Optimal Management of Small Renal Masses

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Ralph HaukeFrom the Genitourinary Oncology Section of Hematology/Oncology, University of Nebraska Medical Center, Omaha, Nebraska.

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The incidence of small renal masses is increasing. Limited data suggest that although most are malignant, they are also likely to show indolent behavior. The tendency of these tumors to occur in older patient populations with multiple comorbidities raises important issues. Retrospective and prospective studies suggest that a substantial proportion of these small renal masses can be observed without compromising the opportunity for cure or subjecting patients to invasive procedures that might impact negatively on quality of life. Less-invasive treatment modalities, including partial nephrectomy and energy ablation techniques, provide multiple options for some patients. This article reviews selected aspects of the management of small renal masses, including their natural history, imaging, diagnostic biopsies, and treatment options. (

Correspondence: Ralph Hauke, MD, 987680 Nebraska Medical Center, Omaha, NE 68198-7680. E-mail: rhauke@unmc.edu
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  • 1.

    American Cancer Society. Cancer Facts & Figures 2006. Available at: http://www.cancer.org/downloads/STT/CAFF2006PWSecured.pdf. Accessed September 12, 2006.

  • 2.

    Chow WH, Devesa SS, Warren JL, Fraumeni JF Jr. Rising incidence of renal cell carcinoma in the United States. JAMA 1999;281:16281631.

  • 3.

    Hock LM, Lynch J, Balaji KC. Increasing incidence of all stages of kidney cancer in the last 2 decades in the United States: an analysis of surveillance, epidemiology and end results program data. J Urol 2002;167:5760.

    • Search Google Scholar
    • Export Citation
  • 4.

    Jayson M, Sanders H. Increased incidence of serendipitously discovered renal cell carcinoma. Urology 1998;51:203205.

  • 5.

    Luciani LG, Cestari R, Tallarigo C. Incidental renal cell carcinoma— age and stage characterization and clinical implications: study of 1092 patients (1982–1997). Urology 2000;56:5862.

    • Search Google Scholar
    • Export Citation
  • 6.

    Bretheau D, Lechevallier E, Eghazarian C et al.. Prognostic significance of incidental renal cell carcinoma. Eur Urol 1995;27:319323.

  • 7.

    Porena M, Vespasiani G, Rosi P et al.. Incidentally detected renal cell carcinoma: role of ultrasonography. J Clin Ultrasound 1992;20:395400.

  • 8.

    Hollingsworth JM, Miller DC, Daignault S, Hollenbeck BK. Rising incidence of small renal masses: a need to reassess treatment effect. J Natl Cancer Inst 2006;98:13311334.

    • Search Google Scholar
    • Export Citation
  • 9.

    Guinan PD, Vogelzang NJ, Fregman AM et al.. Renal cell carcinoma: tumor stage, size and survival. Members of the Cancer Incidence and End Results Committee. J Urol 1995;153:901903.

    • Search Google Scholar
    • Export Citation
  • 10.

    Frank I, Blute ML, Cheville JC et al.. Solid renal tumors: an analysis of pathological features related to tumor size. J Urol 2003;170:22172220.

  • 11.

    Reddan DN, Raj GV, Polascik TJ. Management of small renal tumors: an overview. Am J Med 2001;110:558562.

  • 12.

    Tosaka A, Ohya K, Yamada K et al.. Incidence and properties of renal masses and asymptomatic renal cell carcinoma detected by abdominal ultrasonography. J Urol 1990;144:10971099.

    • Search Google Scholar
    • Export Citation
  • 13.

    Foster WL Jr, Roberts L Jr, Halvorsen RA Jr, Dunnick NR. Sonography of small renal masses with indeterminant density characteristics on computed tomography. Urol Radiol 1988;10:5967.

    • Search Google Scholar
    • Export Citation
  • 14.

    Levine E, Huntrakoon M, Wetzel LH. Small renal neoplasms: clinical, pathologic and imaging features. AJR Am J Roentgenol 1989;153:6973.

  • 15.

    Bosniak MA, Megibow AJ, Hulnick DH et al.. CT diagnosis of renal angiomyolipoma: the importance of detecting small amounts of fat. AJR Am J Roentgenol 1988;151:497501.

    • Search Google Scholar
    • Export Citation
  • 16.

    Choyke PL. Detection and staging of renal cancer. Magn Reson Imaging Clin N Am 1997;5:2947.

  • 17.

    Janus CL, Mendelson DS. Comparison of MRI and CT for study of renal and perirenal masses. Crit Rev Diagn Imaging 1991;32:69118.

  • 18.

    Curry NS, Bissada NK. Radiologic evaluation of small and indeterminant renal masses. Urol Clin North Am 1997;24:493505.

  • 19.

    Kang DE, White RL, Zuger JH et al.. Clinical use of fluorodeoxyglucose F 18 positron emission tomography for detection of renal cell carcinoma. J Urol 2004;171:18061809.

    • Search Google Scholar
    • Export Citation
  • 20.

    Ak I, Can C. F-18 FDG PET in detecting renal cell carcinoma. Acta Radiol 2005;46:895899.

  • 21.

    Wunderlich H, Hindermann W, Al Mustafa AM et al.. The accuracy of 250 fine needle biopsies of renal tumors. J Urol 2005;174:4446.

  • 22.

    Neuzillet Y, Lechevallier E, Andre M et al.. Accuracy and clinical role of fine needle percutaneous biopsy with computerized tomography guidance of small (less than 4.0 cm) renal masses. J Urol 2004;171:18021805.

    • Search Google Scholar
    • Export Citation
  • 23.

    Chawla SN, Crispen PL, Hanlon AL et al.. The natural history of observed enhancing renal masses: meta-analysis and review of the world literature. J Urol 2006;175:425431.

    • Search Google Scholar
    • Export Citation
  • 24.

    Shah RB, Bakshi N, Hafez KS et al.. Image-guided biopsy in the evaluation of renal mass lesions in contemporary urological practice: indications, adequacy, clinical impact and limitations of the pathological diagnosis. Hum Pathol 2005;36:13091315.

    • Search Google Scholar
    • Export Citation
  • 25.

    Dechet CB, Sebo T, Farrow G et al.. Prospective analysis of intraoperative frozen needle biopsy of solid renal masses in adults. J Urol 1999;162:12821284.

    • Search Google Scholar
    • Export Citation
  • 26.

    Fuhrman SA, Lasky LC, Limas C. Prognostic significance of morphologic parameters in renal cell carcinoma. Am J Surg Pathol 1982;6:655663.

  • 27.

    Young AN, Amin MB, Moreno CS et al.. Expression profiling of renal epithelial neoplasms: a method for tumor classification and discovery of diagnostic molecular markers. Am J Pathol 2001;158:16391651.

    • Search Google Scholar
    • Export Citation
  • 28.

    Takahashi M, Yang XJ, Sugimora J et al.. Molecular subclassification of kidney tumors and the discovery of new diagnostic markers. Oncogene 2003;22:68106818.

    • Search Google Scholar
    • Export Citation
  • 29.

    Rendon RA, Jewett MA. Expectant management for the treatment of small renal masses. Urol Oncol 2006;24:6267.

  • 30.

    Volpe A, Jewett MA. The natural history of small renal masses. Nat Clin Pract Urol 2005;2:384390.

  • 31.

    Volpe A, Panzarella T, Rendon RA et al.. The natural history of incidentally detected small renal masses. Cancer 2004;100:738745.

  • 32.

    Lamb GW, Bromwich EJ, Vasey P, Aitchison M. Management of renal masses in patients medically unsuitable for nephrectomy— natural history, complications, and outcome. Urology 2004;64:909913.

    • Search Google Scholar
    • Export Citation
  • 33.

    Ozono S, Miyao N, Igarashi T et al.. Tumour doubling time of renal cell carcinoma measured by CT: collaboration of Japanese Society of Renal Cancer. Jpn J Clin Oncol 2004;34:8285.

    • Search Google Scholar
    • Export Citation
  • 34.

    Herr HW. Partial nephrectomy for unilateral renal cell carcinoma and a normal contralateral kidney: 10-year followup. J Urol 1999;161:3335.

    • Search Google Scholar
    • Export Citation
  • 35.

    Belldegrun A, Tsui KH, deKernian JB, Smith RB. Efficacy of nephron-sparing surgery for renal cell carcinoma: analysis based on the new 1997 tumor-node-metastasis staging system. J Clin Oncol 1999;17:28682875.

    • Search Google Scholar
    • Export Citation
  • 36.

    Lee CT, Katz J, Shi W et al.. Surgical management of renal tumors 4 cm or less in a contemporary cohort. J Urol 2000;163:730736.

  • 37.

    Patard JJ, Shvarts O, Lam JS et al.. Safety and efficacy of partial nephrectomy for all T1 tumors based on an international multicenter experience. J Urol 2004;171(6 Pt 1):21812185.

    • Search Google Scholar
    • Export Citation
  • 38.

    Fogarty JD, Hafron JM, Hoenig DM, Ghavamian R. Laparoscopic nephron-sparing surgery for the small exophytic renal mass. JSLS 2005;9:199204.

  • 39.

    Clark PE, Schover LR, Uzzo RG et al.. Quality of life and psychological adaptation after surgical treatment for localized renal cell carcinoma: impact of the amount of remaining renal tissue. Urology 2001;57:252256.

    • Search Google Scholar
    • Export Citation
  • 40.

    Shinohara N, Harabayashi T, Sato S et al.. Impact of nephron-sparing surgery on quality of life in patients with localized renal cell carcinoma. Eur Urol 2001;39:114119.

    • Search Google Scholar
    • Export Citation
  • 41.

    Stiles KP, Moffatt MJ, Agodoa LY et al.. Renal cell carcinoma as a cause of end-stage renal disease in the United States: patient characteristics and survival. Kidney Int 2003;64:247253.

    • Search Google Scholar
    • Export Citation
  • 42.

    McKiernan J, Simmons R, Katz J, Russo P. Natural history of chronic renal insufficiency after partial and radical nephrectomy. Urology 2002;59:816820.

    • Search Google Scholar
    • Export Citation
  • 43.

    Miller DC, Hollingsworth JM, Hafez KS et al.. Partial nephrectomy for small renal masses: an emerging quality of care concern? J Urol 2006;175(3 Pt 1):853858.

    • Search Google Scholar
    • Export Citation
  • 44.

    Gervais DA, McGovern FJ, Arellano RS et al.. Radiofrequency ablation of renal cell carcinoma: part I, indications, results, and role in patient management over a 6-year period and ablation of 100 tumors. AJR Am J Roentgenol 2005;185:6471.

    • Search Google Scholar
    • Export Citation
  • 45.

    Varkarakis IM, Allaf ME, Inagaki T et al.. Percutaneous radio frequency ablation of renal masses: results at a 2-year mean follow-up. J Urol 2005;174:456460.

    • Search Google Scholar
    • Export Citation
  • 46.

    Gill IS, Remer EM, Hasan WA et al.. Renal cryoablation: outcome at 3 years. J Urol 2005;173:19031907.

  • 47.

    Schwartz BF, Rewcastle JC, Powell T et al.. Cryoablation of small peripheral renal masses: a retrospective analysis. Urology 2006;68 [suppl 1]:1418.

    • Search Google Scholar
    • Export Citation
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