From the Guidelines
The evaluation of a solid renal mass should begin with high-quality, multiphase, cross-sectional abdominal imaging to optimally characterize and clinically stage the renal mass, as recommended by the American Urological Association guideline 1. The initial assessment of a solid renal mass requires a comprehensive approach, including imaging studies and laboratory tests.
- The imaging modality of choice is high-quality, multiphase, cross-sectional abdominal imaging, such as CT or MRI, to characterize the renal mass and assess tumor complexity, degree of contrast enhancement, and presence or absence of fat 1.
- In addition to imaging, laboratory tests should include a comprehensive metabolic panel, complete blood count, and urinalysis to evaluate renal function and rule out infection or other underlying conditions 1.
- Evaluation for proteinuria, CKD, hematuria, hypercalcemia, hepatic dysfunction, and blood count abnormalities should also be pursued, as these may reflect poor health status or advanced cancer 1.
- Metastatic evaluation should include chest imaging to evaluate for possible thoracic metastases, as the lung is the most common site of metastasis for renal cell carcinoma 1.
- The decision for intervention should be based on tumor size, location, patient age, comorbidities, and renal function, with management options including partial or radical nephrectomy, thermal ablation techniques, or active surveillance 1.
From the Research
Evaluation of Solid Renal Mass
The evaluation of a solid renal mass typically involves imaging studies to determine whether the mass is surgical or nonsurgical, or if follow-up studies are necessary 2. The choice of imaging modality depends on various factors, including the patient's clinical history and the potential pitfalls and limitations of each modality.
Imaging Modalities
- Computed Tomography (CT) is the first choice for imaging of renal masses and has been the mainstay for several decades due to its high resolution, reproducibility, and reasonable preparation and acquisition time 3.
- Magnetic Resonance Imaging (MRI) is considered an important alternative in patients requiring further imaging or in cases of allergies, pregnancy, or surveillance, and has several advantages, including inherent soft tissue contrast and detection of lipid and blood products 4.
- Ultrasound has been the most commonly used imaging technique for renal imaging in general, but is not typically used for the evaluation of solid renal masses 3.
Diagnostic Approach
The diagnostic approach to a solid renal mass typically involves:
- A high-quality imaging examination, such as CT or MRI, to characterize the mass and determine its likelihood of being malignant 2.
- Consideration of the patient's clinical history and potential conditions that may mimic a renal neoplasm 2.
- Awareness of the potential pitfalls and limitations of each imaging modality, such as the limited ability of CT to differentiate between stage I and stage II lesions 5.
Staging and Management
The staging and management of renal cell carcinoma (RCC) has evolved in recent decades, with a significant stage migration towards smaller, organ-confined tumors that are amenable to nephron-sparing approaches 6. The evaluation and management of RCC typically involves: