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To present a new nomogram that uses preoperative clinical features to predict benign pathology in clinical T1a solid renal masses.

Demographic, clinical and pathologic data related to 579 patients diagnosed with clinical solid T1a renal mass were retrospectively collected. Univariate and multivariable logistic regression analyses were used to determine the variables related to benign pathology. Variables with statistical significance were used to develop a nomogram.

The female-to-male ratio was 240/339, with a median age of 56 (47-64) years. 40% (232/579) of all patients had a diagnosis of hypertension or diabetes mellitus or both. All patients had solitary renal lesion with a median size of 3.0 (23-35) cm. Cystic component was noticed in 20.7% (119/579) of the lesions. Benign pathology was detected in 19.9% (115/579) of cases. On univariate analysis, female gender, age less than 60 years, absence of hypertension or diabetes mellitus, symptomatic presentation, smaller tumor size and absence of cystic component were all related to benign pathology. Female gender, age less than 60 years, smaller tumor size and absence of cystic component kept their significance on multivariable analysis. A nomogram was built depending on these variables. The model was close to the ideal and had a c-index value of 0.79.

The nomogram in the present study has good predictive ability for benign pathology in T1a solid renal masses. This will help physicians and patients while making decisions related to the management paradigm.