Impact of tumor size and sex on diagnostic discrepancies in renal mass imaging.

Renal masses identified on CT or MRI scans may raise suspicion of malignancy, leading to radical or partial nephrectomy; however, pathology reports may reveal benign conditions. This study aimed to identify clinical and radiological factors associated with discrepancies between imaging and pathology reports, which may inform strategies to enhance diagnostic accuracy. We retrospectively reviewed 132 patients who underwent partial or radical nephrectomy between April 2022 and October 2024. All patients underwent preoperative CT, and MRI was conducted when deemed necessary at the physician's discretion. The discrepancy was defined as cases where imaging findings suspicious of malignancy were reported on CT or MRI, but the pathology report later confirmed benign findings. Predictive factors for discrepancies were identified using a multivariate logistic regression model. Of the 132 patients, 98 (74.2%) were diagnosed with renal cell carcinoma (RCC). Among the 31 patients who underwent MRI, 24 (77.4%) were diagnosed with RCC. The discrepancy rate between CT imaging and pathology was 20.6% (27/131). Of these, 7 patients underwent MRI, and in 1 case, the MRI report aligned with the pathology. The overall discrepancy between imaging and pathology was 19.8% (26/131). Multivariable regression analysis revealed that female sex (OR = 5.219, p = 0.001) and a tumor size < 2 cm (OR = 4.826, p = 0.002) were significant factors influencing the discrepancy between imaging and pathology reports. Smaller renal masses (< 2 cm) and female sex were associated with a higher likelihood of diagnostic discrepancy. Considering these factors during imaging interpretation may help reduce overdiagnosis and improve accuracy.