Standardized Reporting of Microscopic Renal Tumor Margins

Introduction of the Renal Tumor Capsule Invasion Scoring System

Connor Snarskis, Adam C. Calaway, Lu Wang, Dibson Gondim, Ian Hughes, Muhammad Idrees, Stephanie Kliethermes, Viraj Maniar, Maria M. Picken, Ronald S. Boris, Gopal N. Gupta

Research output: Contribution to journalArticle

12 Citations (Scopus)

Abstract

Purpose Renal tumor enucleation allows for maximal parenchymal preservation. Identifying pseudocapsule integrity is critically important in nephron sparing surgery by enucleation. Tumor invasion into and through the capsule may have clinical implications, although it is not routinely commented on in standard pathological reporting. We describe a system to standardize the varying degrees of pseudocapsule invasion and identify predictors of invasion. Materials and Methods We performed a multicenter retrospective review between 2002 and 2014 at Indiana University Hospital and Loyola University Medical Center. A total of 327 tumors were evaluated following removal via radical nephrectomy, standard margin partial nephrectomy or enucleation partial nephrectomy. Pathologists scored tumors using our i-Cap (invasion of pseudocapsule) scoring system. Multivariate analysis was done to determine predictors of higher score tumors. Results Tumor characteristics were similar among surgical resection groups. Enucleated tumors tended to have thinner pseudocapsule rims but not higher i-Cap scores. Rates of complete capsular invasion, scored as i-Cap 3, were similar among the surgical techniques, comprising 22% of the overall cohort. Papillary histology along with increasing tumor grade was predictive of an i-Cap 3 score. Conclusions A capsule invasion scoring system is useful to classify renal cell carcinoma pseudocapsule integrity. i-Cap scores appear to be independent of surgical technique. Complete capsular invasion is most common in papillary and high grade tumors. Further work is warranted regarding the relevance of capsular invasion depth as it relates to the oncologic outcome for local recurrence and disease specific survival.

Original languageEnglish (US)
Pages (from-to)23-30
Number of pages8
JournalJournal of Urology
Volume197
Issue number1
DOIs
StatePublished - Jan 1 2017

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Capsules
Kidney
Neoplasms
Nephrectomy
Nephrons
Renal Cell Carcinoma
Histology
Multivariate Analysis
Recurrence

Keywords

  • carcinoma
  • classification
  • kidney neoplasms
  • neoplasm invasiveness
  • nephrectomy
  • renal cell

ASJC Scopus subject areas

  • Urology

Cite this

Standardized Reporting of Microscopic Renal Tumor Margins : Introduction of the Renal Tumor Capsule Invasion Scoring System. / Snarskis, Connor; Calaway, Adam C.; Wang, Lu; Gondim, Dibson; Hughes, Ian; Idrees, Muhammad; Kliethermes, Stephanie; Maniar, Viraj; Picken, Maria M.; Boris, Ronald S.; Gupta, Gopal N.

In: Journal of Urology, Vol. 197, No. 1, 01.01.2017, p. 23-30.

Research output: Contribution to journalArticle

Snarskis, C, Calaway, AC, Wang, L, Gondim, D, Hughes, I, Idrees, M, Kliethermes, S, Maniar, V, Picken, MM, Boris, RS & Gupta, GN 2017, 'Standardized Reporting of Microscopic Renal Tumor Margins: Introduction of the Renal Tumor Capsule Invasion Scoring System', Journal of Urology, vol. 197, no. 1, pp. 23-30. https://doi.org/10.1016/j.juro.2016.07.086
Snarskis, Connor ; Calaway, Adam C. ; Wang, Lu ; Gondim, Dibson ; Hughes, Ian ; Idrees, Muhammad ; Kliethermes, Stephanie ; Maniar, Viraj ; Picken, Maria M. ; Boris, Ronald S. ; Gupta, Gopal N. / Standardized Reporting of Microscopic Renal Tumor Margins : Introduction of the Renal Tumor Capsule Invasion Scoring System. In: Journal of Urology. 2017 ; Vol. 197, No. 1. pp. 23-30.
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abstract = "Purpose Renal tumor enucleation allows for maximal parenchymal preservation. Identifying pseudocapsule integrity is critically important in nephron sparing surgery by enucleation. Tumor invasion into and through the capsule may have clinical implications, although it is not routinely commented on in standard pathological reporting. We describe a system to standardize the varying degrees of pseudocapsule invasion and identify predictors of invasion. Materials and Methods We performed a multicenter retrospective review between 2002 and 2014 at Indiana University Hospital and Loyola University Medical Center. A total of 327 tumors were evaluated following removal via radical nephrectomy, standard margin partial nephrectomy or enucleation partial nephrectomy. Pathologists scored tumors using our i-Cap (invasion of pseudocapsule) scoring system. Multivariate analysis was done to determine predictors of higher score tumors. Results Tumor characteristics were similar among surgical resection groups. Enucleated tumors tended to have thinner pseudocapsule rims but not higher i-Cap scores. Rates of complete capsular invasion, scored as i-Cap 3, were similar among the surgical techniques, comprising 22{\%} of the overall cohort. Papillary histology along with increasing tumor grade was predictive of an i-Cap 3 score. Conclusions A capsule invasion scoring system is useful to classify renal cell carcinoma pseudocapsule integrity. i-Cap scores appear to be independent of surgical technique. Complete capsular invasion is most common in papillary and high grade tumors. Further work is warranted regarding the relevance of capsular invasion depth as it relates to the oncologic outcome for local recurrence and disease specific survival.",
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AU - Wang, Lu

AU - Gondim, Dibson

AU - Hughes, Ian

AU - Idrees, Muhammad

AU - Kliethermes, Stephanie

AU - Maniar, Viraj

AU - Picken, Maria M.

AU - Boris, Ronald S.

AU - Gupta, Gopal N.

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N2 - Purpose Renal tumor enucleation allows for maximal parenchymal preservation. Identifying pseudocapsule integrity is critically important in nephron sparing surgery by enucleation. Tumor invasion into and through the capsule may have clinical implications, although it is not routinely commented on in standard pathological reporting. We describe a system to standardize the varying degrees of pseudocapsule invasion and identify predictors of invasion. Materials and Methods We performed a multicenter retrospective review between 2002 and 2014 at Indiana University Hospital and Loyola University Medical Center. A total of 327 tumors were evaluated following removal via radical nephrectomy, standard margin partial nephrectomy or enucleation partial nephrectomy. Pathologists scored tumors using our i-Cap (invasion of pseudocapsule) scoring system. Multivariate analysis was done to determine predictors of higher score tumors. Results Tumor characteristics were similar among surgical resection groups. Enucleated tumors tended to have thinner pseudocapsule rims but not higher i-Cap scores. Rates of complete capsular invasion, scored as i-Cap 3, were similar among the surgical techniques, comprising 22% of the overall cohort. Papillary histology along with increasing tumor grade was predictive of an i-Cap 3 score. Conclusions A capsule invasion scoring system is useful to classify renal cell carcinoma pseudocapsule integrity. i-Cap scores appear to be independent of surgical technique. Complete capsular invasion is most common in papillary and high grade tumors. Further work is warranted regarding the relevance of capsular invasion depth as it relates to the oncologic outcome for local recurrence and disease specific survival.

AB - Purpose Renal tumor enucleation allows for maximal parenchymal preservation. Identifying pseudocapsule integrity is critically important in nephron sparing surgery by enucleation. Tumor invasion into and through the capsule may have clinical implications, although it is not routinely commented on in standard pathological reporting. We describe a system to standardize the varying degrees of pseudocapsule invasion and identify predictors of invasion. Materials and Methods We performed a multicenter retrospective review between 2002 and 2014 at Indiana University Hospital and Loyola University Medical Center. A total of 327 tumors were evaluated following removal via radical nephrectomy, standard margin partial nephrectomy or enucleation partial nephrectomy. Pathologists scored tumors using our i-Cap (invasion of pseudocapsule) scoring system. Multivariate analysis was done to determine predictors of higher score tumors. Results Tumor characteristics were similar among surgical resection groups. Enucleated tumors tended to have thinner pseudocapsule rims but not higher i-Cap scores. Rates of complete capsular invasion, scored as i-Cap 3, were similar among the surgical techniques, comprising 22% of the overall cohort. Papillary histology along with increasing tumor grade was predictive of an i-Cap 3 score. Conclusions A capsule invasion scoring system is useful to classify renal cell carcinoma pseudocapsule integrity. i-Cap scores appear to be independent of surgical technique. Complete capsular invasion is most common in papillary and high grade tumors. Further work is warranted regarding the relevance of capsular invasion depth as it relates to the oncologic outcome for local recurrence and disease specific survival.

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