2017 AUA Renal Mass and Localized Renal Cancer Guidelines: Imaging Implications

Renal cell carcinoma (RCC) is a common cancer that is increasing in incidence because of the increased prevalence of risk factors, including tobacco use, hypertension, and obesity, and the improved detection of these tumors due to increased use of imaging. Localized renal cancer now accounts for more than 60%-70% of new RCC cases. Renal masses suggestive of cancer include enhancing solid renal lesions and Bosniak III and IV complex cystic lesions. Most of these tumors are detected incidentally, and many are slow growing with little propensity to metastasize. Radiologists have a vital role in evaluation of these tumors and subsequent patient counseling. Options for managing RCC include radical nephrectomy (RN), partial nephrectomy (PN), thermal ablation, and active surveillance. However, historically, the use of these strategies has varied among practices. Improved understanding of the biologic features of these tumors and data indicating the heterogeneous clinical course of many clinically localized renal tumors led to the development of the American Urological Association (AUA) Localized Renal Cancer Panel Guidelines in 2009, and these guidelines were updated in 2017. The format of the updated guidelines has moved from management recommendations based on index patients to individualized decision making, taking into account patient age and comorbidities, tumor characteristics, and important renal function considerations. A distinct role for RN is defined for cases of tumors with increased oncologic potential in patients with a normal contralateral kidney. Beyond this, nephron-sparing options, particularly PN, should be a priority. The updated guidelines also recommend increased use of renal mass biopsy, thermal ablation, and active surveillance in appropriately selected patients. The 2017 AUA guidelines are reviewed, with emphasis on the implications for practicing radiologists. ^©RSNA, 2018.