Diagnostic performance and interreader agreement of a standardized MR imaging approach in the prediction of small renal mass histology

Research output: Contribution to journalArticle

14 Citations (Scopus)

Abstract

Purpose: To assess the diagnostic performance and interreader agreement of a standardized diagnostic algorithm in determining the histologic type of small (≤4 cm) renal masses (SRMs) with multiparametric magnetic resonance (MR) imaging. Materials and Methods: This single-center retrospective HIPAA-compliant institutional review board.approved study included 103 patients with 109 SRMs resected between December 2011 and July 2015. The requirement for informed consent was waived. Presurgical renal MR images were reviewed by seven radiologists with diverse experience. Eleven MR imaging features were assessed, and a standardized diagnostic algorithm was used to determine the most likely histologic diagnosis, which was compared with histopathology results after surgery. Interreader variability was tested with the Cohen κ statistic. Regression models using MR imaging features were used to predict the histopathologic diagnosis with 5% significance level. Results: Clear cell renal cell carcinoma (RCC) and papillary RCC were diagnosed, with sensitivities of 85% (47 of 55) and 80% (20 of 25), respectively, and specificities of 76% (41 of 54) and 94% (79 of 84), respectively. Interreader agreement was moderate to substantial (clear cell RCC, κ = 0.58; papillary RCC, κ = 0.73). Signal intensity (SI) of the lesion on T2-weighted MR images and degree of contrast enhancement (CE) during the corticomedullary phase were independent predictors of clear cell RCC (SI odds ratio [OR]: 3.19; 95% confidence interval [CI]: 1.4, 7.1; P =.003; CE OR, 4.45; 95% CI: 1.8, 10.8; P <.001) and papillary RCC (CE OR, 0.053; 95% CI: 0.02, 0.2; P <.001), and both had substantial interreader agreement (SI, κ = 0.69; CE, κ = 0.71). Poorer performance was observed for chromophobe histology, oncocytomas, and minimal fat angiomyolipomas, (sensitivity range, 14%.67%; specificity range, 97%.99%), with fair to moderate interreader agreement (k range = 0.23.0.43). Segmental enhancement inversion was an independent predictor of oncocytomas (OR, 16.21; 95% CI: 1.0, 275.4; P =.049), with moderate interreader agreement (k = 0.49). Conclusion: The proposed standardized MR imaging.based diagnostic algorithm had diagnostic accuracy of 81% (88 of 109) and 91% (99 of 109) in the diagnosis of clear cell RCC and papillary RCC, respectively, while achieving moderate to substantial interreader agreement among seven radiologists.

Original languageEnglish (US)
Pages (from-to)543-553
Number of pages11
JournalRadiology
Volume287
Issue number2
DOIs
StatePublished - May 1 2018

Fingerprint

Renal Cell Carcinoma
Histology
Magnetic Resonance Imaging
Kidney
Odds Ratio
Confidence Intervals
Oxyphilic Adenoma
Magnetic Resonance Spectroscopy
Health Insurance Portability and Accountability Act
Angiomyolipoma
Research Ethics Committees
Informed Consent
Fats

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging

Cite this

@article{1c888630abdb422dad9d3fd607a738e0,
title = "Diagnostic performance and interreader agreement of a standardized MR imaging approach in the prediction of small renal mass histology",
abstract = "Purpose: To assess the diagnostic performance and interreader agreement of a standardized diagnostic algorithm in determining the histologic type of small (≤4 cm) renal masses (SRMs) with multiparametric magnetic resonance (MR) imaging. Materials and Methods: This single-center retrospective HIPAA-compliant institutional review board.approved study included 103 patients with 109 SRMs resected between December 2011 and July 2015. The requirement for informed consent was waived. Presurgical renal MR images were reviewed by seven radiologists with diverse experience. Eleven MR imaging features were assessed, and a standardized diagnostic algorithm was used to determine the most likely histologic diagnosis, which was compared with histopathology results after surgery. Interreader variability was tested with the Cohen κ statistic. Regression models using MR imaging features were used to predict the histopathologic diagnosis with 5{\%} significance level. Results: Clear cell renal cell carcinoma (RCC) and papillary RCC were diagnosed, with sensitivities of 85{\%} (47 of 55) and 80{\%} (20 of 25), respectively, and specificities of 76{\%} (41 of 54) and 94{\%} (79 of 84), respectively. Interreader agreement was moderate to substantial (clear cell RCC, κ = 0.58; papillary RCC, κ = 0.73). Signal intensity (SI) of the lesion on T2-weighted MR images and degree of contrast enhancement (CE) during the corticomedullary phase were independent predictors of clear cell RCC (SI odds ratio [OR]: 3.19; 95{\%} confidence interval [CI]: 1.4, 7.1; P =.003; CE OR, 4.45; 95{\%} CI: 1.8, 10.8; P <.001) and papillary RCC (CE OR, 0.053; 95{\%} CI: 0.02, 0.2; P <.001), and both had substantial interreader agreement (SI, κ = 0.69; CE, κ = 0.71). Poorer performance was observed for chromophobe histology, oncocytomas, and minimal fat angiomyolipomas, (sensitivity range, 14{\%}.67{\%}; specificity range, 97{\%}.99{\%}), with fair to moderate interreader agreement (k range = 0.23.0.43). Segmental enhancement inversion was an independent predictor of oncocytomas (OR, 16.21; 95{\%} CI: 1.0, 275.4; P =.049), with moderate interreader agreement (k = 0.49). Conclusion: The proposed standardized MR imaging.based diagnostic algorithm had diagnostic accuracy of 81{\%} (88 of 109) and 91{\%} (99 of 109) in the diagnosis of clear cell RCC and papillary RCC, respectively, while achieving moderate to substantial interreader agreement among seven radiologists.",
author = "Kay, {Fernando Uliana} and Canvasser, {Noah E.} and Yin Xi and Pinho, {Daniella F} and Costa, {Daniel N} and {Diaz De Leon III}, Alberto and Gaurav Khatri and John Leyendecker and Takeshi Yokoo and Lay, {Aaron H.} and Nicholas Kavoussi and Ersin Koseoglu and Cadeddu, {Jeffrey A} and Ivan Pedrosa",
year = "2018",
month = "5",
day = "1",
doi = "10.1148/radiol.2018171557",
language = "English (US)",
volume = "287",
pages = "543--553",
journal = "Radiology",
issn = "0033-8419",
publisher = "Radiological Society of North America Inc.",
number = "2",

}

TY - JOUR

T1 - Diagnostic performance and interreader agreement of a standardized MR imaging approach in the prediction of small renal mass histology

AU - Kay, Fernando Uliana

AU - Canvasser, Noah E.

AU - Xi, Yin

AU - Pinho, Daniella F

AU - Costa, Daniel N

AU - Diaz De Leon III, Alberto

AU - Khatri, Gaurav

AU - Leyendecker, John

AU - Yokoo, Takeshi

AU - Lay, Aaron H.

AU - Kavoussi, Nicholas

AU - Koseoglu, Ersin

AU - Cadeddu, Jeffrey A

AU - Pedrosa, Ivan

PY - 2018/5/1

Y1 - 2018/5/1

N2 - Purpose: To assess the diagnostic performance and interreader agreement of a standardized diagnostic algorithm in determining the histologic type of small (≤4 cm) renal masses (SRMs) with multiparametric magnetic resonance (MR) imaging. Materials and Methods: This single-center retrospective HIPAA-compliant institutional review board.approved study included 103 patients with 109 SRMs resected between December 2011 and July 2015. The requirement for informed consent was waived. Presurgical renal MR images were reviewed by seven radiologists with diverse experience. Eleven MR imaging features were assessed, and a standardized diagnostic algorithm was used to determine the most likely histologic diagnosis, which was compared with histopathology results after surgery. Interreader variability was tested with the Cohen κ statistic. Regression models using MR imaging features were used to predict the histopathologic diagnosis with 5% significance level. Results: Clear cell renal cell carcinoma (RCC) and papillary RCC were diagnosed, with sensitivities of 85% (47 of 55) and 80% (20 of 25), respectively, and specificities of 76% (41 of 54) and 94% (79 of 84), respectively. Interreader agreement was moderate to substantial (clear cell RCC, κ = 0.58; papillary RCC, κ = 0.73). Signal intensity (SI) of the lesion on T2-weighted MR images and degree of contrast enhancement (CE) during the corticomedullary phase were independent predictors of clear cell RCC (SI odds ratio [OR]: 3.19; 95% confidence interval [CI]: 1.4, 7.1; P =.003; CE OR, 4.45; 95% CI: 1.8, 10.8; P <.001) and papillary RCC (CE OR, 0.053; 95% CI: 0.02, 0.2; P <.001), and both had substantial interreader agreement (SI, κ = 0.69; CE, κ = 0.71). Poorer performance was observed for chromophobe histology, oncocytomas, and minimal fat angiomyolipomas, (sensitivity range, 14%.67%; specificity range, 97%.99%), with fair to moderate interreader agreement (k range = 0.23.0.43). Segmental enhancement inversion was an independent predictor of oncocytomas (OR, 16.21; 95% CI: 1.0, 275.4; P =.049), with moderate interreader agreement (k = 0.49). Conclusion: The proposed standardized MR imaging.based diagnostic algorithm had diagnostic accuracy of 81% (88 of 109) and 91% (99 of 109) in the diagnosis of clear cell RCC and papillary RCC, respectively, while achieving moderate to substantial interreader agreement among seven radiologists.

AB - Purpose: To assess the diagnostic performance and interreader agreement of a standardized diagnostic algorithm in determining the histologic type of small (≤4 cm) renal masses (SRMs) with multiparametric magnetic resonance (MR) imaging. Materials and Methods: This single-center retrospective HIPAA-compliant institutional review board.approved study included 103 patients with 109 SRMs resected between December 2011 and July 2015. The requirement for informed consent was waived. Presurgical renal MR images were reviewed by seven radiologists with diverse experience. Eleven MR imaging features were assessed, and a standardized diagnostic algorithm was used to determine the most likely histologic diagnosis, which was compared with histopathology results after surgery. Interreader variability was tested with the Cohen κ statistic. Regression models using MR imaging features were used to predict the histopathologic diagnosis with 5% significance level. Results: Clear cell renal cell carcinoma (RCC) and papillary RCC were diagnosed, with sensitivities of 85% (47 of 55) and 80% (20 of 25), respectively, and specificities of 76% (41 of 54) and 94% (79 of 84), respectively. Interreader agreement was moderate to substantial (clear cell RCC, κ = 0.58; papillary RCC, κ = 0.73). Signal intensity (SI) of the lesion on T2-weighted MR images and degree of contrast enhancement (CE) during the corticomedullary phase were independent predictors of clear cell RCC (SI odds ratio [OR]: 3.19; 95% confidence interval [CI]: 1.4, 7.1; P =.003; CE OR, 4.45; 95% CI: 1.8, 10.8; P <.001) and papillary RCC (CE OR, 0.053; 95% CI: 0.02, 0.2; P <.001), and both had substantial interreader agreement (SI, κ = 0.69; CE, κ = 0.71). Poorer performance was observed for chromophobe histology, oncocytomas, and minimal fat angiomyolipomas, (sensitivity range, 14%.67%; specificity range, 97%.99%), with fair to moderate interreader agreement (k range = 0.23.0.43). Segmental enhancement inversion was an independent predictor of oncocytomas (OR, 16.21; 95% CI: 1.0, 275.4; P =.049), with moderate interreader agreement (k = 0.49). Conclusion: The proposed standardized MR imaging.based diagnostic algorithm had diagnostic accuracy of 81% (88 of 109) and 91% (99 of 109) in the diagnosis of clear cell RCC and papillary RCC, respectively, while achieving moderate to substantial interreader agreement among seven radiologists.

UR - http://www.scopus.com/inward/record.url?scp=85046041213&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85046041213&partnerID=8YFLogxK

U2 - 10.1148/radiol.2018171557

DO - 10.1148/radiol.2018171557

M3 - Article

VL - 287

SP - 543

EP - 553

JO - Radiology

JF - Radiology

SN - 0033-8419

IS - 2

ER -