Importance of patient compliance in small renal mass active surveillance.
Bibliographic record
Abstract
An 81-year-old man was found to have a 2.5 × 2.4 × 2.0 cm right renal mass during hematuria evaluation using computerized tomographic (CT) scan of the abdomen in 2007 (Fig. 1, panel A, arrow). The patient was placed in a multicentre active surveillance trial.1 Pathologic examination of the small renal mass (SRM) biopsy was inconclusive and not repeated. A year later, the mass expanded to 3.0 × 2.5 × 2.0 cm (Fig. 1, panel B, arrow). However, the patient withdrew from the trial and was lost to follow-up. Fig. 1. A: Image of the 2.5 × 2.4 × 2.0 cm right renal mass (2007); B: A year later (2008), image of the expanded mass to 3.0 × 2.5 × 2.0 cm; C: Image of the mass expanded to 7.0 × 7.0 × 6.5 cm (2010); D: 2010 tumour ... In 2010, a repeat CT scan performed to investigate gross hematuria demonstrated that the mass grew to 7.0 × 7.0 × 6.5 cm (Fig. 1, panel C, arrow), with tumour thrombus extension into the inferior vena cava to the right atrium (Fig. 1, panel D, arrow). The patient underwent radical nephrectomy and caval thrombectomy. The pathology report disclosed Fuhrman grade 3 clear cell renal cell carcinoma, negative margins and negative nodes. Nine months postoperatively, the patient developed pulmonary metastasis. Although active surveillance of a SRM is considered an appropriate strategy for patients with significant comorbidity or with short life expectancy, compliance to surveillance is paramount. This case illustrates how delaying immediate resection in lieu of active surveillance may lead to significant progression as a result of non-compliance.
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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 | 0.006 | 0.041 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.002 | 0.001 |
| Scholarly communication | 0.002 | 0.002 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.003 | 0.003 |
| Insufficient payload (model declined to judge) | 0.002 | 0.001 |
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".