Top

Published in:

01-12-2020 | Computed Tomography | Educational Review

Active surveillance of small renal masses

Authors: Carmen Sebastià, Daniel Corominas, Mireia Musquera, Blanca Paño, Tarek Ajami, Carlos Nicolau

Published in: Insights into Imaging | Issue 1/2020

Abstract

Most renal masses incidentally detected by cross-sectional images are benign, being mainly cysts, and if they are malignant, they are indolent in nature with limited metastatic potential. Enhanced renal masses less than 4 cm in size are known as small renal masses (SRMs), and their growth rate (GR) and the possibility of developing metastasis are extremely low. Delayed intervention of SRMs by closed and routine imaging follow-up known as active surveillance (AS) is now an option according to urological guidelines. Radiologists have a key position in AS management of SRMs even unifocal and multifocal (sporadic or associated with genetic syndromes) and also in the follow-up of complex renal cysts by Bosniak cyst classification system. Radiologists play a key role in the AS of both unifocal and multifocal (sporadic or associated with genetic syndromes) SRMs as well as in the follow-up of complex renal cysts using the Bosniak cyst classification system. Indeed, radiologists must determine which patients with SRMs or complex renal cysts can be included in AS, establish the follow-up radiological test algorithm to be used in different scenarios, perform measurements in follow-up tests, and decide when AS should be discontinued. The purpose of this article is to review the indications and management of AS in SRMs, especially focused on specific scenarios, such as complex renal cysts and multifocal renal tumors (sporadic or hereditary). In this work, the authors aimed to provide a thorough review of imaging in the context of active surveillance of renal masses.

Gill IS, Aron M, DA Gervais MJ (2010) Small renal mass. N Engl J Med 362(7):624–634CrossRef

Finelli A, Ismaila N, Bro B et al (2017) Management of small renal masses: American Society of Clinical Oncology clinical practice guideline. J Clin Oncol. 35(6):668–680

Ward RD, Tanaka H, Campbell SC, Remer EM (2018) 2017 AUA renal mass and localized renal cancer guidelines: imaging implications. Radiographics 38(7):2021–2033 Available from: http://pubs.rsna.org/doi/10.1148/rg.2018180127

Cadeddu JA, Chang A, Clark PE et al (2017) American Urological Association (AUA). Renal mass and localized renal cancer: AUA guideline American Urological Association (AUA). Am Urol Assoc:1–49 Available from: http://auanet.org/guidelines/renal-mass-and-localized-renal-cancer-new-(2017)

Chawla SN, Crispen PL, Hanlon AL, Greenberg RE, Chen DYT, Uzzo RG (2006) The natural history of observed enhancing renal masses: meta-analysis and review of the world literature. J Urol. 175(2):425–431CrossRef

Volpe A, Panzarella T, Rendon RA, Haider MA, Kondylis FI, Jewett MAS (2004) The natural history of incidentally detected small renal masses. Cancer. 100(4):738–745CrossRef

Greenberg RE, Crispen PL, Viterbo R, Uzzo RG, Fox EB, Chen DYT (2008) Delayed intervention of sporadic renal masses undergoing active surveillance. Cancer. 112(5):1051–1057CrossRef

Touma N, Hosier G, Di Lena M et al (2018) Growth rates and outcomes of observed large renal masses. Can Urol Assoc J 13(8).

Hora M, Powles T, Mulders P, Dabestani S, Staehler M, Canfield S et al (2015) EAU guidelines on renal cell carcinoma: 2014 update. Eur Urol. 67(5):913–924 Available from: https://doi.org/10.1016/j.eururo.2015.01.005

10.

Gervais DA, Giambarresi L, Lane BR et al (2017) Renal mass and localized renal cancer: AUA guideline. J Urol. 198(3):520–529 Available from: https://doi.org/10.1016/j.juro.2017.04.100

11.

Jewett MAS, Richard PO, Finelli A (2015) Management of small renal mass: an opportunity to address a growing problem in early stage kidney cancer. Eur Urol. 68(3):416–417 Available from: https://doi.org/10.1016/j.eururo.2015.05.011

12.

Gordetsky J, Eich M, Garapati M, Rodriguez C, Rais-bahrami S (2019) Defining a small renal mass. Urology 123:157–166 Available from: https://doi.org/10.1016/j.urology.2018.09.017

13.

Bosniak MA (1986) The current radiological approach to renal cyst. Radiology 158(1):1–10CrossRef

14.

Herts BR, Silverman SG, Hindman NM et al (2018) Management of the incidental renal mass on CT: a white paper of the ACR Incidental Findings Committee. J Am Coll Radiol. 15(2):264–273 Available from: https://doi.org/10.1016/j.jacr.2017.04.028

15.

Bertolotto M, Cicero C, Perrone R, Degrassi F, Cacciato F, Cova MA (2015) Renal masses with equivocal enhancement at CT: characterization with contrast-enhanced ultrasound. AJR Am J Roentgenol. 204(5):W557–W565

16.

Nicolau C, Bunesch L, Sebastia C (2011) Renal complex cysts in adults: contrast-enhanced ultrasound. Abdom Imaging. 36(6):742–752CrossRef

17.

Nicolau C, Buñesch L, Paño B et al (2015) Prospective evaluation of CT indeterminate renal masses using US and contrast-enhanced ultrasound. Abdom Imaging. 40(3):542–551

18.

Egbert ND, Caoili EM, Cohan RH, Davenport MS, Francis IR, Ellis JH et al (2013) Differentiation of papillary renal cell carcinoma subtypes on CT and MRI. AJR Am J Roentgenol 201(2):347–355

19.

Williamson SR, Taneja K, Cheng L (2019) Renal cell carcinoma staging: pitfalls, challenges, and updates. Histopathology. 74(1):18–30CrossRef

20.

Hu EM, Zhang A, Silverman SG et al (2018) Multi-institutional analysis of CT and MRI reports evaluating indeterminate renal masses: comparison to a national survey investigating desired report elements. Abdom Radiol (NY) Available from:1–10 https://doi.org/10.1007/s00261-018-1609-x

21.

Kay FU, Pedrosa I (2018) Imaging of solid renal masses. Urol Clin North Am 45(3):311–330 Available from: https://doi.org/10.1016/j.ucl.2018.03.013

22.

Lopes Vendrami C, Parada Villavicencio C, DeJulio TJ et al (2017) Differentiation of solid renal tumors with multiparametric MR imaging. Radiographics 37(7):2026–2042 Available from: http://pubs.rsna.org/doi/10.1148/rg.2017170039

23.

Marconi L, Powles T, Volpe A et al (2015) Systematic review and meta-analysis of diagnostic accuracy of percutaneous renal tumour biopsy. Eur Urol. 69(4):660–673 Available from: https://doi.org/10.1016/j.eururo.2015.07.072

24.

Bhindi B, Thompson RH, Lohse CM et al (2018) The probability of aggressive versus indolent histology based on renal tumor size: implications for surveillance and treatment. Eur Urol 74(4):489–497 Available from: https://doi.org/10.1016/j.eururo.2018.06.003

25.

Dabestani S, Beisland C, Stewart GD et al (2019). Long-term outcomes of follow-up for initially localised clear cell renal cell carcinoma: RECUR Database Analysis. Eur Urol Focus 5(5):857–866.

26.

Sim SH, Messenger MP, Gregory WM et al (2012) Prognostic utility of pre-operative circulating osteopontin, carbonic anhydrase IX and CRP in renal cell carcinoma. Br J Cancer 107(7):1131–1137 Available from: https://doi.org/10.1038/bjc.2012.360

27.

Paterson C, Ghaemi J, Alashkham A et al (2018) Diagnostic accuracy of image-guided biopsies in small (<4 cm) renal masses with implications for active surveillance: a systematic review of the evidence. Br J Radiol 91(1090):20170761.

28.

Turajlic S, Xu H, Litchfield K et al (2018) Deterministic evolutionary trajectories influence primary tumor growth: TRACERx Renal. Cell 173(3):595–610.e11

29.

Ueno D, Xie Z, Boeke M et al (2018) Genomic heterogeneity and the small renal mass. Clin Cancer Res. 24(17):4137–4144

30.

Richard PO, Jewett MAS, Bhatt JR et al (2015) Renal tumor biopsy for small renal masses: a single-center 13-year experience. Eur Urol. 68(6):1007–1013 Available from: https://doi.org/10.1016/j.eururo.2015.04.004

31.

Volpe A, Finelli A, Gill IS et al (2012) Rationale for percutaneous biopsy and histologic characterisation of renal tumours. Eur Urol. 62(3):491–504

32.

Motzer RJ, Jonasch E, Agarwal N et al (2017) Kidney cancer, version 2.2017: clinical practice guidelines in oncology. J Natl Compr Cancer Netw. 15(6):804–834

33.

Khan I, Beksac AT, Paulucci DJ et al (2017) Differences in renal tumor size measurements for computed tomography versus magnetic resonance imaging: implications for patients on active surveillance. J Laparoendosc Adv Surg Tech A 27(12):1275–1278 Available from: http://online.liebertpub.com/doi/10.1089/lap.2017.0234

34.

Choi SM, Choi DK, Kim TH et al (2015). A comparison of radiologic tumor volume and pathologic tumor volume in renal cell carcinoma (RCC). PLoS One. 10(3):1–10

35.

Kurta JM, Thompson RH, Kundu S et al (2009) Contemporary imaging of patients with a renal mass: does size on computed tomography equal pathological size? BJU Int. 103(1):24–27

36.

Chen W, Wang L, Yang Q, Liu B, Sun Y (2013) Comparison of radiographic and pathologic sizes of renal tumors. Int Braz J Urol. 39(2):189–194CrossRef

37.

Nayyar M, Cheng P, Desai B et al (2016) Active surveillance of small renal masses: a review on the role of imaging with a focus on growth rate. J Comput Assist Tomogr. 40(4):517–523

38.

Dorin R, Jackson M, Cusano A et al (2014) Active surveillance of renal masses: an analysis of growth kinetics and clinical outcomes stratified by radiological characteristics at diagnosis. Int Braz J Urol. 40(5):627–636

39.

Dababneh H, Brunocilla E, Bianchi L et al (2014) Small renal masses managed with active surveillance: predictors of tumor growth rate after long-term follow-up. Clin Genitourin Cancer 13(2):e87–e92 Available from: https://doi.org/10.1016/j.clgc.2014.08.006

40.

Mehrazin R, Smaldone MC, Kutikov A et al (2014) Growth kinetics and short-term outcomes of cT1b and cT2 renal masses under active surveillance. J Urol. 192(3):659–664 Available from: https://doi.org/10.1016/j.juro.2014.03.038

41.

Organ M, Jewett M, Basiuk J et al (2014) Growth kinetics of small renal masses: a prospective analysis from the renal cell carcinoma consortium of Canada. Can Urol Assoc J 8(1-2):24–27

42.

Smaldone MC, Kutikov A, Egleston BL et al (2012) Small renal masses progressing to metastases under active surveillance: a systematic review and pooled analysis. Cancer. 118(4):997–1006

43.

Weibl P, Klatte T, Kollarik B et al (2011) Interpersonal variability and present diagnostic dilemmas in Bosniak classification system. Scand J Urol Nephrol 45(4):239–244 Available from: http://www.tandfonline.com/doi/full/10.3109/00365599.2011.562233

44.

Liaw CW, Winoker JS, Mehrazin R (2018) Imaging protocols for active surveillance in renal cell carcinoma. Curr Urol Rep. 19(10):1–7CrossRef

45.

Uzosike AC, Patel HD, Alam R et al (2018) Growth kinetics of small renal masses on active surveillance: variability and results from the DISSRM Registry. J Urol 199(3):641–648 Available from: https://doi.org/10.1016/j.juro.2017.09.087

46.

Crispen PL, Viterbo R, Boorjian SA, Greenberg RE, Chen DYT, Uzzo RG (2009) Natural history, growth kinetics, and outcomes of untreated clinically localized renal tumors under active surveillance. Cancer. 115(13):2844–2852CrossRef

47.

Punnen S, Haider MA, Lockwood G, Moulding F, O’Malley ME, Jewett MAS (2006) Variability in size measurement of renal masses smaller than 4 cm on computerized tomography. J Urol. 176(6):2386–2390CrossRef

48.

Mucksavage P, Ramchandani P, Malkowicz SB, Guzzo TJ (2012) Is ultrasound imaging inferior to computed tomography or magnetic resonance imaging in evaluating renal mass size? Urology. 79(1):28–31CrossRef

49.

Chandrasekar T, Ahmad AE, Fadaak K et al (2018) Natural history of complex renal cysts: clinical evidence supporting active surveillance. J Urol 199(3):633–640 Available from: https://doi.org/10.1016/j.juro.2017.09.078

50.

Siegel RL, Miller KD, Jemal A (2019) Cancer statistics, 2019. CA Cancer J Clin 69(1):7–34 Available from: http://www.ncbi.nlm.nih.gov/pubmed/30620402

51.

Schoots IG, Zaccai K, Hunink MG, Verhagen PCMS (2017) Bosniak classification for complex renal cysts reevaluated: a systematic review. J Urol. 198(1):12–21 Available from: https://doi.org/10.1016/j.juro.2016.09.160

52.

Bosniak MA (2012) The Bosniak renal cyst classification: 25 years later. Radiology. 262(3):781–785CrossRef

53.

Pruthi DK, Liu Q, Kirkpatrick IDC, Gelfond J, Drachenberg DE (2018) Long-term surveillance of complex cystic renal masses and heterogeneity of Bosniak 3 lesions. J Urol 200(6):1192–1199 Available from: https://doi.org/10.1016/j.juro.2018.07.063

54.

Reese AC, Johnson PT, Gorin MA et al (2014) Pathological characteristics and radiographic correlates of complex renal cysts. Urol Oncol Semin Orig Investig 32(7):1010–1016 Available from: https://doi.org/10.1016/j.urolonc.2014.02.022

55.

Weibl P, Hora M, Kollarik B, Shariat SF, Klatte T (2015) Management, pathology and outcomes of Bosniak category IIF and III cystic renal lesions. World J Urol. 33(3):295–300CrossRef

56.

Smith AD, Allen BC, Carson JD et al (2015) Outcomes and complications related to the management of Bosniak cystic renal lesions. AJR Am J Roentgenol 204(5):550–556

57.

Quaia E, Bertolotto M, Cioffi V et al (2008) Comparison of contrast-enhanced sonography with unenhanced sonography and contrast-enhanced CT in the diagnosis of malignancy in complex cystic renal masses. AJR Am J Roentgenol. 191(4):1239–1249

58.

Braunagel M, Graser A, Reiser M, Notohamiprodjo M (2014) The role of functional imaging in the era of targeted therapy of renal cell carcinoma. World J Urol. 32(1):47–58CrossRef

59.

Hora M, Hes O, Michal M et al (2005) Extensively cystic renal neoplasms in adults (Bosniak Classification II or III) - possible “common” histological diagnoses: multilocular cystic renal cell carcinoma, cystic nephroma, and mixed epithelial and stromal tumor of the kidney. Int Urol Nephrol. 37(4):743–750

60.

Hora M, Ürge T, Eret V et al (2011) Tubulocystic renal carcinoma: a clinical perspective. World J Urol. 29(3):349–354

61.

Siracusano S, Bertolotto M, Ciciliato S, Valentino M, Liguori G, Visalli F (2011) The current role of contrast-enhanced ultrasound (CEUS) imaging in the evaluation of renal pathology. World J Urol. 29(5):633–638CrossRef

62.

Shuch B, Singer EA, Bratslavsky G (2012) The surgical approach to multifocal renal cancers: hereditary syndromes, ipsilateral multifocality, and bilateral tumors. Urol Clin North Am. 39(2):133–148CrossRef

63.

Sheikh NA, Khan MH, Pillai S, Lang S, Nabi G (2018) Outcomes of synchronous and metachronous bilateral small renal masses (< 4 cm): a population-based cohort study. Int Urol Nephrol. 50(4):657–663CrossRef

64.

Hu X-Y, Xu L, Guo J-M, Wang H (2017) Surgical strategy of bilateral synchronous sporadic renal cell carcinoma-experience of a Chinese university hospital. World J Surg Oncol. 15(1):53CrossRef

65.

Berczi C, Thomas B, Bacso Z, Flasko T (2016) Bilateral renal cancers: oncological and functional outcomes. Int Urol Nephrol. 48(10):1617–1622CrossRef

66.

Wells GM, Schroth W, Brauch H, Ross EA (2009) Bilateral renal-cell carcinoma associated with an acquired VHL mutation and long-term trichloroethylene exposure. Clin Nephrol. 71(6):708–713CrossRef

67.

Hollingsworth JM, Miller DC, Daignault S, Hollenbeck BK (2006) Rising incidence of small renal masses: a need to reassess treatment effect. J Natl Cancer Inst. 98(18):1331–1334CrossRef

68.

Whang M, O’Toole K, Bixon R et al (1995) The incidence of multifocal renal cell carcinoma in patients who are candidates for partial nephrectomy. J Urol. 154(3):968–970 discussion 970-1

69.

Cheng WS, Farrow GM, Zincke H (1991) The incidence of multicentricity in renal cell carcinoma. J Urol. 146(5):1221–1223

70.

Gudbjartsson T, Jónasdóttir TJ, Thoroddsen Á et al (2002) A population-based familial aggregation analysis indicates genetic contribution in a majority of renal cell carcinomas. Int J Cancer. 100(4):476–479

71.

Bratslavsky G, Linehan WM (2010) Long-term management of bilateral, multifocal, recurrent renal carcinoma. Nat Rev Urol. 7(5):267–275CrossRef

72.

Walther MM, Choyke PL, Glenn G et al (1999) Renal cancer in families with hereditary renal cancer: prospective analysis of a tumor size threshold for renal parenchymal sparing surgery. J Urol. 161(5):1475–1479

73.

Herring JC, Enquist EG, Chernoff A, Linehan WM, Choyke PL, Walther MM (2001) Parenchymal sparing surgery in patients with hereditary renal cell carcinoma: 10-year experience. J Urol. 165(3):777–781CrossRef

Title: Active surveillance of small renal masses
Authors: Carmen Sebastià
Daniel Corominas
Mireia Musquera
Blanca Paño
Tarek Ajami
Carlos Nicolau
Publication date: 01-12-2020
Publisher: Springer Berlin Heidelberg
Keywords: Computed Tomography
Kidney Cancer
Kidney Cancer
Renal Cancer
Computed Tomography
Kidney Cancer
Published in: Insights into Imaging / Issue 1/2020
Electronic ISSN: 1869-4101
DOI: https://doi.org/10.1186/s13244-020-00853-y

At a glance: The STEP trials

Springer Medicine

Active surveillance of small renal masses

Abstract

At a glance: The STEP trials

Springer Medicine

Abstract

Please log in to get access to this content

Other articles of this Issue 1/2020

Integrative radiogenomics for virtual biopsy and treatment monitoring in ovarian cancer

Deep learning-based thigh muscle segmentation for reproducible fat fraction quantification using fat–water decomposition MRI

Prevalence and risk factors for lung involvement on low-dose chest CT (LDCT) in a paucisymptomatic population of 247 patients affected by COVID-19

MRI characterization of focal liver lesions in non-cirrhotic patients: assessment of added value of gadoxetic acid-enhanced hepatobiliary phase imaging

Giving radiologists a voice: a review of podcasts in radiology

Application of ultrasound multimodal score in the assessment of endometrial receptivity in patients with artificial abortion