Karabay E, Karsiyakali N, Duvar S, et al. - Researchers evaluated the Plasma atherogenic index (PAI), which is the logarithmic ratio of serum TG level to HDL-C and related to cardiovascular diseases, for its accuracy in determining renal malignancy in localized renal masses preoperatively. Using institutional renal cancer database, they retrospectively analyzed a total of 169 patients who were diagnosed with Bosniak III-IV lesions by imaging modalities and treated in their hospital with partial or radical nephrectomy between 2013 and 2018. Median tumor size of 6.5 (2–18) cm was reported. In 145 (85.8%), pathological diagnosis was malignant and in 24 (14.2%) patients, pathological diagnosis was benign. In multivariable logistic regression analysis, 5.019 times higher risk of malignancy was observed, when PAI was > 0.34. Findings support the utility of the PAI as a predictive tool in suspicion of malignant renal masses. PAI levels may be encouraging for surgeons for nephron-sparing surgery when benign pathology is evident.