Renal cell carcinoma: angiography in the CT era

Accurate preoperative staging of renal cell carcinoma determines which patients may benefit from surgery and influences the surgical approach to potentially curable lesions. Recently, computed tomography has been shown to be as accurate as angiography for staging renal tumors, suggesting that angiography may be limited to those cases where clarification of equivocal computed tomographic findings or additional staging information would alter the therapy. To test this hypothesis, the radiographic evaluation of 42 patients with renal cell carcinoma was reviewed. Of the 42 patients, 24 (57%) were examined by computed tomography alone, while 18 (43%) had angiographic and computed tomographic examinations (nine venograms and 11 arteriograms). Seven of the nine venograms obtained for diagnosis or staging added additional information or clarified an equivocal computed tomographic finding, but none of the 11 arteriograms added significant diagnostic information. Venograms were particularly useful in patients with bulky right-sided lesions. Computed tomographic staging of renal cell carcinoma can be accepted by urologists and has, in fact, reduced the use of routine preoperative angiography in our medical center.