Staging CT chest for cT1a renal masses: Does it change management?

Area of Science:

• Oncology
• Radiology
• Urology

Background:

• Baseline staging for renal masses typically includes a chest CT scan.
• European Association of Urology (EAU) guidelines suggest omitting chest CT for asymptomatic, incidental T1a tumors (≤4 cm) due to low metastasis incidence.

Purpose of the Study:

• To evaluate the clinical utility of baseline staging chest CT in patients with T1a renal tumors.

Main Methods:

• Prospective screening of patients with solid and cystic cT1a renal tumors for the NEST study.
• Retrospective review of electronic records for follow-up data in 383 eligible patients.

Main Results:

• No thoracic renal metastases were diagnosed in 264 patients who underwent baseline chest CT.
• 14% of patients (37/264) showed abnormalities, including benign lung lesions, three primary lung tumors, one mesothelioma, and one pleural effusion.
• Concurrent primary lung tumors were detected in 1% of patients.

Conclusions:

• Baseline chest CT has limited value in staging cT1a renal tumors and minimal impact on management.
• Chest CT can lead to further investigations for incidental findings and detection of concurrent lung tumors.