The diagnosis and local staging of renal cancer--an appraisal

The standard pattern of investigation for renal masses usually involves excretion urography, ultrasonography and angiography. This study was undertaken to determine whether computed tomography (CT) and fine needle aspiration cytology could provide information that might allow this pattern to be modified. Diagnostic information was obtained by needle aspiration cytology in 25 patients who were shown at operation to have a neoplasm. The diagnosis was correct in 22 cases (88%). By comparison, arteriography was accurate in 22 out of 24 (92%), and computed tomography provided the correct diagnosis in 19 out of 21 (90%). Staging was performed surgically and histologically in 21 patients, and when this was compared with the results of CT staging there was complete agreement in 13 cases (62%). A literature review revealed an average staging accuracy for CT of 81% while arteriography was accurate in only 57%. Thus CT appears to be as good as arteriography for diagnosis and potentially better for local staging. It is also less invasive, rapid and cost effective and could supersede arteriography as the primary diagnostic and staging investigation in patients with a solid renal mass.