title: Standardized Reporting of Microscopic Renal Tumor Margins: Introduction of the Renal Tumor Capsule Invasion Scoring System.
abstract: Renal tumor enucleation allows for maximal parenchymal preservation. Identifying pseudocapsule integrity is critically important in nephron sparing surgery by enucleation. Tumor invasion into and through the capsule may have clinical implications, although it is not routinely commented on in standard pathological reporting. We describe a system to standardize the varying degrees of pseudocapsule invasion and identify predictors of invasion.
  
  
  
  We performed a multicenter retrospective review between 2002 and 2014 at Indiana University Hospital and Loyola University Medical Center. A total of 327 tumors were evaluated following removal via radical nephrectomy, standard margin partial nephrectomy or enucleation partial nephrectomy. Pathologists scored tumors using our i-Cap (invasion of pseudocapsule) scoring system. Multivariate analysis was done to determine predictors of higher score tumors.
  
  
  
  Tumor characteristics were similar among surgical resection groups. Enucleated tumors tended to have thinner pseudocapsule rims but not higher i-Cap scores. Rates of complete capsular invasion, scored as i-Cap 3, were similar among the surgical techniques, comprising 22% of the overall cohort. Papillary histology along with increasing tumor grade was predictive of an i-Cap 3 score.
  
  
  
  A capsule invasion scoring system is useful to classify renal cell carcinoma pseudocapsule integrity. i-Cap scores appear to be independent of surgical technique. Complete capsular invasion is most common in papillary and high grade tumors. Further work is warranted regarding the relevance of capsular invasion depth as it relates to the oncologic outcome for local recurrence and disease specific survival.
authors: Stritch School of Medicine, Loyola University Chicago, Chicago, Illinois.
authors: Connor
authors: C
authors: Snarskis
authors: Department of Urology, Indiana University Hospital, Indianapolis, Indiana.
authors: Adam C
authors: AC
authors: Calaway
authors: Department of Pathology, Loyola University Medical Center, Maywood, Illinois.
authors: Lu
authors: L
authors: Wang
authors: Department of Pathology, Indiana University Hospital, Indianapolis, Indiana.
authors: Dibson
authors: D
authors: Gondim
authors: Department of Pathology, Loyola University Medical Center, Maywood, Illinois.
authors: Ian
authors: I
authors: Hughes
authors: Department of Pathology, Indiana University Hospital, Indianapolis, Indiana.
authors: Muhammad T
authors: MT
authors: Idrees
authors: Clinical Research Office, Loyola University Chicago, Chicago, Illinois.
authors: Stephanie
authors: S
authors: Kliethermes
authors: Indiana University School of Medicine, Indianapolis, Indiana.
authors: Viraj
authors: V
authors: Maniar
authors: Department of Pathology, Loyola University Medical Center, Maywood, Illinois.
authors: Maria M
authors: MM
authors: Picken
authors: Department of Urology, Indiana University Hospital, Indianapolis, Indiana.
authors: Ronald S
authors: RS
authors: Boris
authors: Department of Urology, Loyola University Medical Center, Maywood, Illinois. Electronic address: gogupta@lumc.edu.
authors: Gopal N
authors: GN
authors: Gupta
mesh_terms: D000368:Aged; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007196:Indiana; D007668:Kidney / Q000473:pathology / Q000601:surgery; D007680:Kidney Neoplasms / Q000473:pathology* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness / Q000473:pathology; D009364:Neoplasm Recurrence, Local / Q000473:pathology*; D009392:Nephrectomy / Q000379:methods*; D012189:Retrospective Studies
keywords: carcinoma; classification; kidney neoplasms; neoplasm invasiveness; nephrectomy; renal cell