The diagnosis and management of small (< or = 3 cm) renal neoplasms: a commentary

Many renal cell carcinomas are discovered incidentally. This phenomenon is largely attributable to advances in renal imaging, particularly regarding CT, to the widespread use of cross-sectional imaging in the diagnosis of abdominal disease, and to growing experience with the detection and diagnosis of renal masses. Accompanying the apparent increasing prevalence of renal masses are several controversies that specifically concern small (< or = 3 cm) neoplasms, those that are of a size associated with relatively slow growth and a low risk of metastasis. Are some of these small neoplasms renal adenomas? What is their growth pattern, and of what significance is their enlargement? Are all small renal carcinomas truly "cancers"? And what are the implications for management of such lesions in an asymptomatic individual? These controversies are discussed in depth in the hope of stimulating further investigation of this complex problem.