Current Management Considerations for the Incidentally Detected Small Renal Mass

Buethe, David D.; Spiess, Philippe E.

doi:10.1177/107327481302000309

Cited by 6 publications

(6 citation statements)

References 98 publications

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“…The drive to evaluate incompletely characterized renal masses is predicated in part on the fact that renal cell carcinoma (RCC) is most commonly diagnosed as an incidental finding (4). Moreover, when a renal cancer is found, the patient's prognosis depends largely on detecting the cancer at the organ-confined stage (4,8). However, the recognition of the indolent behavior of many small renal masses, including some that are cancers, is now prompting a less aggressive, conservative approach and one that could include not imaging further many masses that are incompletely characterized.…”

Section: Many Solid Renal Masses Are Benignmentioning

confidence: 99%

“…Active surveillance has been used to manage selected renal masses for many years; Bosniak category IIF cystic renal masses are followed up (64), and it has been suggested that solid renal masses smaller than 1 cm be followed up (7). Recent data have contributed to the growing acceptance of active surveillance for a larger subset of renal masses (8,27), bolstered further by the acceptance of percutaneous biopsy as a useful test to diagnose both cancers and benign neoplasms (4). Several distinct clinical settings for the role of biopsy in the diagnosis of solid and cystic renal masses were detailed in 2006 (65).…”

Section: Active Surveillance Of Renal Masses Is Safe In Selected Patimentioning

confidence: 99%

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Incompletely Characterized Incidental Renal Masses: Emerging Data Support Conservative Management

Silverman¹,

Israel²,

Trinh³

2015

Radiology

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With imaging, most incidental renal masses can be diagnosed promptly and with confidence as being either benign or malignant. For those that cannot, management recommendations can be devised on the basis of a thorough evaluation of imaging features. However, most renal masses are either too small to characterize completely or are detected initially in imaging examinations that are not designed for full evaluation of them. These masses constitute a group of masses that are considered incompletely characterized. On the basis of current published guidelines, many masses warrant additional imaging. However, while the diagnosis of renal cancer at a curable stage remains the first priority, there is the additional need to reduce unnecessary healthcare costs and radiation exposure. As such, emerging data now support foregoing additional imaging for many incompletely characterized renal masses. These data include the low risk of progression to metastases or death for small renal masses that have undergone active surveillance (including biopsy-proven cancers) and a better understanding of how specific imaging features can be used to diagnose their origins. These developments support (a) avoidance of imaging entirely for those incompletely characterized renal masses that are highly likely to be benign cysts and (b) delay of further imaging of small solid masses in selected patients. Although more evidence-based data are needed and comprehensive management algorithms have yet to be defined, these recommendations are medically appropriate and practical, while limiting the imaging of many incompletely characterized incidental renal masses.

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Section: Many Solid Renal Masses Are Benignmentioning

confidence: 99%

Section: Active Surveillance Of Renal Masses Is Safe In Selected Patimentioning

confidence: 99%

Incompletely Characterized Incidental Renal Masses: Emerging Data Support Conservative Management

Silverman¹,

Israel²,

Trinh³

2015

Radiology

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“…20 Laparoscopic RN was first introduced in the early 1990s. Laparoscopic RN, when feasible, reduces pain, length of hospital stay, and recovery time.…”

Section: Radical Nephrectomymentioning

confidence: 99%

Management of Small Renal Masses in the Older Adult

Mirza

2015

Clinics in Geriatric Medicine

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“…[7][8][9][10] Utilization rates, however, have remained low for a variety of reasons. [11][12][13] Cryoablation, radiofrequency ablation (RFA) and active surveillance (AS) have become recognized, viable, nephronsparing treatment options for clinical T1a RCC, especially in elderly patients and those with a higher surgical risk. [13][14][15] While there are several evidence-based guidelines regarding the management of T1a RCC, many factors affect the ultimate treatment decision.…”

Section: Introductionmentioning

confidence: 99%

Surgeon-specific factors affecting treatment decisions among Canadian urologists in the management of pT1a renal tumours

Millman

Pace

Ordon

et al. 2014

CUAJ

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Introduction: The ubiquitous use of diagnostic imaging has resulted in an increased incidental detection of small renal masses (SRM). Patient-and tumour-related factors affect treatment decisions greatly; however, with multiple treatment options available, surgeonspecific characteristics and biases may also influence treatment recommendations. We determine the impact of surgeon-specific factors on treatment decisions in the management of SRM in Canada. Methods: An online survey study was conducted among Canadian urologists currently registered with the Canadian Urological Association. The questionnaire collected demographic information and recommended treatments for 6 SRM index cases involving theoretical patients of various ages (51-80 years) and comorbidities. Results: A total of 110 urologists responded (17% response rate) to the survey. Of these, 18% were over 65 years old and 45% were from academic centres. With increasing patient age and comorbidity, active surveillance and thermal ablative therapies were more the recommended treatment. Laparoscopic/robotic surgery was more commonly recommended by academic urologists and those under 65. Recommending surgery (radical nephrectomy or partial nephrectomy) for both elderly (about 80 years old) index patients correlated with surgeon age (surgeons over 65, p < 0.001), surgeons with no oncologic fellowship training (p = 0.021), surgeons with a non-academic practice (p = 0.003), surgeons with a personal history of cancer (p = 0.038) and surgeons with a family history of cancer death in the last 10 years (p = 0.022). Conclusions: There are various factors that influence the management options offered to patients with SRMs. Our results suggest that surgeon age, personal history of cancer, practice-type and other surgeon-specific variables may affect treatments offered among urologists across Canada.

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Current Management Considerations for the Incidentally Detected Small Renal Mass

Abstract: The management of small renal masses encompasses a host of therapeutic options, all of which must be considered and discussed with the individual patient.

Cited by 6 publications

References 98 publications

Incompletely Characterized Incidental Renal Masses: Emerging Data Support Conservative Management

Incompletely Characterized Incidental Renal Masses: Emerging Data Support Conservative Management

Management of Small Renal Masses in the Older Adult

Surgeon-specific factors affecting treatment decisions among Canadian urologists in the management of pT1a renal tumours

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