Question 2#
A 67-year-old man is noted to have an incidental small renal mass in his left kidney whilst undergoing investigation for rectal bleeding. An upper pole tumour is noted to be entirely endophytic and 38 mm in maximal dimension. The tumour lies anteriorly within the upper pole and is in contact with the collecting system though does not cross the inter-polar lines. What would be the R.E.N.A.L. nephrometry score of this tumour?
A. 7aB. 8a
C. 9p
D. 10a
E. 12p
Correct Answer is B
Comment:
The R.E.N.A.L nephrometry scoring system was introduced by Kutikov et al. [3] as a standardised scoring system to characterise renal tumour anatomy and complexity in a reproducible, quantifiable manner. The aim of the scoring system was to allow meaningful comparisons of renal masses in clinical practice and in the urological literature. Tumours are evaluated using a 3-point scale on the basis of the following:
The above tumours would be scored as; R = 1, E = 3, N = 3, a, L = 1, giving a nephrometry score of 8a.
R.E.N.A.L nephrometry scores have been used to develop a nomogram that helps to predict the likelihood of malignant and high-grade pathology of an enhancing renal mass. Increasing tumour complexity as determined by nephrometry score is associated with an increased likelihood of major complications. Two alternative scoring systems have also been developed (PADUA and C-index) with the intention of providing a standardised descriptive system for renal masses based on radiologic findings.