From the Guidelines
The recommended workup for renal cell carcinoma (RCC) includes a comprehensive evaluation starting with a thorough history and physical examination, focusing on risk factors and symptoms such as hematuria, flank pain, or a palpable mass, as outlined in the most recent guidelines 1. The workup should include laboratory tests such as complete blood count, comprehensive metabolic panel (with renal and liver function tests), urinalysis, and sometimes erythrocyte sedimentation rate.
- Imaging is crucial, beginning with a contrast-enhanced CT scan of the abdomen and pelvis, which is the gold standard for diagnosis and staging, as recommended by the European Association of Urology guidelines 1.
- MRI may be used when CT is contraindicated or for evaluating venous involvement.
- Chest imaging (CT or X-ray) is necessary to assess for lung metastases.
- For patients with symptoms suggesting bone or brain metastases, bone scans and brain MRI should be performed.
- Renal mass biopsy may be considered in select cases where diagnosis is uncertain or before ablative therapies, with a core biopsy technique preferred over fine needle aspiration for histological characterization of solid renal tumors 1. The extent of workup should be tailored to the clinical presentation and initial findings, with a focus on accurate diagnosis, staging, and treatment planning for RCC.
- A bone scan is not routinely performed unless patients have an elevated serum alkaline phosphatase or complain of bone pain, and CT or MRI of the brain is performed if the history or physical examination suggests brain metastases 1. This comprehensive approach prioritizes morbidity, mortality, and quality of life outcomes, and is guided by the most recent and highest quality evidence available 1.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Renal Cell Carcinoma Workup
The workup for renal cell carcinoma (RCC) involves various imaging modalities to diagnose, stage, and follow-up the disease. The recommended workup includes:
- Computed Tomography (CT) scans: CT remains the most appropriate imaging modality to differentiate benign from malignant lesions 2, 3.
- Magnetic Resonance Imaging (MRI): MRI is considered an important alternative in patients requiring further imaging or in cases of allergies, pregnancy, or surveillance 3, 4.
- Ultrasonography: Although ultrasound has been the most commonly used imaging technique for renal imaging, it is not the first choice for imaging of renal masses 3.
Imaging Modalities
The choice of imaging modality depends on the specific needs of the patient and the treating physician. The imaging modalities used in RCC workup include:
- CT scans with contrast enhancement to assess tumor size, localization, and organ confinement 2.
- MRI to evaluate the involvement of the adrenal gland and to identify visceral metastases 2, 4.
- Positron Emission Tomography (PET) to evaluate treatment response, particularly in the era of antiangiogenetic therapy 4.
Diagnostic Algorithm
A diagnostic algorithm for the most informative imaging techniques in the evaluation of RCC is recommended 2. This algorithm includes:
- CT scans as the first-line imaging modality.
- MRI as an alternative or additional imaging modality.
- Ultrasonography as a supplementary imaging modality.
Treatment Strategies
The workup for RCC also involves determining treatment strategies, including: