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Diagnostic Modalities

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The Management of Small Renal Masses

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Abbreviations

CT:

Computed tomography

CECT:

Contrast-enhanced CT

CEUS:

Contrast-enhanced ultrasound

DWI:

Diffusion-weighted imaging

FSE:

Fast spin echo

FDG:

Fluorine-18 fluoro-2-deoxyglucose

GRE:

Gradient-recalled echo

PET:

Positron emission tomography

RCC:

Renal cell carcinomas

US:

Ultrasound

References

  1. Cancer Research UK. Kidney Cancer Statistics. http://www.cancerresearchuk.org/health-professional/cancer-statistics/statistics-by-cancer-type/kidney-cancer#heading-Zero. Accessed on 15 Nov 2014.

  2. Jayson M, Sanders H. Increased incidence of serendipitously discovered renal cell carcinoma. Urology. 1998;51:203–5.

    Article  CAS  PubMed  Google Scholar 

  3. Cohen HT, McGovern FJ. Renal-cell carcinoma. N Engl J Med. 2005;353:2477–90.

    Article  CAS  PubMed  Google Scholar 

  4. Frank I, Blute ML, Cheville JC, Lohse CM, Weaver AL, Zincke H. Solid renal tumours: an analysis of pathological features related to tumor size. J Urol. 2003;170:2217–20.

    Article  PubMed  Google Scholar 

  5. Kukitov A, Fossett LK, Ramchandani P, Tomaszewski JE, Siegelman ES, Banner MP, Van Arsdalen KN, Wein AJ, Malkowicz SB. Incidence of benign pathologic findings at partial nephrectomy for solitary renal mass presumed to be renal cell carcinoma on preoperative imaging. Urology. 2006;68:737–40.

    Article  Google Scholar 

  6. Jeon HG, Lee SR, Kim KH, Oh YT, Cho NH, Rha KH, Yang SC, Han WK. Benign lesions after partial nephrectomy for presumed renal cell cancer in masses 4 cm or less: prevalence in Korean patients. Urology. 2010;76:574–9.

    Article  PubMed  Google Scholar 

  7. Israel GM, Hindman N, Bosniak MA. Evaluation of cystic renal masses: comparison of CT and MR imaging by using the Bosniak classification system. Radiology. 2004;231:365–71.

    Article  PubMed  Google Scholar 

  8. Israel GM, Bosniak MA. How I do it: evaluating renal masses. Radiology. 2005;236:441–50.

    Article  PubMed  Google Scholar 

  9. Maki DD, Birnbaum BA, Chakraborty DP, Jacobs JE, Carvalho BM, Herman GT. Renal cyst pseudoenhancement: beam hardening effects on CT numbers. Radiology. 1999;213:468–72.

    Article  CAS  PubMed  Google Scholar 

  10. Kim JK, Park SY, Shon JL, Cho KS. Angiomyolipoma with minimal fat: differentiation from renal cell carcinoma at biphasic helical CT. Radiology. 2004;230:677–84.

    Article  PubMed  Google Scholar 

  11. Jinzaki M, Tanimoto A, Narimatsu Y, Ohkuma K, Kurata T, Shinmoto H, Hiramatsu K, Mukai M, Murai M. Angiomyolipoma: imaging findings in lesions with minimal fat. Radiology. 1997;205:497–502.

    Article  CAS  PubMed  Google Scholar 

  12. Richmond L, Atri M, Sherman C, Sharir S. Renal cell carcinoma containing macroscopic fat on CT mimics an angiomyolipoma due to bone metaplasia without macroscopic calcification. Br J Radiol. 2010;83:179–81.

    Article  Google Scholar 

  13. Strotzer M, Lehner KB, Becker K. Detection of fat in renal cell carcinoma mimicking angiomyolipoma. Radiology. 1993;188:427–8.

    Article  CAS  PubMed  Google Scholar 

  14. Prando A. Intratumoral fat in a renal cell carcinoma. AJR Am J Roentgenol. 1991;156:871.

    Article  CAS  PubMed  Google Scholar 

  15. Lesavre A, Correas J, Merran S, Grenier N, Vieillefond A, Helenon O. CT of papillary renal cell carcinomas with cholesterol necrosis mimicking angiomyolipomas. AJR Am J Roentgenol. 2003;181:143–5.

    Article  PubMed  Google Scholar 

  16. Chawla SN, Crispen PL, Hanlon AL, Greenberg RE, Chen DYT, Uzzo RG. The natural history of observed renal enhancing masses: meta-analysis and review of the world literature. J Urol. 2006;175:425–31.

    Article  PubMed  Google Scholar 

  17. Kassouf W, Aprikian AG, Laplante M, Tanguay S. Natural history of renal masses followed expectantly. J Urol. 2004;171:111–3.

    Article  CAS  PubMed  Google Scholar 

  18. Crispen PL, Viterbo R, Boorjian SA, Greenberg RE, Chen DYT, Uzzo RG. Natural history, growth kinetics, and outcomes of untreated clinically localized renal tumors under active surveillance. Cancer. 2009;115:2844–52.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Jewett MAS, Mattar K, Basiuk J, Morash CG, Pautler SE, Siemens DR, Tanguay S, Rendon RA, Gleave ME, Drachenberg DE, Chow R, Chung H, Chin JL, Fleshner NE, Evans AJ, Gallie BL, Haider MA, Kachura JR, Kurban G, Fernandes K, Finelli A. Active surveillance of small renal masses: progression patterns of early stage kidney cancer. Eur Urol. 2011;60:39–44.

    Article  PubMed  Google Scholar 

  20. Kunkle DA, Crispen PL, Chen DY, Greenberg RE, Uzzo RG. Enhancing renal masses with zero net growth during active surveillance. J Urol. 2007;177:849–53.

    Article  PubMed  Google Scholar 

  21. Siu W, Hafez KS, Johnston WK III, Wolf JS Jr. Growth rates of renal cell carcinoma and oncocytoma under surveillance are similar. Urol Oncol. 2007;25:115–9.

    Article  PubMed  Google Scholar 

  22. Smaldone MC, Kutikov A, Egleston BL, Canter DJ, Viterbo R, Chen DYT, Jewett MA, Greenberg RE, Uzzo RG. Small renal masses progressing to metastases under active surveillance. Cancer. 2012;118:997–1006.

    Article  PubMed  Google Scholar 

  23. Schatz SM, Lieber MM. Update on oncocytoma. Curr Urol Rep. 2003;4:30–5.

    Article  PubMed  Google Scholar 

  24. Quinn MJ, Hartman DS, Friedman AC, Sherman JL, Lautin EM, Pyatt RS, Ho CK, Csere R, Fromowitz FB. Renal oncocytoma: new observations. Radiology. 1984;153:49–53.

    Article  CAS  PubMed  Google Scholar 

  25. Choudharya S, Rajesha A, Mayerb NJ, Mulcahya KA, Haroon A. Renal oncocytoma: CT features cannot reliably distinguish oncocytoma from other renal neoplasms. Clin Radiol. 2009;64:517–22.

    Article  Google Scholar 

  26. Siegel CL, McFarland EG, Brink JA, Fisher AJ, Humphrey P, Heiken JP. CT of cystic renal masses: analysis of diagnostic performance and interobservor variation. AJR Am J Roentgenol. 1997;169:813–8.

    Article  CAS  PubMed  Google Scholar 

  27. Parienty RA, Pradel J, Pariety I. Cystic renal cancers: CT characteristics. Radiology. 1985;157:741–4.

    Article  CAS  PubMed  Google Scholar 

  28. Bosniak MA. The current radiological approach to renal cysts. Radiology. 1986;158:1–10.

    Article  CAS  PubMed  Google Scholar 

  29. Curry NS, Cochran ST, Bissada NK. Cystic renal masses: accurate Bosniak classification requires adequate renal CT. AJR Am J Roentgenol. 2000;175:339–42.

    Article  CAS  PubMed  Google Scholar 

  30. Bosniak MA. Bosniak classification system for renal cysts and cystic tumours. J Urol. 1997;157:1852–3.

    Article  CAS  PubMed  Google Scholar 

  31. Warren KS, McFarlane J. The Bosniak classification of renal cystic masses. BJU Int. 2005;95:939–42.

    Article  PubMed  Google Scholar 

  32. Kutikov A, Uzzo RG. The R.E.N.A.L. nephrometry score: A comprehensive standardized system for quantitating renal tumor size, location and depth. J Urol. 2009;182:844–53.

    Google Scholar 

  33. Ficarra V, Novara G, Secco S, Macchi V, Porzionato A, De Caro R, Artibani W. Preoperative aspects and dimensions used for an anatomical (PADUA) classification of renal tumours in patients who are candidates for nephron-sparing surgery. Eur Urol. 2009;56:786–93.

    Article  PubMed  Google Scholar 

  34. Simmons MN, Ching CB, Samplaski MK, Park CH, Gill IS. Kidney tumor location measurement using the C index method. J Urol. 2010;183:1708–13.

    Article  PubMed  Google Scholar 

  35. Nisen H, Ruutu M, Glucker E, Visapaa H, Taari K. Renal tumour invasion index as a novel anatomical classification predicting urological complications after partial nephrectomy. Scand J Urol. 2014;48:41–51.

    Article  PubMed  Google Scholar 

  36. Tomaszewski JJ, Cung B, Smaldone MC, Mehrazin R, Kutikov A, Viterbo R, et al. Renal pelvic anatomy is associated with incidence grade and need for intervention for urine leak following partial nephrectomy. Eur Urol. 2013:pii: S0302.

    Google Scholar 

  37. Hayn MH, Schwaab T, Underwood W, Kim HL. RENAL nephrometry score predicts surgical outcomes of laparoscopic partial nephrectomy. BJU Int. 2011;108:87–1.

    Google Scholar 

  38. Khemees TA, Yuh BJ, Stacey A, Sharp DS, Abaza R, Box GN, et al. Post-operative morbidity of robotic versus open partial nephrectomy: the impact of preoperative tumour characteristics. J Urol. 2010;183:386.

    Article  Google Scholar 

  39. Hew MN. Baseskioglu B, Barwari K, Axwijk PH, can C, Horenblas S, Bex a, de lat rosette JJMCH, Laguna pes MP. Critical appraisal of the PADUA classification and assessment of the RENAL nephrometry scores in patients undergoing partial nephrectomy. J Urol. 2011;186:42–6.

    Article  CAS  PubMed  Google Scholar 

  40. Millet I, Duyon FC, Pages E, Thuret R, Taourel P. Morphometric scores for renal tumours: what does the radiologist need to know? Eur J Radiol. 2014;83:1303–10.

    Article  PubMed  Google Scholar 

  41. Weight CJ, Atwell TD, Fassio RT, Kim SP, Kenny M, Lohse CM, et al. A multidisciplinary evaluation of inter-reviewer agreement of the nephrometry score and the prediction of long-term outcomes. J Urol. 2011;186:1223–8.

    Article  PubMed  Google Scholar 

  42. Willatt JM, Hussain HK, Chong S, Kappil M, Azar SF, Liu PS, Ruma JA, Elsayes KM. MR imaging in the characterisation of small renal masses. Abdom Imaging. 2014;39:761–9.

    Article  PubMed  Google Scholar 

  43. Pedrosa I, Sun MR, Spencer M, Genega EM, Olumi AF, Dewolf WC, Rofsky NM. MR imaging of renal masses: correlation with findings at surgery and pathologic analysis. Radiographics. 2008;28:985–1003.

    Article  PubMed  Google Scholar 

  44. Hecht EM, Israel GM, Krinsky GA, Hahn WY, Kim DC, Belitskaya-Levy I Lee VS. Renal masses: quantitative analysis of enhancement with signal intensity measurements versus qualitative analysis of enhancement with image subtraction for diagnosing malignancy at MR imaging. Radiology. 2004;232:373–8.

    Google Scholar 

  45. Ho VB, Allen SF, Hood MN, Choyke PL. Renal masses: quantitative assessment of enhancement with dynamic MR imaging. Radiology. 2002;224:695–700.

    Article  PubMed  Google Scholar 

  46. Hosokawa Y, Kinouchi T, Sawai Y, Mano M, Kiuchi H, Meguro N, Maeda O, Kuroda M, Usami M. Renal angiomyolipoma with minimal fat. Int J Clin Oncol. 2002;7:120–3.

    PubMed  Google Scholar 

  47. Shinmoto H, Yuasa Y, Tanimoto A, Narimatsu Y, Jinzaki M, Hiramatsu K, Mukai M. Small renal cell carcinoma: MRI with pathologic correlation. J Magn Reson Imaging. 1998;8:690–4.

    Article  CAS  PubMed  Google Scholar 

  48. Beer AJ, Dobritz M, Zantl N, Weirich G, Stollfuss J, Rummeny EJ. Comparison of 16-MDCT and MRI for characterisation of kidney lesions. AJR Am J Roentgenol. 2006;186:1639–50.

    Article  PubMed  Google Scholar 

  49. Lassel EA, Rao R, Schwenke C, Schoenberg SO, Michaely HJ. Diffusion-weighted imaging of focal renal lesions: a meta-analysis. Eur Radiol. 2014;24:241–9.

    Article  CAS  PubMed  Google Scholar 

  50. Piscaglia F, Bolondi L. The safety of SonoVue in abdominal applications: retrospective analysis of 23188 investigations. Ultrasound Med Biol. 2006;32:1369–75.

    Article  PubMed  Google Scholar 

  51. Piscaglia F, Nolsoe C, Dietrich CF, Cosgrove DO, Gilja OH, et al. The EFSUMB guidelines and recommendations on the clinical practice of contrast enhanced ultrasound (CEUS): update 2011 on non-hepatic applications. Ultraschall Med. 2012;33:33–59.

    Article  CAS  PubMed  Google Scholar 

  52. Fan I, Lianfang D, Jinfang X, et al. Diagnostic efficacy of contrast-enhanced ultrasonography in solid renal parenchymal lesions with maximum diameters of 5cm. J Ultrasound Med. 2008;27:875–85.

    Article  PubMed  Google Scholar 

  53. Xu ZF, Xu HX, Xie XY et al.x Renal cell carcinoma and renal angiomyolipoma: differential diagnosis with real-time contrast enhanced ultrasonography. J Ultrasound Med 2010; 29: 709–717.

    Google Scholar 

  54. Oh TH, Lee YH, Seo IY. Diagnostic efficacy of contrast-enhanced ultrasound for small renal masses. Korean J Urol. 2014;55:587–92.

    Article  PubMed  PubMed Central  Google Scholar 

  55. Ascenti G, Mazziotti S, Zimbaro G, Setttineri N, Magno C, Melloni D, Caruso R, Scribano E. Complex cystic renal masses: characterisation with contrast-enhanced ultrasound. Radiology. 2007;243:158–65.

    Article  PubMed  Google Scholar 

  56. Park BK, Kim B, Kim SH, Ko K, Lee HM, Choi HY. Assessment of cystic renal masses based on Bosniak classification: comparison of CT and contrast-enhanced US. Eur J Radiol. 2007;61:310–4.

    Article  PubMed  Google Scholar 

  57. Quaia E, Bertolotto M, Cioffi V, Rossi A, Baratella E, Pizzolato R, Cova MA. Comparison of contrast-enhanced sonography and contrast-enhanced CT in the diagnosis of malignancy in complex cystic renal masses. AJR Am J Roentgenol. 2008;191:1239–49.

    Article  PubMed  Google Scholar 

  58. Ly X, Lu Q, Huang BJ, Ma JJ, Yan LX, Wen JX, Wang WP. Contrast-enhanced ultrasonography for evaluation of cystic renal mass: in comparison to contrast-enhanced CT and conventional ultrasound. Abdominal Imaging. 2014;39:1274–83.

    Article  Google Scholar 

  59. Ramdave S, Thomas GW, Berlangieri S, et al. Clinical role of F-18 fluorodeoxyglucose positron emission tomography for detection and management of renal cell carcinoma. J Urol. 2001;166:825–30.

    Article  CAS  PubMed  Google Scholar 

  60. Kang DE, White RL Jr, Zuger JH, Sasser H, Teigland C. Clinical use of fluorodeoxyglucose F18 positron emission tomography for detection of renal cell carcinoma. J Urol. 2004;171:1806–9.

    Article  PubMed  Google Scholar 

  61. Ak I, Can C. F-18 FDG PET in detecting renal cell carcinoma. Acta Radiol. 2005;46:895–9.

    Article  CAS  PubMed  Google Scholar 

  62. Aide N, Cappele O, Bottet P, Bensadoun H, Regeasse A, Comoz F, Sobrio F, Bouvard G. Agostini. Efficiency of [18F] FDG PET in characterising renal cancer and detecting distant metastases: a comparison with CT. Eur J Nucl Med Mol Imaging. 2003;30:1236–45.

    Article  PubMed  Google Scholar 

  63. Divgi CR, Pandit-Taskar N, Jungbluth AA, Reuter VE, Gonen M, Ruan S, Pierre C, Nagel A, Pryma DA, Humm J, Larson SM, Old LJ, Russo P. Preoperative characterization of clear-cell renal carcinoma using iodine-124-labelled antibody chimeric G250 (124I-cG250) and PET in patients with renal masses: a phase 1 trial. Lancet Oncol. 2007;8:304–10.

    Article  CAS  PubMed  Google Scholar 

  64. Bolton DM, Wong P, Lawrentschuk N. Renal cell carcinoma: imaging and therapy. Curr Opin Urol. 2007;17:337–40.

    Article  PubMed  Google Scholar 

  65. Lane et al. Renal mass biopsy—a renaissance? J Urol. 208;179:20–7.

    Google Scholar 

  66. Eshed I, Elias S, Sidi AA. Diagnostic value of CT guided biopsy of indeterminate renal masses. Clin Radiol. 2004;59:262–7.

    Article  CAS  PubMed  Google Scholar 

  67. Dechet CB, Zincke H, Sebo TJ, King BF, LeRoy AJ, Farrow GM, Blute ML. Prospective analysis of computerized tomography and needle biopsy with permanent sectioning to determine the nature of solid renal masses in adults. J Urol. 2003;169:71–4.

    Article  PubMed  Google Scholar 

  68. Richter F, Kasabian NG, Rj I Jr, Watson RA, Lang EK. Accuracy of diagnosis by guided biopsy of renal mass lesions classified indeterminate by imaging studies. Urology. 2000;55:348–52.

    Article  CAS  PubMed  Google Scholar 

  69. Hara I, Miyake H, Hara S, Arakawa S, Hanioka K, Kamidono S. Role of percutaneous image-guided biopsy in the evaluation of renal masses. Urol Int. 2001;67:199–202.

    Article  CAS  PubMed  Google Scholar 

  70. Lechevallier E, Andre M, Barriol D, et al. Fine needle percutaneous biopsy of renal masses with helical CT guidance. Radiology. 2000;216:506–10.

    Article  CAS  PubMed  Google Scholar 

  71. Caoili EM, Bude RO, Higgins EJ, Hoff DL, Nghiem HV. Evaluation of sonographically guided percutaneous core biopsy of renal masses. AJR Am J Roentgenol. 2002;179:373–8.

    Article  PubMed  Google Scholar 

  72. Rybicki FJ, Shu KM, Cibas ES, Fielding JR, van Sonnenberg E, Silverman SG. Percutaneous biopsy of renal masses: sensitivity and negative predictive value stratified by clinical setting and size of masses. AJR Am J Roentgenol. 2003;180:1281–73.

    Article  PubMed  Google Scholar 

  73. Sofikerim M, Tatlisen A, Canoz O, Tokat F, Demirtas A, Mavili E. What is the role of percutaneous needle core biopsy in diagnosis of renal masses? Urology. 2010;76:614–8.

    Article  PubMed  Google Scholar 

  74. Upport RN, Harisinghani MG, Gervais DA. Imaging-guided percutaneous renal biopsy: rationale and approach. AJR Am J Roentgenol. 2010;194:1443–9.

    Article  Google Scholar 

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Alison, E., Patel, U., Gonsalves, M. (2018). Diagnostic Modalities. In: Ahmed, K., Raison, N., Challacombe, B., Mottrie, A., Dasgupta, P. (eds) The Management of Small Renal Masses. Springer, Cham. https://doi.org/10.1007/978-3-319-65657-1_3

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