preoperative imaging consistent with RCC. Identification of these patients may reduce the incidence of unnecessary PN for benign renal lesions.
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KEYWORD
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Angiomyolipoma, Decision support techniques, Nephrectomy, Renal cell carcinoma
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