Retrospective evaluation of ultrasound-indeterminate renal multilocular cystic masses by using neutrophil-lymphocyte ratio and computed tomography

Purpose: To evaluate the clinical usefulness of neutrophil-lymphocyte ratio (NLR) in differentiating the ultrasound-indeterminate renal multilocular cystic masses (RMCM) in comparison with computed tomography (CT) and whether NLR has additional benefits to CT on sensitivity of detecting the malignant. Materials and methods: Overall, 93 patients who underwent normal ultrasound with a conclusion of indeterminate RMCM were examined by NLR and CT within 30 days before surgery or follow-up from March to September 2014 at PLA General Hospital and enrolled in this retrospective study. Logistic regression model was performed to find independent predictors for differentiating true nature of RMCM; differences in the validity parameters and diagnostic power of CT, NLR, and their combination were compared using McNemar tests and AUC model, respectively. Results: The final diagnoses of the 93 patients consisted of 36 patients with benign complex cysts, 16 with multilocular cystic renal cell carcinoma, 9 with multilocular cystic nephroma, and 32 with clear cell renal cell carcinoma. Higher NLR were strongly associated with malignant masses. Multivariate logistic regression analysis revealed that NLR could be an independent predictor for differentiating true nature of these masses (OR = 3.617; 95% CI: 1.219-10.727; P = 0.020). For detecting the malignant masses, the sensitivity, specificity, and accuracy were 71.9%, 80.6%, and 75.3% for CT and 57.9%, 88.9%, and 69.9% for NLR under cutoff value of 2.31, respectively, whereas those of CT + NLR were 89.5%, 69.4%, and 81.7%. No significant difference was found between CT and NLR in sensitivity (P = 0.185), specificity (P = 0.549), and accuracy (P = 0.428). But the sensitivity of CT + NLR was significantly higher than those of CT (P = 0.002) and NLR (P < 0.001), respectively; AUC model analysis indicated that CT + NLR got the largest area of 0.795 (P < 0.001, 95% CI: 0.693-0.896) in comparison with those of CT (area = 0.795, P < 0.001, 95% CI: 0.661-0.864) and NLR (area = 0.734, P < 0.001, 95% CI: 0.631-0.836). Conclusions: Given that NLR, under cutoff value of 2.31, had no diagnostic difference with CT in evaluating the ultrasound indeterminate RMCM. However, combination of CT and NLR could increase the sensitivity of detecting malignant masses and acquire the best diagnostic power. Prospectively larger cohort and multicenter studies are still necessary. (C) 2017 Elsevier Inc. All rights reserved.