Management of Small Renal Masses

2018 ◽  
Author(s):  
Keith A Lawson ◽  
Antonio Finelli
Keyword(s):  
Natural History ◽  
Renal Mass ◽  
The Body ◽  
Renal Tumors ◽  
Small Renal Mass ◽  
Small Renal Masses ◽  
Tumor Biopsy ◽  
Renal Masses ◽  
History Of

The rise in incidentally discovered enhancing solid renal tumors has spurred the development of new approaches to managing this unique clinical entity known as the small renal mass (SRM). These approaches are grounded on a better understanding of the natural history of SRM, with the goal to reduce the morbidity associated with their management and avoid overtreatment. In this chapter, we review the body of evidence pertaining to the classification and clinical management of SRMs with respect to diagnosis, treatment, and follow-up. In addition, we discuss the controversies and active areas of development for this rapidly evolving field that strides towards a precision medicine paradigm.  This review contains 6 figures, 6 tables and 63 references Keywords: Small renal mass, renal cell carcinoma, radical nephrectomy, renal tumor biopsy, active surveillance, natural history, oncocytoma, robotic surgery, partial nephrectomy

Management of Small Renal Masses

2018 ◽  
Author(s):  
Keith A Lawson ◽  
Antonio Finelli
Keyword(s):  
Natural History ◽  
Renal Mass ◽  
The Body ◽  
Renal Tumors ◽  
Small Renal Mass ◽  
Small Renal Masses ◽  
Tumor Biopsy ◽  
Renal Masses ◽  
History Of

The rise in incidentally discovered enhancing solid renal tumors has spurred the development of new approaches to managing this unique clinical entity known as the small renal mass (SRM). These approaches are grounded on a better understanding of the natural history of SRM, with the goal to reduce the morbidity associated with their management and avoid overtreatment. In this chapter, we review the body of evidence pertaining to the classification and clinical management of SRMs with respect to diagnosis, treatment, and follow-up. In addition, we discuss the controversies and active areas of development for this rapidly evolving field that strides towards a precision medicine paradigm.  This review contains 6 figures, 6 tables and 63 references Keywords: Small renal mass, renal cell carcinoma, radical nephrectomy, renal tumor biopsy, active surveillance, natural history, oncocytoma, robotic surgery, partial nephrectomy

scholarly journals The Role of Surveillance in the Management of Small Renal Masses

2007 ◽  
Vol 7 ◽  
pp. 860-868 ◽  
Author(s):  
Alessandro Volpe
Keyword(s):  
Natural History ◽  
Active Treatment ◽  
Initial Period ◽  
Renal Tumors ◽  
Small Renal Masses ◽  
Renal Masses ◽  
Cross Sectional ◽  
Slow Growth Rate ◽  
History Of

Incidentally detected, small renal masses (SRMs) have been increasing significantly in recent years due to the widespread use of improved cross-sectional imaging. A significant number of incidental SRMs are diagnosed in elderly patients who are more likely to undergo imaging for other medical issues. The natural history of SRMs has not been historically well understood because most masses are surgically removed soon after diagnosis.Several reports of surveillance of SRMs have been published in the last few years. When followed conservatively with serial imaging, SRMs have variable growth rates with an average of 0.28 cm/year, according to a recent meta-analysis. Larger series with longer follow-up are needed, but a significant number of small tumors seem to have an indolent behavior with a slow growth rate and a limited tendency to progress. The standard of care for enhancing SRMs is surgery. Up to one-third of surgically removed, <4-cm tumors are histologically benign. The outcomes of current surgical treatment of histologically confirmed, <4-cm, renal cell carcinomas are excellent, but this has not led to a decrease in mortality. Based on these considerations and on the available data on the natural history of SRMs, it seems reasonable to consider that we may be overtreating these lesions. This is especially true for elderly or unfit patients who have a decreased life expectancy. In these selected patients and in patients who refuse active treatment, it seems reasonable to propose an initial period of active surveillance for incidental SRMs, with delayed intervention for those tumors that will exhibit fast growth during follow-up. Percutaneous needle biopsies of renal tumors can be safely performed with the use of modern techniques and have the potential to characterize SRMs at histologically diagnosis, thereby allowing a better selection of the conservative or active treatment that is best suited for each individual patient.

scholarly journals The Natural History and Predictors for Intervention in Patients with Small Renal Mass Undergoing Active Surveillance

2015 ◽  
Vol 2015 ◽  
pp. 1-5 ◽  
Author(s):  
Zaher Bahouth ◽  
Sarel Halachmi ◽  
Gil Meyer ◽  
Ofir Avitan ◽  
Boaz Moskovitz ◽  
...  
Keyword(s):  
Natural History ◽  
Active Surveillance ◽  
Renal Mass ◽  
Nephron Sparing Surgery ◽  
Small Renal Mass ◽  
Small Renal Masses ◽  
Renal Masses ◽  
Nephron Sparing ◽  
The Mean

Aim. To describe the natural history of small renal mass on active surveillance and identify parameters that could help in predicting the need for intervention in patients with small renal masses undergoing active surveillance. We also discuss the need for renal biopsy in the management of these patients.Methods. A retrospective analysis of 78 renal masses ≤4 cm diagnosed at our Urology Department at Bnai Zion Medical Center between September 2003 and March 2012.Results. Seventy patients with 78 small renal masses were analyzed. The mean age at diagnosis was 68 years (47–89). The mean follow-up period was 34 months (12–112). In 54 of 78 masses there was a growth of at least 2 mm between imaging on last available follow-up and diagnosis. Eight of the 54 (15%) masses which grew in size underwent a nephron-sparing surgery, of which two were oncocytomas and six were renal cell carcinoma. Growth rate and mass diameter on diagnosis were significantly greater in the group of patients who underwent a surgery.Conclusions. Small renal masses might eventually be managed by active surveillance without compromising survival or surgical approach. All masses that were eventually excised underwent a nephron-sparing surgery. None of the patients developed metastases.

scholarly journals The natural history of incidentally detected small renal masses

Cancer ◽  
2004 ◽  
Vol 100 (4) ◽  
pp. 738-745 ◽  
Author(s):  
Alessandro Volpe ◽  
Tony Panzarella ◽  
Ricardo A. Rendon ◽  
Masoom A. Haider ◽  
Filippos I. Kondylis ◽  
...  
Keyword(s):  
Natural History ◽  
Small Renal Masses ◽  
Renal Masses ◽  
History Of

scholarly journals Small Renal Mass with Sarcomatoid Features

2020 ◽  
Vol 14 (1) ◽  
pp. 54-56
Author(s):  
Anthony D. Oberle ◽  
James A. Brown
Keyword(s):  
Renal Cell Carcinoma ◽  
Renal Mass ◽  
Small Renal Mass ◽  
Common Pathway ◽  
Small Renal Masses ◽  
Renal Masses ◽  
Threshold Size ◽  
Sarcomatoid Renal Cell Carcinoma ◽  
Worse Prognosis ◽  
Sarcomatoid Differentiation

Interest in surveillance for small renal masses has expanded exponentially due to incidental detection with increased imaging. However, some of these small renal masses behave aggressively. Sarcomatoid pathology is associated with a worse prognosis. Traditionally, it has been thought of as a common pathway of dedifferentiation once a renal malignancy of any histology reaches a threshold size of approximately 3 cm. We report a case of a 65-year-old male with a 2 cm sarcomatoid renal cell carcinoma. To our knowledge, this is the smallest tumor with sarcomatoid differentiation reported in the literature.

THE NATURAL HISTORY OF SMALL RENAL MASSES

2000 ◽  
pp. 1143-1147 ◽  
Author(s):  
RICARDO A. RENDON ◽  
NIR STANIETZKY ◽  
TONY PANZARELLA ◽  
MICHAEL ROBINETTE ◽  
LAWRENCE H. KLOTZ ◽  
...  
Keyword(s):  
Natural History ◽  
Small Renal Masses ◽  
Renal Masses ◽  
History Of

scholarly journals The Past, Present, and Future in Management of Small Renal Masses

2015 ◽  
Vol 2015 ◽  
pp. 1-7 ◽  
Author(s):  
Sarah C. Ha ◽  
Haley A. Zlomke ◽  
Nicholas Cost ◽  
Shandra Wilson
Keyword(s):  
Renal Mass ◽  
Treatment Modalities ◽  
Small Renal Mass ◽  
Consensus Guidelines ◽  
Small Renal Masses ◽  
Renal Masses ◽  
Cross Sectional ◽  
The Past ◽  
Cross Sectional Imaging ◽  
Ablative Techniques

Management of small renal masses (SRMs) is currently evolving due to the increased incidence given the ubiquity of cross-sectional imaging. Diagnosing a mass in the early stages theoretically allows for high rates of cure but simultaneously risks overtreatment. New consensus guidelines and treatment modalities are changing frequently. The multitude of information currently available shall be summarized in this review. This summary will detail the historic surgical treatment of renal cell carcinoma with current innovations, the feasibility and utility of biopsy, the efficacy of ablative techniques, active surveillance, and use of biomarkers. We evaluate how technology may be used in approaching the small renal mass in order to decrease morbidity, while keeping rates of overtreatment to a minimum.

scholarly journals Radiologic Evaluation of Small Renal Masses (I): Pretreatment Management

2008 ◽  
Vol 2008 ◽  
pp. 1-16 ◽  
Author(s):  
A. Marhuenda ◽  
M. I. Martín ◽  
C. Deltoro ◽  
J. Santos ◽  
Jose Rubio Briones
Keyword(s):  
Renal Mass ◽  
Relevant Literature ◽  
Main Question ◽  
Small Renal Mass ◽  
Small Renal Masses ◽  
Renal Masses ◽  
Detailed Review ◽  
Radiologic Evaluation ◽  
Followup Studies ◽  
Ct And Mri

When characterizing a small renal mass (SRM), the main question to be answered is whether the mass represents a surgical or nonsurgical lesion or, in some cases, if followup studies are a reasonable option. Is this a task for a urologist or a radiologist? It is obvious that in the increasing clinical scenario where this decision has to be made, both specialists ought to work together. This paper will focus on the principles, indications, and limitations of ultrasound, CT, and MRI to characterize an SRM in 2008 with a detailed review of relevant literature. Special emphasis has been placed on aspects regarding the bidirectional information between radiologists and urologists needed to achieve the best radiological approach to an SRM.

scholarly journals 509: The Natural History of Small Renal Masses: A Prospective Multi-Center Canadian Trial

2007 ◽  
Vol 177 (4S) ◽  
pp. 169-170 ◽  
Author(s):  
Kamal Mattar ◽  
Julian Azuero ◽  
Ricardo Rendon ◽  
Christopher Morash ◽  
D. Robert Siemens ◽  
...  
Keyword(s):  
Natural History ◽  
Small Renal Masses ◽  
Renal Masses ◽  
History Of
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