Objective: To evaluate the value of clear cell likelihood score (ccLS) in identifying renal oncocytoma (RO) and clear cell renal cell carcinoma (ccRCC). Methods: Retrospective data of pathologically confirmed 43 RO patients [24 men and 19 women, aged 22-77 (54±14) years] between February 2008 and September 2021 and 43 ccRCC patients [30 men and 13 women, aged 29-78 (56±12) years] between May and July 2021 were consecutively included in the department of radiology, Chinese PLA General Hospital. Two radiologists used ccLS to assess each case independently, and disagreements were resolved by consensus. The ability of ccLS to identify RO and ccRCC was examined by the receiver operating characteristic (ROC) curve which identified the best optimal diagnostic cut-off values, sensitivity, specificity, accuracy, positive predictive value, and negative predictive value. Results: The mean tumor diameter was 3.8 cm in RO patients and 3.7 cm in ccRCC patients. Central scar and segmental enhancement inversion (SEI) were more frequently observed in the RO group compared to the ccRCC group [53.5% (23∶43) versus 11.6% (5∶43) and 41.9% (18∶43) versus 7.0% (3∶43), respectively], with statistical differences (P<0.001). The ccLS scores in the RO group ranged from 1 to 4, while 79.0% of the cases were 3. The ccLS scores in the ccRCC group ranged from 2 to 5, while 72% of the cases were 4. The scores of the two groups were statistically different (P<0.001). The ccLS showed the best performance when the threshold was 4 according to the ROC curve. The sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of ccLS for distinguishing RO from ccRCC were 83.7%, 90.7%, 87.2%, 90.0%, and 84.8%, respectively, and the area under the ROC curve value was 0.879. Conclusion: The ccLS has credible sensitivity and specificity in differentiating renal oncocytoma from clear cell carcinoma, which may be helpful for the preoperative diagnosis.
目的： 评估透明细胞癌可能性评分系统（ccLS）在肾嗜酸细胞腺瘤（RO）和肾透明细胞癌（ccRCC）鉴别诊断中的价值。 方法： 回顾性连续纳入解放军总医院第一医学中心放射诊断科2008年2月至2021年9月经病理证实的43例RO患者，男24例，女19例，年龄22~77（54±14）岁；并回顾性纳入2021年5至7月经病理证实的43例ccRCC患者，男30例，女13例，年龄29~78（56±12）岁。由两名放射科医师使用ccLS对所有入组病灶进行独立评分，对有分歧的病例进行协商达成一致，作为最后的结果。采用受试者工作特征曲线评估ccLS对RO和ccRCC的鉴别能力，确定最佳诊断阈值、灵敏度、特异度、准确度、阳性预测值与阴性预测值。 结果： RO患者的肿瘤平均直径为3.8 cm，ccRCC患者的肿瘤平均直径为3.7 cm。与ccRCC组相比，RO组中央瘢痕、节段反转强化（SEI）出现的频率高［分别为53.5%（23/43）比11.6%（5/43）、41.9%（18/43）比7.0%（3/43）］（均P<0.001）。RO组的ccLS评分分布在1~4分，其中79.0%为3分；ccRCC组的ccLS评分分布在2~5分，其中72%为4分；两组评分差异具有统计学意义（P<0.001）。阈值为4分时，ccLS模型诊断效能最高，其鉴别RO与ccRCC的灵敏度、特异度、准确度、阳性预测值、阴性预测值分别为83.7%、90.7%、87.2%、90.0%、84.8%，曲线下面积为0.879。 结论： ccLS鉴别诊断RO与ccRCC具有较高的灵敏度和特异度，有助于两者术前诊断。.