Imaging of Small Renal Masses

Autor: Ronald J. Zagoria
Rok vydání: 2000
Předmět:
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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