Imaging of Small Renal Masses
Autor: | Ronald J. Zagoria |
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Rok vydání: | 2000 |
Předmět: |
Diagnostic Imaging
medicine.medical_specialty Biopsy medicine.medical_treatment Kidney Sensitivity and Specificity Radiologic sign Renal cell carcinoma Humans Medicine Radiology Nuclear Medicine and imaging Carcinoma Renal Cell Survival rate business.industry Cancer General Medicine Image Enhancement medicine.disease Kidney Neoplasms Surgery Radiation therapy medicine.anatomical_structure Radiology Tomography X-Ray Computed business Radiographic Magnification Kidney cancer Kidney disease |
Zdroj: | American Journal of Roentgenology. 175:945-955 |
ISSN: | 1546-3141 0361-803X |
Popis: | 945 enal cell carcinoma is the most common primary malignancy of the kidney. This tumor accounts for 2% of all cancer diagnoses in humans [1]. More than 30,000 new cases of kidney cancer are discovered and 12,000 deaths are caused by this disease in the United States each year [2]. Despite a great deal of research and many innovations in the treatment of renal cell carcinoma, the disease remains essentially resistant to radiation therapy and chemotherapy [3]. Modifiers of host biologic response, including agents such as interferon and interleukin, have been researched extensively for the treatment of advanced renal cell carcinoma [3]. However, therapeutic techniques have led to little improvement in the prognosis for patients with metastatic renal cell carcinoma; only 5–10% of these patients will be alive 5 years after diagnosis [1]. In addition, the incidence of renal cell carcinoma has risen steadily, increasing by 38% between 1974 and 1990 [3]. However, even though little progress has been made in the therapy for renal cell carcinoma, the 5-year survival rate for patients with renal cell carcinoma has improved significantly from 37% for patients whose disease was diagnosed in the early 1960s, to 52% for diagnoses between 1974 and 1976 [3, 4], to 58% for diagnoses between 1983 and 1989 [3]. Both of these trends—the increased incidence and the improved survival rate—appear to be due to improvements in the radiologic diagnosis of renal cell carcinoma [3] that allow the diagnosis to be made at an earlier stage of the disease. Low-stage renal cell carcinoma can be successfully treated with surgery, and the prognosis for patients with low-stage disease at diagnosis is considerably more favorable than for those with a more advanced stage at diagnosis [3]. Lead time and length biases may play some role in the apparent survival benefits [5], but the data strongly suggest that improved outcomes are due to earlier diagnosis. Many renal tumors are diagnosed incidentally. Approximately 25–40% of renal cell carcinomas are diagnosed after the incidental detection of a renal mass [6–8]. Before the widespread use of cross-sectional imaging techniques, including sonography, CT, and MR imaging, only 10% were incidentally detected [9, 10]. The increase in incidental detection of renal masses is not surprising given the increasing use of cross-sectional imaging. In a study that analyzed autopsies performed between 1958 and 1969, two thirds of cases of renal cell carcinoma occurred in patients for whom the diagnosis was not clinically suspected [11]. Several studies have confirmed that the number of renal cell carcinoma cases detected during imaging studies performed for nonurologic reasons is increasing [6–8]. Patients with incidentally discovered renal cell carcinoma have a more favorable prognosis than patients who present with urologic symptoms attributable to renal cell carcinoma [8, 10, 12]. The difference R Imaging of Small Renal Masses: A Medical Success Story Ronald J. Zagoria 1 Centennial Dissertation Honoring David R. Bowen, MD and James T. Case, MD |
Databáze: | OpenAIRE |
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