title: Intra-tumor Doppler flow patterns do not predict malignancy of renal masses in a United States population.
abstract: BACKGROUND
  Increased use of nephron sparing surgery has revealed a small but significant percentage of benign tumors. Improved imaging techniques have aided in diagnosis, but are still unable to differentiate benign from malignant tumors. We sought to evaluate whether the intra-tumor Doppler flow pattern could predict the presence of renal cell cancer (RCC).
  
  
  METHODS
  Standard grayscale ultrasound (US) and Power Doppler ultrasound (PDUS) were performed on 40 patients referred to our clinic for suspicious renal masses diagnosed by CT or MRI from December 2007 to May 2010. PDUS findings were used to classify tumors according to vascular patterns as proposed by Jinzaki et al, where pattern 0, 1, or 2 are considered diagnostic of benign renal lesions while patterns 3 and 4 predict malignancy. Clinical and pathological data were reviewed; ultrasound findings were correlated with histopathology.
  
  
  RESULTS
  Of the 40 patients included for analysis, 13 underwent active surveillance, 24 underwent partial or radical nephrectomy, and 3 underwent ablative procedures. Twenty-seven (67.5%) patients had pathological specimens available for review, of which 22 patients had RCC and 5 had benign pathology. Intra-observer (kappa 0.46-0.70) and inter-observer (kappa 0.41-0.56) reliability were reasonable, but ratings didn't correlate with pathologic outcomes (all kappa < 0).
  
  
  CONCLUSIONS
  Our results suggest that PDUS may not be helpful in the diagnosis of malignant renal masses detected by CT or MRI. Further studies are needed to elucidate a preoperative tool useful in diagnosing malignancy in renal masses.
authors.affiliation: Department of Urology, Emory University, Atlanta, Georgia 30322, USA.
authors.forename: Wayland
authors.initials: W
authors.lastname: Hsiao
authors.forename: Adam B
authors.initials: AB
authors.lastname: Shrewsberry
authors.forename: Kelvin A
authors.initials: KA
authors.lastname: Moses
authors.forename: Mathew
authors.initials: M
authors.lastname: Malek-Jones
authors.forename: Deborah
authors.initials: D
authors.lastname: Baumgarten
authors.forename: Viraj A
authors.initials: VA
authors.lastname: Master
authors.forename: Kenneth
authors.initials: K
authors.lastname: Ogan
mesh_terms: D000328:Adult; D000368:Aged; D002292:Carcinoma, Renal Cell / Q000000981:diagnostic imaging* / Q000453:epidemiology; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000000981:diagnostic imaging* / Q000453:epidemiology; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000000981:diagnostic imaging* / Q000453:epidemiology; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed; D018608:Ultrasonography, Doppler; D014481:United States