ROLE OF R.E.N.A.L NEPHROMETRY IN PREDICTING TUMOR HISTOLOGY AND GRADE OF RENAL MASS.

Abstract

Background: The R.E.N.A.L.(radius, exophytic/endophytic properties, nearness of tumor to the collecting systemor sinus in mm, anterior/posterior location relative to polar lines) nephrometry scoring system was recently introduced as an objective reproducible means to describe salient renal tumor anatomy. Objective of this study is to evaluate the role of R.E.N.A.L. Nephrometry score in predicting tumor histology and grade.

 Methods: It is a prospective study carried out in Lilawati Hospital and Research Centre, a tertiary care centre consisting of 40 patients including male and female who had T1 renal mass.  Preoperative R.E.N.A.L. Nephrometry scoring  done for every patient and after treatment (Open Partial Nephrectomy, Laproscopic partial Nephrectomy, Radical Nephrectomy)  tumor sent for histopathology to predict tumor histology and grade for solid renal mass.

Results: Clear cell histology also increased with R.E.N.A.L score, from 2/6 (33.3%) in patients with low R.E.N.A.L scores ( 4–6) up to 15/17 (88.24%) for patients with high R.E.N.A.L scores( 10–12) . Conversely, the probability of the potentially more indolent papillary RCC decreased with increasing lesion complexity (from 66.67% in low score to 11.76% in moderate score).The Fuhrman grade is an important prognostic indicator for RCCs. In our study Fuhrman grade 1 tumours represented 4/40 (66.7%) low and 2(13%)high- complexity lesions . Conversely, there is no grade 3 lesion in low score (0.0%) compared with 5/40 (33.3%%) moderate complexity lesions, respectively showing more the nephrometry score higher will be Fuhrman grade.

Conclusions: Proportion with ?clear cell histology also increases with R.E.N.A.L score and the probability of the potentially more indolent papillary RCC decreased with increasing lesion complexity. The Fuhrman grade also increases with increase in nephrometry score

Keywords:  R.E.N.A.L  Nephrometry score, Fuhrman grade, Tumor histology