ArticleUrologic oncology2023
Distinguishing lipid-poor angiomyolipoma from renal carcinoma using tumor shape.
Article in Urologic oncology, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 6 papers.
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Who cites it
6 citing papers in PubMed, 12 citations in OpenAlex.
- Article
- Resolution of hypokalemia following nephrectomy for a presumed renal cell carcinoma revealing a large angiomyolipoma: A case report.Urology case reports · 2025Article
- Article
- Usefulness of the internal-to-external circle area ratio in contrast-enhanced CT to differentiate small (< 3 cm) fat-poor angiomyolipoma from renal cell carcinoma.BMC medical imaging · 2025Article
- In Pursuit of KI-RADS: Toward a Single, Evidence-based Imaging Classification of Renal Masses.Radiology · 2025Review
- Determinants of conventional and contrast-enhanced ultrasound diagnosis of fat-poor angiomyolipoma <5 cm.Frontiers in oncology · 2024Article
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Authors and funding
4 authors at 1 institution in 1 country.
Funding
Abstract
objectivesTo validate the "overflowing beer sign" (OBS) for distinguishing between lipid-poor angiomyolipoma (AML) and renal cell carcinoma, and to determine whether it improves the detection of lipid-poor AML when added to the angular interface sign, a previously-validated morphologic feature associated with AML.
methodsRetrospective nested case-control study of all 134 AMLs in an institutional renal mass database matched 1:2 with 268 malignant renal masses from the same database. Cross-sectional imaging from each mass was reviewed and the presence of each sign was identified. A random selection of 60 masses (30 AML and 30 benign) was used to measure interobserver agreement.
resultsBoth signs were strongly associated with AML in the total population (OBS: OR 17.4 95% CI 8.0-42.5, p < 0.001; angular interface: OR 12.6, 95% CI 5.9-29.7, p < 0.001) and the population of patients excluding those with visible macroscopic fat (OBS: OR 11.2, 95% CI 4.8-28.7, p < 0.001; angular interface: 8.5, 95% CI 3.7-21.1, p < 0.001). In the lipid-poor population, the specificity of both signs was excellent (OBS: 95.6%, 95% CI 91.9%-98%; angular interface: 95.1%, 95% CI 91.3%-97.6%). Sensitivity was low for both signs (OBS: 31.4%, 95% CI 24.0-45.4%; angular interface: 30.5%, 95% CI 20.8%-41.6%). Both signs showed high levels of inter-rater agreement (OBS 90.0% 95% CI 80.5 - 95.9; angular interface 88.6, 95% CI 78.7-94.9) Testing for AML using the presence of either sign in this population improved sensitivity (39.0%, 95% CI 28.4%-50.4%, p = 0.023) without significantly reducing specificity (94.2%, 95% CI 90%-97%, p = 0.2) relative to the angular interface sign alone.
conclusionsRecognition of the OBS increases the sensitivity of detection of lipid-poor AML without significantly reducing specificity.
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