Active surveillance in small renal masses
DOI:
https://doi.org/10.52786/isu.a.54Keywords:
Renal mass, active survellance, renal cancerAbstract
Active surveillance is one of the options available for management of renal masses smaller than 4 cm with a suspicion of malignancy in association with nephrectomy and ablative procedures. In general, small renal masses grow slowly and have a very low metastatic potential, but exceptions occur. Active surveillance is generally offered in the elderly with high comorbidities but there is a lack of validated data in other patient demographics. Data from younger and healthier patients are gradually emerging and have shown promising results but still require further validation. Computed tomography (CT), magnetic resonance imagin (MRI), and ultrasonography (US) are all acceptable imaging modalities for surveillance of renal masses, but CT is the most commonly used. Intervals of surveillance differs from study to study, but the most common schedule is 3, 6, and 12 months after initiation, then annually. The cut off point for delayed intervention is growth > 0.5 cm/year or absolute size > 4 cm. Oncologic outcome is comparable to nephrectomy and ablation in terms of cancer-specific survival. Quality of life for patients undergoing active surveillance is also comparable but is significantly lower in those with confirmed malignant biopsy results. Cost of active surveillance is as a rule more cost effective than nephrectomy or ablation.
References
Capitanio U, Bensalah K, Bex A, Boorjian SA, Bray F, Coleman J, et al. Epidemiology of renal cell carcinoma. Eur Urol 2019;75:74-84.
Lightfoot N, Conlon M, Kreiger N, Bissett R, Desai M, Warde P, et al. Impact of noninvasive imaging on increased incidental detection of renal cell carcinoma. Eur Urol 2000;37:521-7.
Nguyen MM, Gill IS, Ellison LM. The Evolving Presentation of Renal Carcinoma in the United States: Trends From the Surveillance, Epidemiology, and End Results Program. J Urol 2006;176:2397-400.
Campbell SC, Lane BR, Pierorazio PM. Malignant Renal Tumors. In: Partin AW, Demochowski RR, Kavoussi LR, Peters CA, editors. Campbell-Walsh- Wein Urology. 12nd ed. Philadelphia: Elsevier; 2021. p. 2164.
Lane BR, Tobert CM, Riedinger CB. Growth kinetics and active surveillance for small renal masses. Curr Opin in Urol 2012;22:353-9.
Uzosike AC, Patel HD, Alam R, Schwen ZR, Gupta M, Gorin MA, et al. Growth Kinetics of Small Renal Masses on Active Surveillance: Variability and Results from the DISSRM Registry. J Urol 2018;199: 641-8.
Organ M, Jewett M, Basiuk J, Morash C, Pautler S, Siemens R, et al. Growth kinetics of small renal masses: A prospective analysis from the Renal Cell Carcinoma Consortium of Canada. Can Urol Assoc J 2014;8:24-7.
McIntosh AG, Ristau BT, Ruth K, Jennings R, Ross E, Smaldone MC, et al. Active surveillance for localized renal masses: tumor growth, delayed intervention rates, and > 5-yr clinical outcomes. Eur Urol 2018;74:157-64.
Jewett MAS, Mattar K, Basiuk J, Morash CG, Pautler SE, Siemens DR, et al. Active surveillance of small renal masses: progression patterns of early stage kidney cancer. Eur Urol 2011;60:39-44.
Smaldone MC, Kutikov A, Egleston BL, Canter DJ, Viterbo R, Chen DYT, et al. Small renal masses progressing to metastases under active surveillance. Cancer 2012;118:997-1006.
Umbreit EC, Shimko MS, Childs MA, Lohse CM, Cheville JC, Leibovich BC, et al. Metastatic potential of a renal mass according to original tumour size at presentation. BJU Int 2012;109:190-4.
Rebez G, Pavan N, Mir MC. Available active surveillance follow-up protocols for small renal mass: a systematic review. World J Urol 2021;39:2875-82.
Crispen PL, Viterbo R, Boorjian SA, Greenberg RE, Chen DYT, Uzzo RG. Natural history, growth kinetics, and outcomes of untreated clinically localized renal tumors under active surveillance. Cancer 2009;115:2844-52.
Lee H, Lee JK, Kim K, Kwak C, Kim HH, Byun S-S, et al. Risk of metastasis for T1a renal cell carcinoma. World J Urol 2016;34:553-9.
Alam R, Patel HD, Osumah T, Srivastava A, Gorin MA, Johnson MH, et al. Comparative effectiveness of management options for patients with small renal masses: a prospective cohort study. BJU Int 2019; 123:42-50.
Wilcox Vanden Berg RN, Basourakos SP, LaRussa S, McClure TD. Management of the Small Renal Mass: a 2020 Update. Curr Oncol Rep 2020;22:69.
Ljungberg B, Albiges L, Abu-Ghanem Y, Bensalah K, Dabestani S, Fernández-Pello S, et al. European Association of Urology Guidelines on Renal Cell Carcinoma: The 2019 Update. Eur Urol 2019;75:799- 810.
Campbell SC, Uzzo RG, Karam JA, Chang SS, Clark PE, Souter L. Renal mass and localized renal can- cer: evaluation, management, and follow-up: AUA Guideline: Part II. J Urol 2021;206:209-18.
National Comprehensive Cancer Network. Kidney cancer (Version 2.2022) [Internet]. [cited 2021 Sep 8] Available from: https://www.nccn.org/professionals/physician_gls/pdf/kidney.pdf.
Metcalf MR, Cheaib JG, Biles MJ, Patel HD, Peña VN, Chang P, et al. Outcomes of active surveillance for young patients with small renal masses: prospective data from the DISSRM Registry. J Urol 2021;205:1286-93.
Deng FM, Melamed J. Histologic variants of renal cell carcinoma: does tumor type influence outcome? Urol Clin North Am 2012;39:119-32.
Deng J, Li L, Xia H, Guo J, Wu X, Yang X, et al. A comparison of the prognosis of papillary and clear cell renal cell carcinoma: Evidence from a meta-analysis. Medicine (Baltimore) 2019;98:e16309.
Finelli A, Cheung DC, Al-Matar A, Evans AJ, Morash CG, Pautler SE, et al. Small renal mass surveillance: histology-specific growth rates in a biopsy-characterized cohort. Eur Urol 2020;78:460-7.
Syed JS, Nawaf CB, Rosoff J, Bryson C, Nguyen KA, Suarez-Sarmiento A, et al. Adverse pathologic characteristics in the small renal mass: implications for active surveillance. Can J Urol 2017;24:8759-64.
Marconi L, Dabestani S, Lam TB, Hofmann F, Stewart F, Norrie J, et al. Systematic review and meta-analysis of diagnostic accuracy of percutaneous renal tumour biopsy. Eur Urol 2016;69:660-73.
Jeon HG, Seo SI, Jeong BC, Jeon SS, Lee HM, Choi H-Y, et al. Percutaneous kidney biopsy for a small renal mass: a critical appraisal of results. J Urol 2016; 195:568-73.
Bada M, Rapisarda S, Cicero C, Mauro MDI, Sebben M, B DEC, et al. The role of renal biopsy to improve small renal mass diagnosis and management: are there predictive factors for a higher detection rate?. The first Italian study of 100 cases. Minerva Urol Nephrol 2021;73:78-83.
Amaral BS, Macek P, Arora A, Pazeto CL, Zugail AS, Mombet A, et al. Renal tumor biopsy: rationale to avoid surgery in small renal masses. Curr Urol Rep 2021;22:46.
Kapur P, Setoodeh S, Araj E, Yan J, Malladi VS, Cadeddu JA, et al. Improving renal tumor biopsy prognostication with BAP1 analyses. Arch Pathol Lab Med 2022;146:154-65.
Maturen KE, Nghiem HV, Caoili EM, Higgins EG, Wolf Jr JS, Wood Jr DP. Renal mass core biopsy: Accuracy and impact on clinical management. Am J Roentgenol 2007;188:563-70.
Nuktong D, Sirisreetreerux P, Jenjitranant P, Viseshsindh W. Presentation and treatment of arterio-venous fistula, arteriovenous malformation, and pseudoaneurysm of the kidney in Ramathibodi Hospital. Insight Urol 2020;41:42-7.
Tikkakoski T, Paivansalo M, Apaja-Sarkkinen M, Ollikainen A, Lohela P, Matti K. Ultrasound-guided aspiration cytology of renal expansions. Rontgenblatter 1990;43:502-6.
Neuzillet Y, Lechevallier E, Andre M, Daniel L, Coulange C. Accuracy and clinical role of fine needle percutaneous biopsy with computerized tomography guidance of small (less than 4.0 Cm) Renal Masses. J Urol 2004;171:1802-5.
Ozambela M, Jr., Wang Y, Leow JJ, Silverman SG, Chung BI, Chang SL. Contemporary trends in percutaneous renal mass biopsy utilization in the United States. Urol Oncol 2020;38:835-43.
Patel DN, Ghali F, Meagher MF, Javier-Desloges J, Patel SH, Soliman S, et al. Utilization of renal mass biopsy in patients with localized renal cell carcinoma: a population-based study utilizing the National Cancer Database. Urol Oncol 2021;39:79.e1-8.
Heilbrun ME, Remer EM, Casalino DD, Beland MD, Bishoff JT, Blaufox MD, et al. ACR Appropriateness criteria indeterminate renal mass. J Am Coll Radiol 2015;12:333-41.
Lukasiewicz A, Bhargavan-Chatfield M, Coombs L, Ghita M, Weinreb J, Gunabushanam G, et al. Radiation dose index of renal colic protocol CT studies in the United States: a report from the American College of Radiology National Radiology Data Registry. Radiology 2014;271:445-51.
Lopez PO, Dauer LT, Loose R, Martin CJ, Miller DL, Vano E, et al. ICRP Publication 139: occupational radiological protection in interventional procedures. Ann ICRP 2018;47:1-118.
Krishna S, Leckie A, Kielar A, Hartman R, Khandelwal A. Imaging of renal cancer. Semin Ultrasound CT MRI 2020;41:152-69.
Sahni VA, Shinagare AB, Silverman SG. Virtual unenhanced CT images acquired from dual-energy CT urography: accuracy of attenuation values and variation with contrast material phase. Clin Radiol 2013;68:264-71.
Neville AM, Gupta RT, Miller CM, Merkle EM, Paulson EK, Boll DT. Detection of renal lesion enhancement with dual-energy multidetector CT. Radiology 2011;259:173-83.
Israel GM, Bosniak MA. Calcification in cystic renal masses: is it important in diagnosis? Radiology 2003;226:47-52.
Bruce R, Wentland AL, Haemel AK, Garrett RW, Sadowski DR, Djamali A, et al. Incidence of nephrogenic systemic fibrosis using gadobenate dimeglumine in 1423 patients with renal insuffi- ciency compared with gadodiamide. Invest Radiol 2016;51:701-5.
Michaely HJ, Aschauer M, Deutschmann H, Bongartz G, Gutberlet M, Woitek R, et al. Gadobutrol in renally impaired patients: results of the GRIP study. Invest Radiol 2017;52:55-60.
American College of Radiology, ACR Committee on Drugs and Contrast M. ACR Manual on Contrast Media. 2021 [Internet]. [cited 2021 Sep 8] Available from: https://www.acr.org/-/media/ACR/files/clin- ical-resources/contrast_media.pdf
Jamis-Dow CA, Choyke PL, Jennings SB, Linehan WM, Thakore KN, Walther MM. Small (< or = 3-cm) renal masses: detection with CT versus US and pathologic correlation. Radiology 1996;198:785-8.
Park BK, Kim B, Kim SH, Ko K, Lee HM, Choi HY. Assessment of cystic renal masses based on Bosniak classification: comparison of CT and contrast-enhanced US. Eur J Radiol 2007;61:310-4.
Bertelli E, Palombella A, Sessa F, Baldi I, Morelli N, Verna S, et al. Contrast-enhanced ultrasound (CEUS) imaging for active surveillance of small renal masses. World J Urol 2021;39:2853-60.
Duffey BG, Choyke PL, Glenn G, Grubb RL, Venzon D, Linehan WM, et al. The relationship between renal tumor size and metastases in patients with von Hippel-Lindau disease. J Urol 2004;172:63-5.
Uhlig A, Hahn O, Strauss A, Lotz J, Trojan L, Müller- Wille R, et al. Treatment for localized T1a clear cell renal cell carcinoma: survival benefit for cryosurgery and thermal ablation compared to deferred therapy. Cardiovasc Intervent Radiol 2018;41:277-83.
McAlpine K, Sud M, Finelli A, Kulkarni GS. Optimizing the management of patients with small renal masses in a Canadian context: A Markov decision-analysis model. Can Urol Assoc J 2021;16:E32-8.
Bhan SN, Pautler SE, Shayegan B, Voss MD, Goeree RA, You JJ. Active surveillance, radiofrequency ablation, or cryoablation for the nonsurgical management of a small renal mass: a cost-utility analysis. Ann Surg Oncol 2013;20:3675-84.
Goldberg H, Ajaj R, Cáceres JOH, Berlin A, Chandrasekar T, Klaassen Z, et al. Psychological distress associated with active surveillance in patients younger than 70 with a small renal mass. Urol Oncol 2020;38:603.e17-25.
Heilbrun ME, Yu J, Smith KJ, Dechet CB, Zagoria RJ, Roberts MS. The cost-effectiveness of immediate treatment, percutaneous biopsy and active surveil- lance for the diagnosis of the small solid renal mass: evidence from a Markov model. J Urol 2012;187:39- 43.
Thavorncharoensap M, Teerawattananon Y, Na- tanant S, Kulpeng W, Yothasamut J, Werayingyong P. Estimating the willingness to pay for a quality-adjusted life year in Thailand: does the context of health gain matter? Clinicoecon Outcomes Res 2013;5:29-36.
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2022 Insight Urology
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
