Management of the Small Renal Mass: a 2020 Update
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INTERVENTIONAL ONCOLOGY (DC MADOFF, SECTION EDITOR)
Management of the Small Renal Mass: a 2020 Update Rand N. Wilcox Vanden Berg 1 & Spyridon P. Basourakos 1 & Samuel LaRussa 2,3 & Timothy D. McClure 1,3
# Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Purpose of Review Small renal masses (≤ cT1a, less than 4 cm) are a subset of renal tumors with low malignant and metastatic potential but increasing incidence given increased use of cross-sectional imaging. Here, we review the diagnostic and treatment options available for the lesions. Recent Findings While the low metastatic potential of SRMs has been known, recent studies show that 30% of SRMs removed surgically are benign. Renal biopsy is a tool that can be implemented to help with diagnosis before treatment (options of which include active surveillance, ablation, and surgery). Active surveillance might be associated with worse cancer-specific survival but all interventional methods appear to fare similarly. Advancements have also been made in percutaneous ablation techniques, and they now are included on multiple guideline statements. Summary Active surveillance, surgery (PN and RN), and thermal ablation are all treatment options for SRMs with similar outcomes but varying side effects. Keywords Small renal mass . Ablation . Nephrectomy . Renal biopsy . Active surveillance
Introduction Globally, kidney cancer is the fourteenth most common cancer amongst women and the ninth most common amongst men [1]. The global distribution of kidney cancer varies up to tenfold with higher incidence rates in countries with richer economies; in 2016, there were an estimated incidence of 300,000 new cases of renal cell carcinoma (RCC), of which 62,000 were in the USA [1, 2]. Over the last few decades, the incidence had increased compared to prior years, reaching a plateau around 2010, which is often attributed to the increased use of cross-sectional imaging [3, 4]. With this increase in incidence, clinicians are now more frequently seeing small renal masses (SRM), which are defined This article is part of the Topical Collection on Interventional Oncology * Timothy D. McClure [email protected] 1
Department of Urology, Weill Cornell Medicine/New York Presbyterian, New York, NY, USA
2
Department of Radiology, Einstein-Jacobi Medical Center, Bronx, NY, USA
3
Department of Interventional Radiology, Weill Cornell Medicine/ New York Presbyterian, New York, NY, USA
as masses less than 4 cm in diameter (T1a) [5]. In order to select the best choice of management, one must appreciate the biology and histology of these lesions. As a renal mass increases in size, the proportion of malignant versus benign pathologies increases. Frank et al. looked at 2770 patients undergoing surgery for a SRM and showed the risk of malignancy ranges from 53.8% when the SRM is less than 1.0 cm in diameter up to 80.1% when greater than 3.0 cm and less than 4.0 cm [6]. With regard to metastasis, for every centimeter increase in diameter, the risk of metastasis increases
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