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Open Access 01-12-2022 | Nephrectomy | Research

Implication of cystic fluid cytology of renal cell carcinoma on surgical practice

Authors: Kyung Jae Hur, Qais Hooti, Dongho Shin, Yong Hyun Park, Woong Jin Bae, Hyukjin Cho, U-syn Ha, Ji Youl Lee, Yeong Jin Choi, Sung-Hoo Hong

Published in: BMC Urology | Issue 1/2022

Abstract

Objectives

To evaluate the incidence of positive cystic fluid cytology and its risk factors in cystic renal cell carcinoma (RCC) addressing its implication on the current surgical practice.

Methods

All clinically diagnosed Bosniak III, IV cystic renal masses from March 2019 to August 2022 were studied prospectively. Database of patients’ demographics and cystic tumor characteristics were recorded. Partial or radical nephrectomies were performed by either laparoscopic or robotic approach. Cystic fluid was collected right after specimen retrieval in the surgical field and examined by pathologist. Cytology results were compared to the demographic, perioperative variables using univariate and multivariate analysis.

Results

A total of 70 patients of histologically confirmed cystic RCC were included. Sixty seven patients underwent radical nephrectomy with laparoscopic or robotic approaches, while 3 patients underwent radical nephrectomy. There was no intraoperative cystic rupture or fluid spillage. Positive cystic fluid cytology findings were identified in 34 (48.6%) patients, while negative cystic fluid cytology were identified in 36 (51.4%) cases. Definite malignant cells were observed in 28 patients while the other six patients showed highly suspicious atypical cells. Histologically, 24 (70.8%) patients were proven clear cell RCC and 25 (73%) showed Fuhrman grade 1 or 2 in final histologic review in positive group. Univariate and multivariate regression analysis between positive and negative cytology groups showed that the presence of the malignant cells in cystic fluid was significantly associated with patients’ age (> 55 years) and Bosniak grade of cystic tumor (p < 0.05).

Conclusions

Definite malignant cells in cystic fluid cytology were observed through our study. Additionally, patients’ age (> 55 years) and Bosniak grade were the significant risk factors of positive cytology in cystic RCC. Therefore, necessity of meticulous manipulation of cystic renal tumors, despite their clinical features, should not be underemphasized to avoid the least possible tumor cell seeding in case of cystic rupture when operating such high risk of positive cytology.

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Title: Implication of cystic fluid cytology of renal cell carcinoma on surgical practice
Authors: Kyung Jae Hur
Qais Hooti
Dongho Shin
Yong Hyun Park
Woong Jin Bae
Hyukjin Cho
U-syn Ha
Ji Youl Lee
Yeong Jin Choi
Sung-Hoo Hong
Publication date: 01-12-2022
Publisher: BioMed Central
Keywords: Nephrectomy
Kidney Cancer
Kidney Cancer
Renal Cancer
Nephrectomy
Kidney Cancer
Nephrectomy
Published in: BMC Urology / Issue 1/2022
Electronic ISSN: 1471-2490
DOI: https://doi.org/10.1186/s12894-022-01144-y

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Springer Medicine

Implication of cystic fluid cytology of renal cell carcinoma on surgical practice

Abstract

Objectives

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Objectives

Methods

Results

Conclusions

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