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Diagnostic strategy in renal mass lesions
A Haubek1, E Lundorf, K N Lauridsen
1Department of Diagnostic Radiology R, Aarhus Kommunehospital, Denmark.
Scandinavian Journal of Urology and Nephrology. Supplementum
|January 1, 1991
Summary
A focused diagnostic strategy using ultrasound and fine needle aspiration (FNA) effectively evaluated malignant renal masses in most patients. Advanced imaging like CT was only needed for a minority, proving this approach efficient for renal mass diagnosis.
Area of Science:
- Urology
- Radiology
- Oncology
Background:
- Accurate diagnosis of malignant renal masses is crucial for appropriate patient management.
- Traditional diagnostic pathways for renal masses can involve multiple imaging modalities and invasive procedures.
Purpose of the Study:
- To evaluate the feasibility and effectiveness of a restricted, individualized diagnostic strategy for suspected malignant renal masses.
- To determine the necessity of advanced imaging techniques such as computed tomography (CT) in the diagnostic workup.
Main Methods:
- A cohort of 169 patients with suspected malignant renal masses underwent a uniform yet individualized evaluation over 8 years.
- All patients received intravenous urography (IVU), ultrasound, and guided fine needle aspiration (FNA).
- CT was reserved for cases with diagnostic uncertainty, and angiography for pre-surgical planning.
Main Results:
- Therapeutic decisions were made using IVU, ultrasound, and cytology alone in 72% of patients.
- Computed tomography (CT) was required in only 19% of cases.
- Fine needle aspiration (FNA) achieved an 86.9% correct cytological diagnosis rate, with 86.8% sensitivity and 87.5% specificity, even with some false positives/negatives that did not impact treatment.
Conclusions:
- A diagnostic strategy prioritizing ultrasound and FNA is feasible and efficient for evaluating malignant renal masses.
- This approach significantly reduces the need for more invasive or expensive imaging like CT in the majority of patients.
- Tentative histological diagnoses are often possible via FNA, aiding in treatment planning.