# Diagnostic performance of the clear cell likelihood score integrated with cystic degeneration or necrosis on MR imaging for identifying clear cell renal cell carcinoma in cT1 solid renal masses

## TL;DR

This study shows that adding cystic degeneration or necrosis to a scoring system improves the accuracy of diagnosing clear cell kidney cancer in early-stage tumors.

## Contribution

The study introduces a modified scoring system (cn-ccLS) that integrates cystic degeneration or necrosis with the clear cell likelihood score for better diagnostic accuracy.

## Key findings

- cn-ccLS significantly increased sensitivity for diagnosing clear cell renal cell carcinoma compared to the original score.
- The modified score maintained high specificity while improving detection rates for both cT1a and cT1b tumors.
- cn-ccLS reduced the proportion of clear cell renal cell carcinoma cases in intermediate-risk lesions.

## Abstract

To evaluate the diagnostic value of the clear cell likelihood score (ccLS) integrated with cystic degeneration or necrosis on renal MR imaging for diagnosing clear cell renal cell carcinoma (ccRCC) in cT1 solid renal masses (SRMs).

This retrospective study consecutively enrolled patients with pathologically confirmed SRMs who underwent MRI at the First Medical Center of the Chinese PLA General Hospital between January 2022 and February 2024. Three radiologists independently scored all cT1 SRMs using ccLS and ccLS integrated with cystic degeneration or necrosis (cn-ccLS), with discrepancies reconciled by consensus. Sensitivity, specificity, and accuracy were used to assess the performance of ccLS and cn-ccLS.

A total of 287 patients with 293 masses were included in this study. The sample comprised 229 ccRCCs (78%), 64 other tumors. The sensitivity of cn-ccLS was significantly higher than ccLS (92% vs 74%; p < 0.001), with equal specificity to ccLS (88% vs 91%; p > 0.05). For cT1a and cT1b SRMs, the sensitivity of cn-ccLS was significantly higher than ccLS (cT1a: 90% vs 74%, p < 0.05; cT1b: 98% vs 75%, p < 0.001).

Incorporating cystic degeneration or necrosis into the ccLS system significantly enhances the diagnostic performance of the ccLS system for ccRCC in cT1 SRMs. However, future validation of the ccLS system through large-sample, multi-center, and prospective studies is still required.

Incorporating cystic degeneration or necrosis into the ccLS system enhances performance for ccRCC in cT1 SRMs. It may enhance the value of ccLS and assist radiologists in their daily diagnostic work.

The cn-ccLS effectively reduced the proportion of ccRCC among ccLS 3 lesions.cn-ccLS better diagnosed ccRCC for cT1a or cT1b renal masses than ccLS.ccRCC sensitivity was improved, but the impact on non-ccRCC remains unevaluated.

The cn-ccLS effectively reduced the proportion of ccRCC among ccLS 3 lesions.

cn-ccLS better diagnosed ccRCC for cT1a or cT1b renal masses than ccLS.

ccRCC sensitivity was improved, but the impact on non-ccRCC remains unevaluated.