Current Management of Small Renal Masses, Including Patient Selection, Renal Tumor Biopsy, Active Surveillance, and Thermal Ablation

Abstract

Renal cancer represents 2% to 3% of all cancers, and its incidence is rising. The increased use of ultrasonography and cross-sectional imaging has resulted in the clinical dilemma of incidentally detected small renal masses (SRMs). SRMs represent a heterogeneous group of tumors that span the full spectrum of metastatic potential, including benign, indolent, and more aggressive tumors. Currently, no composite model or biomarker exists that accurately predicts the diagnosis of kidney cancer before treatment selection, and the use of renal mass biopsy remains controversial. The management of SRMs has changed dramatically over the last two decades as our understanding of tumor biology and competing risks of mortality in this population has improved. In this review, we critically assess published consensus guidelines and recent literature on the diagnosis and management of SRMs, with a focus on patient treatment selection and use of renal mass biopsy, active surveillance, and thermal ablation. Finally, we highlight important opportunities for leveraging recent research discoveries to identify patients with SRMs at high risk for renal cell carcinoma–related mortality and minimize overtreatment and patient morbidity.

Efficacy and safety of US-guided thermal ablation for primary hyperparathyroidism: a systematic review and meta-analysis

“…Thermal ablation has been an important minimally invasive technique, and its appearance has expanded the selection range of non-surgical minimally invasive treatment. It has been proved to be safe and effective for the treatment of liver cancer, renal cancer and thyroid nodules, and has become an alternative of surgery in these fields [16][17][18]. Up to now, there has been several options of thermal ablation such as microwave ablation (MWA), radiofrequency ablation (RFA), laser ablation (LA), and high-intensity focused ultrasound (HIFU) [16,[19][20][21][22].…”

Interventional oncology at the time of COVID-19 pandemic: Problems and solutions

“…The incidence of renal cell carcinoma (RCC) has steadily increased in Europe in the last 2 decades, with stage I tumors now accounting for 40% to 50% of new patients. Up to 75% of these small RCC are found incidentally on ultrasound or cross-sectional imaging performed for another reason, and approximately 50% of patients are now older than 65 years, and carry risk factors of RCC such as smoking, obesity and hypertension [42]. These comorbidities, along with the renal function, are key factors when determining the best treatment strategy.…”

Needle track seeding in renal mass biopsies

“…Renal biopsy can be of value in characterizing renal masses in selected patients, and may be helpful in triaging patients to an increasing assortment of therapeutic options . A wide range of needle sizes are used for this procedure, ranging from 21‐gauge to 27‐gauge needles for fine‐needle aspiration (FNA) to 17‐gauge to 20‐gauge needles for core needle biopsy.…”

“…Ideally, one would like to determine the diagnosis, subtype, grade, and molecular features of every tumor. However, categorizing renal masses into 2 broad risk groups (low risk and high risk) even without a specific diagnosis in all cases would allow the urologist to make evidence‐based decisions regarding the need for intervention and the choice of therapeutic options . Such a strategy is similar to how cytologists already categorize thyroid lesions using the Bethesda System for Reporting Thyroid Cytopathology .…”