I have two major concerns with this article. First, where does the clinician start counting? The median perirenal fat (PF) distance that correlated with clear-cell renal-cell carcinoma (ccRCC) was 13.1 mm (8.6–17 mm), and for all other masses, including nonclear-cell cancers, it was 11 mm (8–15 mm). It appears that these median values represent all patients, including men and women, young and old, and patients with body mass indices ranging from 13.5 to 55 kg/m2. What we do not have is an individualized baseline for each subset of patients so we know where to begin counting to assess their increased risk of ccRCC. The authors state that for each additional mm increase in PF, the risk of ccRCC also increases, but how does one know that a documented value of 12 mm is actually an increase?
Second, does the preincision discussion of the possible increased risk of having ccRCC, as opposed to a chromophobe, papillary, or sarcomatoid renal-cell cancer, justify a delay in cancer extirpation? Will this measurement actually make a difference in clinical decision making? As with any new diagnostic tool, the ultimate value may not reside in its singular use, but rather add to a future panel of radiographic and serologic markers.
