838 IMAGE-BASED FEASIBILITY OF RENAL SPARING SURGERY FOR LOW VOLUME UNILATERAL WILMS TUMORS
Bibliographic record
Abstract
You have accessJournal of UrologyPediatrics: Stones/Tumors1 Apr 2012838 IMAGE-BASED FEASIBILITY OF RENAL SPARING SURGERY FOR LOW VOLUME UNILATERAL WILMS TUMORS Fernando Ferrer, Rosen Nancy, Fernandez Conrad, Katherine Herbst, Geetika Khanna, Jeffrey dome, Robert Shamberger, Michael Ritchey, and Peter Ehrlich Fernando FerrerFernando Ferrer Hartford, CT More articles by this author , Rosen NancyRosen Nancy New York, NY More articles by this author , Fernandez ConradFernandez Conrad Halifax, Canada More articles by this author , Katherine HerbstKatherine Herbst Hartford, CT More articles by this author , Geetika KhannaGeetika Khanna St Louis, MO More articles by this author , Jeffrey domeJeffrey dome Washington DC, DC More articles by this author , Robert ShambergerRobert Shamberger Boston, MA More articles by this author , Michael RitcheyMichael Ritchey Phoenix, AZ More articles by this author , and Peter EhrlichPeter Ehrlich Ann Arbor, MI More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2012.02.929AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Partial nephrectomy is performed infrequently in children with unilateral Wilms tumor. Our objective was to assess the theoretical feasibility, as predicted by preoperative imaging, of performing renal sparing surgery in patients with very low risk, stage 1 disease enrolled in COG study AREN03B2. We hypothesized that this group of patients would be most amenable to a renal sparing approach because of the smaller tumor size. METHODS 60 consecutive patients enrolled on ARENO3B2 met our study inclusion criteria (age < 2 years, tumor < 550 gms and Stage I). Preoperative CT scans were reviewed simultaneously by a COG Renal Tumor Committee surgeon experienced in partial nephrectomy and, a COG Renal Tumor Committee radiologist. Parameters evaluated were: tumor dimension, tumor weight, location of tumor, vascular involvement, feasibility of partial nephrectomy and percentage of kidney spared, if partial was possible. Specific criteria determining feasibility of renal salvage included: ability to perform procedure in-situ, absence of tumor involving/directly abutting the renal hilar vessels, ability to obtain an adequate margin (> 1 cm) while preserving at least 1/3 of the renal unit. RESULTS The mean patient age was 10.6 months, 48% were females-52% males. 55% tumors were left side, 45% right. Mean tumor weight was 315gms at nephrectomy. Tumor locations are shown in the figure 1. In 32% of tumors the vasculature was engulfed by tumor preventing PN. Partial nephrectomy was deemed not feasible in 91% of cases. In 9% (5 pts) of cases, partial nephrectomy was considered theoretically feasible. 75 % or greater of the kidney could have been preserved in 1 child (a polar lesion), 50% in 4 patients (polar lesions involving the central zone). CONCLUSIONS In this cohort of very low risk patients, 9% would theoretically have been candidates for PN based on preoperative imaging. Utilizing the current COG approach of upfront surgery, a minority of very low risk unilateral Wilms tumor patients are candidates for renal sparing procedures. © 2012 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 187Issue 4SApril 2012Page: e342 Advertisement Copyright & Permissions© 2012 by American Urological Association Education and Research, Inc.MetricsAuthor Information Fernando Ferrer Hartford, CT More articles by this author Rosen Nancy New York, NY More articles by this author Fernandez Conrad Halifax, Canada More articles by this author Katherine Herbst Hartford, CT More articles by this author Geetika Khanna St Louis, MO More articles by this author Jeffrey dome Washington DC, DC More articles by this author Robert Shamberger Boston, MA More articles by this author Michael Ritchey Phoenix, AZ More articles by this author Peter Ehrlich Ann Arbor, MI More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.033 | 0.003 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".