Open AccessClassification tree for the prediction of malignant disease and the prediction of non-diagnostic biopsies in patients with small renal masses
Author(s) -
Michael Organ,
Landan MacDonald,
Michael A.S. Jewett,
Henry Ajzenberg,
Ashraf Almatar,
Mohamed Abdolell,
Matthew R. Acker,
Ricardo Rendon
Publication year - 2018
Publication title -
canadian urological association journal
Language(s) - English
Resource type - Journals
eISSN - 1920-1214
pISSN - 1911-6470
DOI - 10.5489/cuaj.5196
Subject(s) - medicine , tree (set theory) , decision tree , radiology , renal mass , disease , computer science , pathology , artificial intelligence , kidney , mathematics , nephrectomy , mathematical analysis
Introduction: Preoperative prediction of benign vs. malignant small renal masses (SRMs) remains a challenge. This study: 1) validates our previously published classification tree (CT) with an external cohort; 2) creates a new CT with the combined cohort; and 3) evaluates the RENAL and PADUA scoring systems for prediction of malignancy.
Methods: This study includes a total of 818 patients with renal masses; 395 underwent surgical resection and 423 underwent biopsy. A CT to predict benign disease was developed using patient and tumour characteristics from the 709 eligible participants. Our CT is based on four parameters: tumour volume, symptoms, gender, and symptomatology. CART modelling was also used to determine if RENAL and PADUA scoring could predict malignancy.
Results: When externally validated with the surgical cohort, the predictive accuracy of the old CT dropped. However, by combining the cohorts and creating a new CT, the predictive accuracy increased from 74% to 87% (95% confidence interval 0.84–0.89). RENAL and PADUA score alone were not predictive of malignancy. One limitation was the lack of available histological data from the biopsy series.
Conclusions: The validated old CT and new combined-cohort CT have a predictive value greater than currently published nomograms and single-biopsy cohorts. Overall, RENAL and PADUA scores were not able to predict malignancy.