TY - JOUR
T1 - Development of a clinical prediction model for assessment of malignancy risk in bosniak III renal lesions
AU - Goenka, Ajit H.
AU - Remer, Erick M.
AU - Smith, Andrew D.
AU - Obuchowski, Nancy A.
AU - Klink, Joseph
AU - Campbell, Steven C.
PY - 2013/9
Y1 - 2013/9
N2 - Objective To identify independent predictors of malignancy in Bosniak III (BIII) renal lesions and to build a prediction model based on readily identifiable clinical variables. Methods In this institutional review board-approved, Health Insurance Portability and Accountability Act (HIPAA)-compliant retrospective study, radiology, and hospital information systems containing data from January 1, 1994, to August 31, 2009, were queried for adult patients (age >18 years) with surgically excised BIII lesions. Clinical variables and results of histopathology were noted. Univariate and multiple-variable logistic regression analyses were performed to identify potential predictors and to build a prediction model. Cross-validation was used to assess generalizability of the model's performance, as characterized by concordance (c) index. Results Of the 107 lesions in 101 patients, 59 were malignant and 48 benign. On univariate analyses, the strongest potential predictors of malignancy were African American race (P =.043), history of renal cell carcinoma (RCC; P =.026), coexisting BIII lesions (P =.032), coexisting Bosniak IV (BIV) lesions (P =.104), body mass index (BMI; P =.078), and lesion size (P <.001). A model with lesion size (odds ratio [OR] = 0.69; 95% confidence interval [CI] 0.58-0.82), history of RCC (9.02; CI 0.99-82.15), and BMI (OR 1.1; 95% CI 0.99-1.19) offered the best performance with a c-index after cross-validation of 0.719. Using an estimated probability of malignancy of >80%, the positive predictive value of the model is 92% (CI 78%-100%). Conclusion Clinical risk factors offer modest but definite predictive ability for malignancy in BIII lesions. In particular, a prediction model encompassing lesion size, BMI, and history of RCC seems promising. Further refinements with possible inclusion of imaging biomarkers and validation on an independent dataset are desirable.
AB - Objective To identify independent predictors of malignancy in Bosniak III (BIII) renal lesions and to build a prediction model based on readily identifiable clinical variables. Methods In this institutional review board-approved, Health Insurance Portability and Accountability Act (HIPAA)-compliant retrospective study, radiology, and hospital information systems containing data from January 1, 1994, to August 31, 2009, were queried for adult patients (age >18 years) with surgically excised BIII lesions. Clinical variables and results of histopathology were noted. Univariate and multiple-variable logistic regression analyses were performed to identify potential predictors and to build a prediction model. Cross-validation was used to assess generalizability of the model's performance, as characterized by concordance (c) index. Results Of the 107 lesions in 101 patients, 59 were malignant and 48 benign. On univariate analyses, the strongest potential predictors of malignancy were African American race (P =.043), history of renal cell carcinoma (RCC; P =.026), coexisting BIII lesions (P =.032), coexisting Bosniak IV (BIV) lesions (P =.104), body mass index (BMI; P =.078), and lesion size (P <.001). A model with lesion size (odds ratio [OR] = 0.69; 95% confidence interval [CI] 0.58-0.82), history of RCC (9.02; CI 0.99-82.15), and BMI (OR 1.1; 95% CI 0.99-1.19) offered the best performance with a c-index after cross-validation of 0.719. Using an estimated probability of malignancy of >80%, the positive predictive value of the model is 92% (CI 78%-100%). Conclusion Clinical risk factors offer modest but definite predictive ability for malignancy in BIII lesions. In particular, a prediction model encompassing lesion size, BMI, and history of RCC seems promising. Further refinements with possible inclusion of imaging biomarkers and validation on an independent dataset are desirable.
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U2 - 10.1016/j.urology.2013.05.016
DO - 10.1016/j.urology.2013.05.016
M3 - Article
C2 - 23876583
AN - SCOPUS:84883218234
SN - 0090-4295
VL - 82
SP - 630
EP - 635
JO - Urology
JF - Urology
IS - 3
ER -