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Imaging work-up: is it renal carcinoma and is it operable?
1Department of Radiology, University of California Los Angeles School of Medicine 90024, USA.
Seminars in Urologic Oncology
|November 1, 1996
Summary
Imaging is crucial for detecting and staging renal cell carcinoma. While it accurately differentiates most tumors, distinguishing oncocytoma remains challenging, impacting treatment decisions.
Area of Science:
- Urology
- Radiology
- Oncology
Background:
- Imaging is vital for renal carcinoma detection and work-up.
- Accurate differentiation of renal masses is essential for appropriate patient management.
- Challenges exist in distinguishing renal cell carcinoma from benign entities like oncocytoma.
Purpose of the Study:
- To review the role of imaging in the detection and staging of renal carcinoma.
- To highlight key imaging findings for local staging, including venous tumor thrombus and lymph node metastases.
- To discuss the indications for renal mass biopsy and the utility of embolization techniques.
Main Methods:
- Review of current literature on renal mass imaging.
- Analysis of diagnostic accuracy for differentiating renal cell carcinoma from other renal masses.
- Evaluation of imaging's role in local staging and detection of distant metastases.
Main Results:
- Imaging accurately differentiates renal cell carcinoma from angiomyolipoma and complex cysts, but not reliably from oncocytoma.
- Venous tumor thrombus and its cephalad extension, along with lymph node metastases, are critical for local staging.
- Helical computed tomography is highly sensitive for detecting small lung metastases.
Conclusions:
- Imaging is paramount in renal carcinoma management, guiding diagnosis, staging, and treatment.
- Renal mass biopsy is indicated selectively, primarily when findings influence treatment in patients with other malignancies.
- Embolization serves specific roles in managing difficult cases preoperatively and palliatively.