title: Novel kidney segmentation system to describe tumour location for nephron-sparing surgery.
abstract: OBJECTIVE
  To propose a novel system based on segmental renal anatomy for objectively reporting location of clinical T1 masses for nephron-sparing surgery.
  
  
  METHODS
  The kidney was subdivided into 12 standard segments, based on the computed tomography images. In 103 patients (105 cT1 tumours), three blinded radiologists (A, B, and C) prospectively reported segmental tumour location, size, and tumour-feeding arteries. Baseline, peri-operative, and post-operative data of 98 patients who underwent partial nephrectomy (PN) were prospectively collected, and the correlation between segmental tumour location and peri-operative data was evaluated. Kappa statistics were used to measure the inter-observer agreements.
  
  
  RESULTS
  Tumour location could be assigned to the defined renal segment in all cases. Median tumour size was 2.8 cm (range 0.6-5.8). Inter-observer concordance was as follows: A versus B 0.82 (95% CI 0.74-0.90); A versus C 0.89 (95% CI 0.83-0.95); and B versus C 0.84 (95% CI 0.76-0.92). First, second, third, and fourth segments were involved by the tumour in 23, 39, 17, and 21% of cases, respectively. Number of segments involved by the tumour correlated with tumour size (p = 0.007), number of tumour-feeding arteries (p = 0.001), estimated blood loss during PN (p = 0.03), and trended towards higher post-operative complication rate (p = 0.07). Tumour-feeding arteries were identifiable in 80 patients (76%).
  
  
  CONCLUSIONS
  Kidney segmentation (KS) system is an objective and reproducible radiologic method of universally reporting tumour location according to 12 renal segments. By adding descriptive information on tumour characteristics in candidates for nephron-sparing surgery, this novel KS system could serve as an adjunct to current nephrometry systems.
authors.affiliation: Department of Urology, Regina Elena National Cancer Institute of Rome, Via Elio Chinesi, 53, 00144, Rome, Italy, mpurri@yahoo.it.
authors.forename: Rocco
authors.initials: R
authors.lastname: Papalia
authors.forename: Andre Luis
authors.initials: AL
authors.lastname: De Castro Abreu
authors.forename: Valeria
authors.initials: V
authors.lastname: Panebianco
authors.forename: Vinay
authors.initials: V
authors.lastname: Duddalwar
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Simone
authors.forename: Scott
authors.initials: S
authors.lastname: Leslie
authors.forename: Salvatore
authors.initials: S
authors.lastname: Guaglianone
authors.forename: Tapas
authors.initials: T
authors.lastname: Tejura
authors.forename: Mariaconsiglia
authors.initials: M
authors.lastname: Ferriero
authors.forename: Maunela
authors.initials: M
authors.lastname: Costantini
authors.forename: Mihir
authors.initials: M
authors.lastname: Desai
authors.forename: Michele
authors.initials: M
authors.lastname: Gallucci
authors.forename: Inderbir Singh
authors.initials: IS
authors.lastname: Gill
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016063:Blood Loss, Surgical; D002292:Carcinoma, Renal Cell / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007668:Kidney / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D007680:Kidney Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D009392:Nephrectomy / Q000379:methods*; D009399:Nephrons; D059351:Organ Sparing Treatments / Q000379:methods*; D011183:Postoperative Complications; D011446:Prospective Studies; D065287:Robotic Surgical Procedures; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome