The fate of small renal masses, less then 1 cm size: Outcome study

Departments of Radiology and Urology SUNY, Downstate Medical School, Brooklyn, NY 11203, USA.
International braz j urol: official journal of the Brazilian Society of Urology (Impact Factor: 0.88). 01/2012; 38(1):40-8; discussion 48. DOI: 10.1590/S1677-55382012000100006
Source: PubMed


We evaluated the outcome and etiologies of small renal masses (less than 1 cm in size) discovered incidentally on 2 consecutive CTs that investigated nonurologic abdominal complaints.
A retrospective search for incidentally discovered small renal masses, less then 1 cm in size, was carried out in the files of 6 major US medical centers. 4822 such lesions had been reported over a 12 year period. A search of these patients' records revealed 1082 subsequent new CTs for non urologic complaints, allowing the assessment of the fate of the masses. Lesions enlarging, of ambivalent contour or enhancement were examined by a third multiphasic MDCT. The findings were interpreted by 2 blinded radiologists.
Six hundred and four masses could no longer be identified, 231 were significantly smaller, 113 unchanged in size and 134 larger. Of the disappearing lesions 448 were located in the medulla, 94 both in medulla and cortex and 62 in cortex. Multiphasic MDCTs obtained in 308 masses enlarging, unchanged in size or of ambivalent appearance, revealed 7 neoplasms, 45 inflammatory lesions, 8 abscesses and 62 renal medullary necrosis. Concurrent antibiotic therapy of GI conditions may have caused some of the 496 lesions to disappear.
It is questionable whether the small number of malignant neoplasms (0.4%), inflammatory lesions (5%) and renal medullary necrosis (6%) justify routine follow-up CTs and exposure to radiation. The delay in intervention in neoplastic lesions probably didn't influence tumor-free survival potential and clinical symptoms would soon have revealed inflammatory conditions. With exception of ambivalent lesions, clinical surveillance appears adequate.

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Available from: Ernest Rudman, Jul 30, 2014
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    ABSTRACT: Early diagnosis of renal masses has resulted in most of them being smaller than in the past, so that up to 61% of masses diagnosed are = 4 cm. Due to this fact the term small renal mass (SRM) has been forged, and there is a search to determine their biology. The objective of this article is to detail the possible help of pathology in this task. We performed a PubMed review of the bibliography from January 2000 to march 2012. Preoperative CT scan evaluation of the size of the renal masses correlates well with specimen measures(It only exceeds 3.1 mm). Size and growing speed do not allow recognizing benign masses, although it is true that the smaller the mass and the slower the growing speed the less aggressive the biology. Biopsy of the mass is the best method to determine the biology; it usually obtains valid material in 80.6% of the cases, and among them histologic subtype is determined in 88% to 93% of the cases and grade from 63.5% to 68%, with good reproducibility between observers (kappa from 0.010 to 0.830). This diagnostic capacity may increase joining biopsy and FNAC (reaching up to 96.5%) or determining some immunohistochemical markers (increase from 96percnt; to 18%) or using some FISH (7% increase) or molecular methods (11.7% increase). The biopsy of SRMs is useful and may answer the new demands to determine their nature and help therapeutic indications both surgical and with new drugs.
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