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Soo Hyun Kim, MD
, Kye jin Park, MD, Mi Hyun Kim, MD, Jeong Kon Kim, MD
, Kye jin Park, MD, Mi Hyun Kim, MD, Jeong Kon Kim, MD
Abstract
The diagnosis rates of small renal masses less than 4 cm in diameter are increasing with the increasing number of CT and MRI examinations. Since these small renal masses include a high proportion of benign tumors and low-malignant renal cell carcinomas, image-guided biopsy plays an important role in facilitating accurate diagnosis, low-invasive percutaneous radiofrequency- or cryo-ablation, and active surveillance for these masses. Therefore, the diagnostic accuracy and safety of image-guided biopsy for small renal masses, but awareness of the technical aspects of image-guided percutaneous ablation and an understanding of active surveillance are crucial in establishing an adequate treatment plan. The purpose of this review is to present the basic knowledge and clinical usefulness of the diagnosis trends for small renal masses, discuss the diagnostic accuracy of imaging-guided biopsy, and assess the use of low-invasive therapy with percutaneous ablation and active surveillance.
Figures and Tables
Fig. 1
Suggested algorithm for the management of SRMs. RMB depicts the clinical scenarios in which RMB can be considered.
*When technically feasible.
†Benign pathology, chromophobe, papillary type 1, or Fuhrman grade 1 to 2 mRCC.
AS = active surveillance, CCI = Charlson Comorbidity Index, mRCC = metastatic renal cell carcinoma, PN = partial nephrectomy, QOL = quality of life, R.E.N.A.L. = Radius, Exophytic/endophytic properties, Nearness of tumor to the collecting system or sinus in millimeters, Anterior/posterior Location relative to polar lines, RMB = renal mass biopsy, SRMs = small renal masses, TA = thermal ablation
Fig. 2
A case of successful radiofrequency ablation for renal cell carcinoma in a 70-year-old female patient.
A. MRI shows a contrast-enhancing mass in the left kidney.
B. The mass closely abuts the descending colon in the prone position.
C. Hydrodissection ensured sufficient space between the mass and the descending colon.
D. Radiofrequency ablation was performed for the renal mass.
E. The CT image obtained immediately after ablation shows no residual contrast enhancement in the renal mass.
F. The CT image obtained 24 hours after ablation shows a completely ablated mass without complication.
Fig. 3
A case of bowel perforation after radiofrequency ablation for renal cell carcinoma in a 57-year-old male patient.
A. CT image shows a 2-cm recurrent mass in the left kidney after right partial nephrectomy for renal cell carcinoma.
B. Radiofrequency ablation was performed for the recurrent tumor in left kidney.
C. Immediately after the ablation, there was no ablation-related complication on CT images.
D. At 24 h after ablation, the patients complained of persistent abdominal pain. CT images obtained 24 h after the procedure show pneumoperitoneum (arrows) caused by perforation of the ileal loop.
Table 3
Summary of the Published Guideline Criteria and Follow-Up for AS of SRMs
*Depending on the patient's comorbidities and life expectancy.
AML = angiomyolipoma, AS = active surveillance, ASCO = American Society of Clinical Oncology, AUA = American Urological Association, CXR = chest X-ray, EAU = European Association of Urology, ESRD = end-stage renal disease, NCCN = National Comprehensive Cancer Network, RCC = renal cell carcinoma, RMB = renal mass biopsy, SRM = small renal mass, US = ultrasound
Acknowledgments
This work was supported by Basic Science Research Program through the National Research Foundation of Korea (NRF) funded by the Ministry of Education, Science and Technology (2017R1A2B3007567).
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