Management of the Incidental Renal Mass

Silverman, Stuart G.; Israel, Gary M.; Herts, Brian R.; Richie, Jerome P.

doi:10.1148/radiol.2491070783

Cited by 385 publications

(263 citation statements)

References 106 publications

(143 reference statements)

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“…11,12,15,[23][24][25][26][27]31,33,34,39,40,42,43,47,51,59 However, the literature is thought to overestimate the true risk of malignancy among category II cysts, as the majority were managed conservatively or had features that made them too complex to be categorized as a Bosniak II cyst. 6,12,26,29,31,32,35,38,59 Importantly, even if malignant, most behave in a relatively benign fashion.…”

Section: Bosniak Category IImentioning

confidence: 99%

CUA guideline on the management of cystic renal lesions

Richard¹,

Violette²,

Jewett³

et al. 2017

CUAJ

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Section: Bosniak Category IImentioning

confidence: 99%

CUA guideline on the management of cystic renal lesions

Richard¹,

Violette²,

Jewett³

et al. 2017

CUAJ

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“…As an alternative, when AML is hyperattenuating on unenhanced CT or homogeneously enhancing on contrast-enhanced CT, MR imaging provides conclusive evidence to differentiate AML from RCC. AMLs with hypointense and homogeneously enhancing lesions on MRI need percutaneous biopsy (25). Therefore, fat-rich AML or classic AML is easily diagnosed by unenhanced CT scans.…”

Section: Imagingmentioning

confidence: 99%

Recent Strategies for the Management of Renal Angiomyolipoma: A Review of Diagnostic and Therapeutic Approaches

et al. 2017

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Recent prophylactic treatment options and diagnostic tools show a suboptimal improvement in patients with renal angiomyolipoma (AML). This study was an attempt to review management strategies applied before invasive options. An extensive research on medical databases such as PubMed and Scopus was performed from 1999 to 2016 using the following keywords: 'kidney', 'renal', and 'angiomyolipoma'. All related studies on patients treating with conservative or minimally-invasive procedures were included. However, reports on surgical treatments were excluded. Treatment strategies have been selected based on outcomes resulting from computed tomography (CT) and magnetic resonance (MR) imaging. Fat content and tumor size are the most common used indications for AMLs. Unenhanced CT and chemical shift imaging provide good evidence in case of fat-poor AMLs. Chemical analysis and percutaneous biopsy are recommended in case of a diagnostic challenge. A tumor size of 6 cm or larger in diameter might necessitate invasive treatment, while AMLs patients with tumors around 4 cm may require prophylactic treatment. Of all treatment options, embolization indicated a high risk of reintervention. Moreover, everolimus and sirolimus as 2 inhibitors of mammalian target of rapamycin (mTOR) have been evaluated in clinical trials and demonstrated promising outcomes. In conclusion, advances in imaging techniques along with mTOR inhibitors and embolic materials potentiate functional outcomes in AMLs.

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“…HU indicated no enhancement [13,[17][18][19]. For tumors imaged with MRI, the relative signal intensity in comparison to the normal renal parenchyma (e.g., hypointense, isointense, hyperintense) was assessed on unenhanced T1, T2, DWI, and contrast-enhanced T1-weighted images.…”

Section: Assessment Of Imaging Features On Both Ct and Mrimentioning

confidence: 99%

Early-stage clear cell tubulopapillary renal cell carcinoma: imaging features and distinction from clear cell and papillary subtypes

et al. 2016

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Purpose: Clear cell tubulopapillary renal cell carcinoma (CCTPRCC) is a recently described, low grade subtype of renal cancer. We determined if imaging features could be used to distinguish early-stage CCTPRCC from stage-matched clear cell RCC (ccRCC) and papillary RCC (pRCC). Subjects and Methods:This IRB-approved retrospective study included 54 stage-Ia patients with pathologically-confirmed CCTPRCC (n=18), ccRCC (n=18), and pRCC (n=18). CT (n=48) and MRI (n=27) exams were reviewed and imaging features compared. Continuous variables were evaluated using ANOVA and Tukey's multiple comparison tests. Categorical variables were compared using Chi square test or Fisher's exact test.Results: Compared to pRCC, CCTPRCC had a lower mean attenuation value on unenhanced CT (p<0.017), was more often hyperintense on T2-weighted images (p<0.0001), showed an illdefined margin (p=0.003), and demonstrated nonenhancing areas (p=0.0003). The presence of all three of these statistically significant features (hypoattenuation [unenhanced attenuation < 25HU], ill-defined margin, nonenhancing areas) yielded an area under the Receiver Operator Curve (ROC) of 0.92 (95% CI: 0.83-0.99) for differentiating CCTPRCC from pRCC. There were no significant differences in the imaging features of CCTPRCC and ccRCC. Conclusions:Early stage clear cell tubulopapillary renal cell carcinoma can be distinguished from papillary RCC based on low attenuation on unenhanced CT, high intensity on T2-weighted images, an ill-defined margin, and presence of nonenhancing areas, but cannot be distinguished from clear cell RCC. Author ManuscriptClick here to view linked References 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 CCTPRCC is now considered the fourth most common variant of RCC, behind ccRCC (70%), pRCC (16.6%), and chromophobe carcinoma (5.9%), with an incidence of 4.1% [1][2][3][4][5][6].CCTPRCC was reported initially in patients with end-stage renal disease, however, the majority of subsequent cases are now known to occur sporadically [1][2][3][5][6][7][8][9]. The average age at presentation is 60 and there is no sex predilection [1,2,8,9].There is limited literature on the biologic behavior of CCTPRCC, however, prior reports suggest that these neoplasms behave indolently, and carry a favorable prognosis [1][2][3][4][7][8][9][10]. To our knowledge, metastases have not been reported [1][2][3][4][7][8][9][10][11]. Therefore, the prospective differentiation of CCTPRCC from the more common subtypes such as clear cell RCC (ccRCC) and papillary RCC (pRCC) at an early stage may be useful for counseling patients on prognosis and treatment plans. For example, an active surveillance approach may be considered in a patient with CCTPRCC [12].To our knowledge, no prior study has attempted to differentiate CCTPRCC from other renal cell tumor subtypes ...

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Management of the Incidental Renal Mass

Cited by 385 publications

References 106 publications

CUA guideline on the management of cystic renal lesions

CUA guideline on the management of cystic renal lesions

Recent Strategies for the Management of Renal Angiomyolipoma: A Review of Diagnostic and Therapeutic Approaches

Early-stage clear cell tubulopapillary renal cell carcinoma: imaging features and distinction from clear cell and papillary subtypes

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