Nephrometry scoring systems: their importance for the planning of nephron-sparing surgery and the relationships among them

Dubeux, Victor; Zanier, José Fernando Cardona; Chantong, Carolina Gianella Cobo; Carrerette, Fabricio; Gabrich, Pedro Nicolau; Damiâo, Ronaldo

doi:10.1590/0100-3984.2021.0166

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Review Article • Radiol Bras 55 (04) • Jul-Aug 2022 • https://doi.org/10.1590/0100-3984.2021.0166 copy

Nephrometry scoring systems: their importance for the planning of nephron-sparing surgery and the relationships among them

Escores nefrométricos: sua importância para o planejamento da nefrectomia parcial e as relações entre eles

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

In recent years, the development of new imaging techniques and scoring systems have improved the diagnosis and management of small renal masses. Imaging-based nephrometry scoring systems play an interesting role in the planning of nephron-sparing surgery, providing surgeons with the information necessary to determine the complexity of the renal mass, to deliver the appropriate postoperative care, and to predict adverse outcomes. The aim of this study was to review nephrometry scoring systems, evaluating their characteristics and the relationships among them. The urology and radiology communities should decide which nephrometry scoring system will prevail and be used in daily practice.

Keywords:
Radiology/standards; Urology/standards; Nephrectomy/methods; Kidney neoplasms/diagnosis; Magnetic resonance imaging; Tomography; X-ray computed

Feature	Points
Feature	1	2	3
Radius (maximum diameter)	≤ 4 cm	> 4 but < 7 cm	≥ 7 cm
Exophytic proportion	≥ 50%	< 50%	0% (100% endophytic)
Nearness of the tumor to the renal collecting system or sinus	≥ 7 mm	> 4 but < 7 mm	≤ 4 mm
Anterior or posterior face	No points given; mass assigned a descriptor of anterior, posterior, or indeterminate
Location relative to the polar lines	Entirely above the upper polar line or entirely below the lower polar line	Mass crosses a polar line	> 50% of the mass is above the upper polar line or below the lower polar line; the mass crosses the axial renal midline; or the mass is entirely between the polar lines

Feature	Points^* * 4-6 points = low risk; 7-9 points = intermediate risk; > 10 points = high risk.
Feature	1	2	3
Anterior or posterior face	No points given; mass assigned a descriptor of anterior or posterior
Longitudinal (polar) location	Upper	Lower	-
Exophytic rate	≥ 50%	< 50%	Endophytic
Renal rim	Lateral	Medial	-
Renal sinus	Not involved	Involved	-
Urinary collecting system	Not involved	Dislocated/infiltrated	-
Tumor diameter	≤ 4.0 cm	4.1-7.0 cm	> 7.0 cm

Feature	Zone 1	Zone 2	Zone 3
Nearness	Mass in contact with the cortex	Mass in contact with the medulla	Mass in contact with the renal collecting system or crossing the renal sinus
Physical zones	Lower pole below collecting system	Lateral but not touching collecting system	Upper pole or touches collecting system
Radius (diameter)	< 2.5 cm	≥ 2.5 cm but < 4.0 cm	≥ 4 cm
Organization	> 50% exophytic	50-75% endophytic	> 75% endophytic
Points^* * 4-6 points = low risk; 7-9 points = intermediate risk; > 10 points = high risk.	1	2	3

Grade	Description	Points
0	Fat around the kidney has no stranding	0
1 (mild/moderate)	Fat around the kidney has some image-dense stranding but no thick bars of inflammation	2
2 (severe)	Fat around the kidney has severe stranding with thick image-dense bars of inflammation	3

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[1] Correspondence: Dr. Victor Dubeux. Hospital Universitário Pedro Ernesto - UERJ. Rua 28 de Setembro, 77, Vila Isabel. Rio de Janeiro, RJ, Brazil, 20551-030. dubeuxvictor@gmail.com.br.