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Objective <p>To systematically evaluate whether the combined application of RENAL nephrometry and clear cell likelihood score (ccLS) could improve the diagnostic reliability of the ccLS in distinguishing clear cell renal cell carcinoma (ccRCC).</p> Methods <p>This retrospective single-center study encompassed 140 histopathologically confirmed solid renal masses in 130 patients who underwent preoperative MRI between March 2011 and January 2025. Two radiologists independently assigned the RENAL nephrometry and ccLS for each lesion. The diagnostic performance of the ccLS and the combined radiological approach was assessed using receiver operating characteristic curve analysis in the whole study cohort and two subgroups stratified by lesion diameter (≤ 4&#xa0;cm vs. &gt;4&#xa0;cm). Interreader consistency was evaluated using the kappa coefficient.</p> Results <p>Overall, 74 (52.9%) ccRCC and 66 (47.1%) non-ccRCC lesions were enrolled. Diagnostic performance analysis yielded a negative predictive value of 90.9%, a specificity of 30.3%, and an AUC of 0.638 for excluding ccRCC when lesions with a ccLS of 2 or lower were accepted as non-ccRCC. With the combined approach, considering low-complexity lesions per the nephrometry score with ccLS of 3 as non-ccRCC improved diagnostic performance using a ccLS cut-off of ≤ 2 for excluding ccRCC (AUC = 0.684, <i>p</i> = 0.022). The combined approach exhibited better performance in lesions ≤ 4&#xa0;cm for excluding ccRCC among ccLS 3 lesions (<i>p</i> = 0.042). Interobserver consistency was found to be near-perfect (κ = 0.927) and substantial (κ = 0.70) for the nephrometry and ccLS, respectively.</p> Conclusion <p>In this preliminary single-center cohort, the combined radiological approach was systematically evaluated for both predicting and excluding ccRCC. Its benefit was concentrated in excluding ccRCC among indeterminate ccLS 3 lesions ≤ 4&#xa0;cm, reducing false-positive outcomes and enhancing diagnostic confidence and suggesting a role in risk stratification rather than detection; external validation is required before clinical adoption.</p>

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Combined radiological approach for characterization of solid renal masses: a proposed strategy for integrating the RENAL nephrometry score into the clear cell likelihood score

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年7月31日

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  • İlhan Hekimsoy,
  • Aziz Anıl Tan,
  • Banu Sarsık Kumbaracı,
  • Ezgi Güler

摘要

Objective

To systematically evaluate whether the combined application of RENAL nephrometry and clear cell likelihood score (ccLS) could improve the diagnostic reliability of the ccLS in distinguishing clear cell renal cell carcinoma (ccRCC).

Methods

This retrospective single-center study encompassed 140 histopathologically confirmed solid renal masses in 130 patients who underwent preoperative MRI between March 2011 and January 2025. Two radiologists independently assigned the RENAL nephrometry and ccLS for each lesion. The diagnostic performance of the ccLS and the combined radiological approach was assessed using receiver operating characteristic curve analysis in the whole study cohort and two subgroups stratified by lesion diameter (≤ 4 cm vs. >4 cm). Interreader consistency was evaluated using the kappa coefficient.

Results

Overall, 74 (52.9%) ccRCC and 66 (47.1%) non-ccRCC lesions were enrolled. Diagnostic performance analysis yielded a negative predictive value of 90.9%, a specificity of 30.3%, and an AUC of 0.638 for excluding ccRCC when lesions with a ccLS of 2 or lower were accepted as non-ccRCC. With the combined approach, considering low-complexity lesions per the nephrometry score with ccLS of 3 as non-ccRCC improved diagnostic performance using a ccLS cut-off of ≤ 2 for excluding ccRCC (AUC = 0.684, p = 0.022). The combined approach exhibited better performance in lesions ≤ 4 cm for excluding ccRCC among ccLS 3 lesions (p = 0.042). Interobserver consistency was found to be near-perfect (κ = 0.927) and substantial (κ = 0.70) for the nephrometry and ccLS, respectively.

Conclusion

In this preliminary single-center cohort, the combined radiological approach was systematically evaluated for both predicting and excluding ccRCC. Its benefit was concentrated in excluding ccRCC among indeterminate ccLS 3 lesions ≤ 4 cm, reducing false-positive outcomes and enhancing diagnostic confidence and suggesting a role in risk stratification rather than detection; external validation is required before clinical adoption.