Grade Heterogeneity in Small Renal Masses: Potential Implications for Renal Mass Biopsy

Mark W. Ball, Stephania M. Bezerra, Michael Gorin, Morgan Cowan, Christian Pavlovich, Phillip Martin Pierorazio, George J. Netto, Mohamad E Allaf

Research output: Contribution to journalArticle

Abstract

Purpose Understanding the degree of phenotypic heterogeneity in a small renal mass may have implications for interpreting renal mass biopsy data. In this study we quantify nuclear grade heterogeneity in small renal masses. Materials and Methods Our institutional renal mass database was queried for patients with T1a (less than 4 cm) renal masses stratified by the criteria of imaging diameter less than 2 cm or 2 cm or greater, clear cell or papillary histology, low grade (Fuhrman 1-2) or high grade (Fuhrman 3-4) with tissue available for review. Four consecutive specimens were chosen from each of the 8 strata for a total of 32. All specimens were reanalyzed and the highest Fuhrman grade present in each 10× powered field was recorded. A case was classified as heterogeneous if multiple grades were present and as discordant if the highest Fuhrman grade was present in less than 50% of the specimen. Results A median of 5 slides (IQR 3.5–7.5) and 59, 10× powered fields (IQR 34–109) were examined per patient. Overall 26 samples (81.3%) were heterogeneous, including 15 of 16 (93.8%) high grade specimens. Among all cases 10 (31.3%) were discordant and of high grade specimens 4 (25%) were discordant. Median fraction of low grade tissue in high grade specimens was 38.9% (IQR 12.2–57.2). Conclusions The majority of small renal masses demonstrated considerable nuclear grade heterogeneity. The greatest degree of heterogeneity and discordance was observed in high grade tumors. One should consider these findings when interpreting renal mass biopsy data as the risk of under sampling high grade tumors may not be insignificant.

Original languageEnglish (US)
Pages (from-to)36-40
Number of pages5
JournalJournal of Urology
Volume193
Issue number1
DOIs
StatePublished - Jan 1 2015

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Kidney
Biopsy
Neoplasms
Histology
Databases

Keywords

  • biopsy
  • carcinoma
  • neoplasm grading
  • renal cell
  • risk

ASJC Scopus subject areas

  • Urology

Cite this

Grade Heterogeneity in Small Renal Masses : Potential Implications for Renal Mass Biopsy. / Ball, Mark W.; Bezerra, Stephania M.; Gorin, Michael; Cowan, Morgan; Pavlovich, Christian; Pierorazio, Phillip Martin; Netto, George J.; Allaf, Mohamad E.

In: Journal of Urology, Vol. 193, No. 1, 01.01.2015, p. 36-40.

Research output: Contribution to journalArticle

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abstract = "Purpose Understanding the degree of phenotypic heterogeneity in a small renal mass may have implications for interpreting renal mass biopsy data. In this study we quantify nuclear grade heterogeneity in small renal masses. Materials and Methods Our institutional renal mass database was queried for patients with T1a (less than 4 cm) renal masses stratified by the criteria of imaging diameter less than 2 cm or 2 cm or greater, clear cell or papillary histology, low grade (Fuhrman 1-2) or high grade (Fuhrman 3-4) with tissue available for review. Four consecutive specimens were chosen from each of the 8 strata for a total of 32. All specimens were reanalyzed and the highest Fuhrman grade present in each 10× powered field was recorded. A case was classified as heterogeneous if multiple grades were present and as discordant if the highest Fuhrman grade was present in less than 50{\%} of the specimen. Results A median of 5 slides (IQR 3.5–7.5) and 59, 10× powered fields (IQR 34–109) were examined per patient. Overall 26 samples (81.3{\%}) were heterogeneous, including 15 of 16 (93.8{\%}) high grade specimens. Among all cases 10 (31.3{\%}) were discordant and of high grade specimens 4 (25{\%}) were discordant. Median fraction of low grade tissue in high grade specimens was 38.9{\%} (IQR 12.2–57.2). Conclusions The majority of small renal masses demonstrated considerable nuclear grade heterogeneity. The greatest degree of heterogeneity and discordance was observed in high grade tumors. One should consider these findings when interpreting renal mass biopsy data as the risk of under sampling high grade tumors may not be insignificant.",
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AU - Cowan, Morgan

AU - Pavlovich, Christian

AU - Pierorazio, Phillip Martin

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AU - Allaf, Mohamad E

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N2 - Purpose Understanding the degree of phenotypic heterogeneity in a small renal mass may have implications for interpreting renal mass biopsy data. In this study we quantify nuclear grade heterogeneity in small renal masses. Materials and Methods Our institutional renal mass database was queried for patients with T1a (less than 4 cm) renal masses stratified by the criteria of imaging diameter less than 2 cm or 2 cm or greater, clear cell or papillary histology, low grade (Fuhrman 1-2) or high grade (Fuhrman 3-4) with tissue available for review. Four consecutive specimens were chosen from each of the 8 strata for a total of 32. All specimens were reanalyzed and the highest Fuhrman grade present in each 10× powered field was recorded. A case was classified as heterogeneous if multiple grades were present and as discordant if the highest Fuhrman grade was present in less than 50% of the specimen. Results A median of 5 slides (IQR 3.5–7.5) and 59, 10× powered fields (IQR 34–109) were examined per patient. Overall 26 samples (81.3%) were heterogeneous, including 15 of 16 (93.8%) high grade specimens. Among all cases 10 (31.3%) were discordant and of high grade specimens 4 (25%) were discordant. Median fraction of low grade tissue in high grade specimens was 38.9% (IQR 12.2–57.2). Conclusions The majority of small renal masses demonstrated considerable nuclear grade heterogeneity. The greatest degree of heterogeneity and discordance was observed in high grade tumors. One should consider these findings when interpreting renal mass biopsy data as the risk of under sampling high grade tumors may not be insignificant.

AB - Purpose Understanding the degree of phenotypic heterogeneity in a small renal mass may have implications for interpreting renal mass biopsy data. In this study we quantify nuclear grade heterogeneity in small renal masses. Materials and Methods Our institutional renal mass database was queried for patients with T1a (less than 4 cm) renal masses stratified by the criteria of imaging diameter less than 2 cm or 2 cm or greater, clear cell or papillary histology, low grade (Fuhrman 1-2) or high grade (Fuhrman 3-4) with tissue available for review. Four consecutive specimens were chosen from each of the 8 strata for a total of 32. All specimens were reanalyzed and the highest Fuhrman grade present in each 10× powered field was recorded. A case was classified as heterogeneous if multiple grades were present and as discordant if the highest Fuhrman grade was present in less than 50% of the specimen. Results A median of 5 slides (IQR 3.5–7.5) and 59, 10× powered fields (IQR 34–109) were examined per patient. Overall 26 samples (81.3%) were heterogeneous, including 15 of 16 (93.8%) high grade specimens. Among all cases 10 (31.3%) were discordant and of high grade specimens 4 (25%) were discordant. Median fraction of low grade tissue in high grade specimens was 38.9% (IQR 12.2–57.2). Conclusions The majority of small renal masses demonstrated considerable nuclear grade heterogeneity. The greatest degree of heterogeneity and discordance was observed in high grade tumors. One should consider these findings when interpreting renal mass biopsy data as the risk of under sampling high grade tumors may not be insignificant.

KW - biopsy

KW - carcinoma

KW - neoplasm grading

KW - renal cell

KW - risk

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