Distinguishing lipid-poor angiomyolipoma from renal carcinoma using tumor shape

Marshall Strother, Robert N. Uzzo, Elizabeth Handorf, Robert G. Uzzo

Research output: Contribution to journalArticlepeer-review

Abstract

OBJECTIVES: To validate the "overflowing beer sign" (OBS) for distinguishing between lipid-poor angiomyolipoma (AML) and renal cell carcinoma, and to determine whether it improves the detection of lipid-poor AML when added to the angular interface sign, a previously-validated morphologic feature associated with AML.

METHODS: Retrospective nested case-control study of all 134 AMLs in an institutional renal mass database matched 1:2 with 268 malignant renal masses from the same database. Cross-sectional imaging from each mass was reviewed and the presence of each sign was identified. A random selection of 60 masses (30 AML and 30 benign) was used to measure interobserver agreement.

RESULTS: Both signs were strongly associated with AML in the total population (OBS: OR 17.4 95% CI 8.0-42.5, p < 0.001; angular interface: OR 12.6, 95% CI 5.9-29.7, p < 0.001) and the population of patients excluding those with visible macroscopic fat (OBS: OR 11.2, 95% CI 4.8-28.7, p < 0.001; angular interface: 8.5, 95% CI 3.7-21.1, p < 0.001). In the lipid-poor population, the specificity of both signs was excellent (OBS: 95.6%, 95% CI 91.9%-98%; angular interface: 95.1%, 95% CI 91.3%-97.6%). Sensitivity was low for both signs (OBS: 31.4%, 95% CI 24.0-45.4%; angular interface: 30.5%, 95% CI 20.8%-41.6%). Both signs showed high levels of inter-rater agreement (OBS 90.0% 95% CI 80.5 - 95.9; angular interface 88.6, 95% CI 78.7-94.9) Testing for AML using the presence of either sign in this population improved sensitivity (39.0%, 95% CI 28.4%-50.4%, p = 0.023) without significantly reducing specificity (94.2%, 95% CI 90%-97%, p = 0.2) relative to the angular interface sign alone.

CONCLUSIONS: Recognition of the OBS increases the sensitivity of detection of lipid-poor AML without significantly reducing specificity.

Original languageEnglish
Pages (from-to)208.e9-208.e14
JournalUrologic Oncology: Seminars and Original Investigations
Volume41
Issue number4
DOIs
StatePublished - Apr 2023

Keywords

  • Angiomyolipoma
  • Magnetic resonance imaging
  • Renal cell carcinomas
  • X-ray computed tomography
  • Kidney Neoplasms/diagnosis
  • Diagnosis, Differential
  • Humans
  • Angiomyolipoma/diagnosis
  • Lipids
  • Case-Control Studies
  • Carcinoma, Renal Cell/diagnosis
  • Sensitivity and Specificity
  • Retrospective Studies

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