BERKELEY, CA (UroToday.com) - The role of radiology in patient management has evolved over the years. We have seen the progression from detection-only based techniques to those that allow not only high detection rates (i.e., high sensitivity), but also a very good correlation to histology findings (i.e., high specificity). In this regard, the possibility of being able to non-invasively characterize histologic subtypes of tumors is a necessary trend, such as in patients with renal cell carcinoma (RCC) where clinical management may be dependent on the tumor histologic subtype. Invasively attempting (percutaneous or surgical) histologic characterization of RCCs for subtyping is not always desirable. Despite its high accuracy, RCCs can be difficult to biopsy percutaneously, particularly small lesions, carrying an important rate of technical failure and false-negative results. As an example, the usually less aggressive papillary tumors may be amenable to watchful waiting management, especially in unwilling or poor surgical candidates.

RCC diagnosis rates have shown a steady increase, mainly due to the incidental diagnosis during imaging for other purposes (up to 61% of new cases). Very often, these imaging studies are in the form of routine computed tomography (CT) examinations, which frequently are performed after the administration of intravenous iodinated contrast. Because renal abnormalities are unsuspected, unenhanced images are not acquired. This practice is in accordance to the efforts to reduce the hazard of the radiation doses given to patients undergoing imaging.

Several reports have demonstrated the feasibility of RCC subtype differentiation employing dynamic multiphasic imaging CT studies, using the unenhanced images for the baseline CT attenuation measurements of renal masses. In our experience, recommendations for additional CT imaging studies for incidentally found renal lesions in patients without baseline unenhanced phase are not always followed, and such additional imaging is burdensome both for the patient (subjected to a incremental amounts of radiation exposure) and to radiology departments (further loading the usually busy working schedules). For such reasons, RCC subtype differentiation in incidentally found renal masses, with no available unenhanced phase, would be of clinical benefit.

In our paper we tried to differentiate the three most common RCC histologic subtypes using images provided by single-phase post-contrast CT examinations of histologic-proven RCCs. We sought to intra-individually compare the ability to differentiate RCC subtypes between multiphasic and arterial single-phase contrast enhanced CT based on both previously described and novel indices, using the psoas muscle as a surrogate. We quantitatively evaluated tumor enhancement, calculating the tumor enhancement (TE) and tumor-to-cortex index (TCI).

Our results showed that it was possible to distinguish papillary tumors from clear cell and cromophobe simultaneously with high accuracy using TE (sensitivity and specificity of 100% and 90%, respectively) and TCI (sensitivity and specificity of 100% and 84%, respectively) thresholds of < 23% and < 0.22, (AUC 0.978 and 0.971), respectively. Comparison of receiver operating characteristic curve analyses between single-phase and multi-phase evaluation methods did not show significant differences. Unfortunately, we were not able to find significant differences in the distinction of clear cell from cromophobe tumors for both evaluated methods (single-phase and multi-phase), but only between clear cell and non-clear cell tumors. Nevertheless, we believe that this can be clinically more useful.

In conclusion, our study provided evidence to support that RCC subtype differentiation can be assessed with high accuracy on an arterial single-phase contrast-enhanced-CT study, similar to multi-phase evaluation when unenhanced images are unavailable.

Written by:
António P. Matos and Miguel Ramalho as part of Beyond the Abstract on UroToday.com. This initiative offers a method of publishing for the professional urology community. Authors are given an opportunity to expand on the circumstances, limitations etc... of their research by referencing the published abstract.

Hospital Garcia de Orta, Almada, Portugal

Renal cell carcinoma subtype differentiation using single-phase corticomedullary contrast-enhanced CT- Abstract

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The human endocrine system comprises number of glands such as thyroid, pituitary, parathyroid, pineal, pancreas, parathyroid, thymus, and gonads. These glands secrete hormones (enzymes that regulate the various activities of the body) into the blood which are responsible for metabolism, growth, sexual development and other body functions.

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Endocrinology drugs are used for the treatment of diseases related with insufficient hormones supply and dysfunctional glands. Various diseases related with endocrine system are Addison’s disease, Cushing’s syndrome, goiter, diabetes, gigantism, hypertension, acromegaly, hyperlipidemia, polycystic ovary syndrome (PCOS), osteomalacia and thyroiditis. The study of endocrinology has become one of the most essential aspects in the medical science owing to rising prevalence of diseases associated with endocrine glands.

The global market for endocrinology drugs are divided into segments such as diabetes market, growth hormone market, acromegaly market and hypogonadism market. The market for diabetes is experiencing tremendous growth under the influence of rapidly increasing prevalence of diabetes worldwide. According to statistics of International Diabetes Foundation (IDF), in 2013, the global population diagnosed with diabetes was around 355 million, and is anticipated to grow to reach 592 million by the end of 2035. Such rapid prevalence of diabetes fuels the growth of diabetes market. Inception of new drug delivery for growth hormone and rising cases of end stage renal disease (ESRD), cancer, along with rise in disposable income are factors that drive the market for human growth hormone. On the other hand off label uses of human growth hormone (HGH) for body building, anti-aging and in sports are posing a challenge to the society not only because it is illegal but also because use of human growth hormone (HGH) is associated with high risk and side effects. Hypogonadism market comprises testosterone, estrogen and progesterone replacement therapy market. This segment will experience the growth due to increasing awareness about post menopausal hazards amongst women, awareness about testosterone amongst men. Extensive R&D is another important factor that propels growth of the market. As of 2013, there are around 180 new formulations under pipeline studies to treat diabetes, out of which, around 13 are waiting for approval from regulatory bodies.

Some of the major drugs in this market include flodrocortisone (Addison’s disease), corticotrophin (adrenocortical dysfunction), hydrocortisone (allergies), carbimazole (anti-thyroid drugs), insulin, metformin, Nateglinide (diabetes) and many others.

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Recent years have witnessed many advances in the treatment of endocrine diseases such as introduction of new drugs and novel drug delivery methods. Recently FDA approved endocrinology drugs include Osphena (ospemifene) of Shiongi for the treatment of dyspareunia, and vulvar and vaginal atrophy due to menopause, and Invokana (canagliflozin) of Janssen Pharmaceuticals, Afrezza by MannKind Corporation for the treatment of diabetes mellitus. Others include Brisdelle (low-dose paroxetine mesylate), Belviq (lorcaserin hydrochloride), Nesina (alogliptin), and Cometriq (cabozantinib). On the other hand, patent expiry, high cost of R&D and treatment and limited awareness for some of the endocrinology disorders are the major hurdles in the growth of this market. The market is expected to face expiration of many patent including Sandostatin, Lantus, and Norditropin that will boost generic manufactures. However, due to loss of revenue due to premium pricing of patented products, the market is expected to face challenges. Further, high cost of treatment and complicated reimbursement policies may create some hurdles in the growth of market.

Some of the key players operating in this market are Abbott Laboratories, Novartis International AG, Eli Lilly and Company, Novo Nordisk A/S, F. Hoffmann La Roche Ltd, Facet Biotech Corporation, Alacer Corporation, Sanofi and Pfizer Inc.

This research report analyzes this market on the basis of its market segments, major geographies, and current market trends. Geographies analyzed under this research report include

• North America
• Asia Pacific
• Europe
• Middle East and Africa
• Latin America

This report provides comprehensive analysis of

• Market growth drivers
• Factors limiting market growth
• Current market trends
• Market structure
• Market projections for upcoming years

This report is a complete study of current trends in the market, industry growth drivers, and restraints. It provides market projections for the coming years. It includes analysis of recent developments in technology, Porter’s five force model analysis and detailed profiles of top industry players. The report also includes a review of micro and macro factors essential for the existing market players and new entrants along with detailed value chain analysis.

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