A nomogram model for challenging cases: differentiating fat-poor angiomyolipoma from clear cell renal cell carcinoma in uncertain or misdiagnosed tumors.

Journal: Abdominal radiology (New York)
Published Date: Jan 12, 2026

Abstract

PURPOSE: To develop and validate a nomogram model that can accurately differentiate fat-poor angiomyolipoma (fp-AML) from clear cell renal cell carcinoma (ccRCC) in clinically challenging scenarios where conventional imaging diagnosis is uncertain or erroneous. METHODS: This retrospective study included 404 patients with renal tumors. Unlike conventional cohort partitioning, we designed a clinically relevant test cohort specifically comprising two types of "difficult" cases: 74 patients with an indeterminate imaging diagnosis and 47 patients whose initial imaging diagnosis contradicted the pathological report. The training cohort (n = 283) consisted of cases with consistent imaging and pathological diagnoses. From preoperative computed tomography (CT) images, 1864 radiomic features were extracted. After a rigorous feature selection process using the Least Absolute Shrinkage, Selection Operator (LASSO) regression, and Max-Relevance and Min-Redundancy (mRMR), 25 robust features were retained. Seven machine learning algorithms were evaluated to build the prediction model. RESULTS: The ExtraTrees model demonstrated the best generalizability on the independent test cohort comprised of challenging cases, achieving an area under the curve (AUC) of 0.777. By integrating the radiomic model with clinical features, we constructed a nomogram. This combined model showed significantly improved performance, with an AUC of 0.815 (95% CI: 0.739-0.891) in the test cohort, outperforming the clinical model (AUC = 0.712) and the radiomics-only model (AUC = 0.777). Decision curve analysis confirmed the substantial clinical net benefit of the nomogram. CONCLUSION: This model provides a reliable tool to assist radiologists and urologists in making precise preoperative diagnoses for the most challenging renal tumors, thereby potentially avoiding unnecessary surgeries.

Authors

  • Yue Xiao
    School of Mechanical Engineering, Nanchang Institute of Technology, Nanchang, Jiangxi 330099, China.
  • Mei Yang
    Department of Geriatric Cardiology; National Center for Clinical Research of Geriatric Diseases, Xiangya Hospital, Central South University, Changsha 410008, China.
  • Zilong Jiang
    School of Computer Science and Technology, Wuhan University of Technology, Wuhan, Hubei Province, China.
  • Yihan Sheng
    The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China.
  • Haifeng Fan
    The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China.
  • Xupeng Ye
    The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China.
  • Ying Lei
    Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, Guangdong, 510000, China.
  • Huchao Mao
    The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China.
  • Yan Zhang
    Affiliated Hospital of Liaoning University of Traditional Chinese Medicine, Shenyang, 110032, China.
  • Quanqian Zhang
    The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China. [email protected].

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