From the Guidelines
The best diagnostic test for detecting kidney cancer recurrence, aside from MRI and CT scans, is ultrasound imaging combined with regular blood tests and urinalysis, as recommended by the most recent guidelines 1. This approach is effective because kidney cancer recurrences often manifest as new masses, changes in kidney structure, or abnormal laboratory values.
- Ultrasound provides real-time visualization of the kidneys and surrounding tissues without radiation exposure, making it suitable for frequent monitoring.
- Blood tests should include complete blood count, comprehensive metabolic panel (focusing on liver and kidney function), and sometimes tumor markers like CA-125 or CEA depending on the specific cancer type.
- Urinalysis can detect microscopic hematuria or proteinuria that might indicate recurrence. For patients with higher risk of recurrence, positron emission tomography (PET) scans may be recommended as they can detect metabolic changes in tissues before structural changes become apparent, although their routine use is not recommended 1. The monitoring frequency typically follows a schedule of every 3-6 months for the first two years after treatment, then extending to longer intervals if no recurrence is detected, with adjustments based on individual risk factors and clinical presentation 1.
From the Research
Diagnostic Tests for Kidney Cancer Recurrence
Aside from Magnetic Resonance Imaging (MRI) and Computed Tomography (CT) scan, several diagnostic tests can be used to detect kidney cancer recurrence. These include:
- Positron Emission Tomography (PET) scan: PET scan has been shown to be helpful in the diagnosis and management of many cancers, including kidney cancer 2. The use of PET/CT has proven to be particularly useful in detecting kidney cancer recurrence, with a pooled sensitivity of 0.89 3.
- Single Photon Emission Computed Tomography (SPECT): SPECT has also been used to detect kidney cancer recurrence, although its diagnostic performance is not as high as PET/CT 3.
- 99mTc-sestamibi SPECT/CT: This test has been shown to have high sensitivity and specificity for detecting renal oncocytomas and other benign renal lesions, and can help improve diagnostic confidence for patients with indeterminate renal masses 4.
Comparison of Diagnostic Tests
A systematic review and meta-analysis compared the diagnostic performance of MRI, SPECT, and PET in detecting renal cell carcinoma, and found that PET/CT had the highest pooled sensitivity and specificity 3. Another study found that PSMA PET/CT was superior to CT alone in detecting biochemical recurrence of prostate cancer after radical prostatectomy, and offered additional therapeutic options in a substantial number of patients 5.
Use of PET Scan in Kidney Disease
PET scan has been increasingly used in patients with underlying kidney disease, and has been shown to be useful in diagnosing and managing a variety of conditions, including kidney cancer 6. The use of PET scan in combination with CT scan allows for additional imaging advantages over either modality alone.
Key Findings
Key findings from the studies include:
- PET/CT has high sensitivity and specificity for detecting kidney cancer recurrence 3.
- SPECT has lower diagnostic performance compared to PET/CT 3.
- 99mTc-sestamibi SPECT/CT is useful for detecting renal oncocytomas and other benign renal lesions 4.
- PSMA PET/CT is superior to CT alone in detecting biochemical recurrence of prostate cancer after radical prostatectomy 5.
- PET scan is useful in diagnosing and managing kidney disease, including kidney cancer 6.