| 1. American Cancer Society. Kidney Cancer. Available at: https://www.cancer.org/cancer/kidney-cancer.html. |
Review/Other-Dx |
N/A |
To provide an overview of kidney cancer and the latest key statistics in the US. |
No results stated in abstract. |
4 |
| 2. Siegel RL, Miller KD, Fuchs HE, Jemal A. Cancer Statistics, 2021. CA Cancer J Clin 2021;71:7-33. |
Review/Other-Dx |
N/A |
Each year, the American Cancer Society estimates the numbers of new cancer cases and deaths in the United States and compiles the most recent data on population-based cancer occurrence. Incidence data (through 2017) were collected by the Surveillance, Epidemiology, and End Results Program; the National Program of Cancer Registries; and the North American Association of Central Cancer Registries. Mortality data (through 2018) were collected by the National Center for Health Statistics. In 2021, 1,898,160 new cancer cases and 608,570 cancer deaths are projected to occur in the United States. After increasing for most of the 20th century, the cancer death rate has fallen continuously from its peak in 1991 through 2018, for a total decline of 31%, because of reductions in smoking and improvements in early detection and treatment. This translates to 3.2 million fewer cancer deaths than would have occurred if peak rates had persisted. Long-term declines in mortality for the 4 leading cancers have halted for prostate cancer and slowed for breast and colorectal cancers, but accelerated for lung cancer, which accounted for almost one-half of the total mortality decline from 2014 to 2018. The pace of the annual decline in lung cancer mortality doubled from 3.1% during 2009 through 2013 to 5.5% during 2014 through 2018 in men, from 1.8% to 4.4% in women, and from 2.4% to 5% overall. This trend coincides with steady declines in incidence (2.2%-2.3%) but rapid gains in survival specifically for nonsmall cell lung cancer (NSCLC). For example, NSCLC 2-year relative survival increased from 34% for persons diagnosed during 2009 through 2010 to 42% during 2015 through 2016, including absolute increases of 5% to 6% for every stage of diagnosis; survival for small cell lung cancer remained at 14% to 15%. Improved treatment accelerated progress against lung cancer and drove a record drop in overall cancer mortality, despite slowing momentum for other common cancers. |
No results stated in abstract. |
4 |
| 3. Li ZC, Zhai G, Zhang J, et al. Differentiation of clear cell and non-clear cell renal cell carcinomas by all-relevant radiomics features from multiphase CT: a VHL mutation perspective. Eur Radiol. 29(8):3996-4007, 2019 Aug. |
Observational-Dx |
170 patients |
To develop a radiomics model with all-relevant imaging features from multiphasic computed tomography (CT) for differentiating clear cell renal cell carcinoma (ccRCC) from non-ccRCC and to investigate the possible radiogenomics link between the imaging features and a key ccRCC driver gene-the von Hippel-Lindau (VHL) gene mutation. |
The model with eight all-relevant features from corticomedullary phase CT achieved an AUC of 0.949 and an accuracy of 92.9% in the validation cohort, which significantly outperformed the model with eight mRMR features (seven from nephrographic phase and one from corticomedullary phase) with an AUC of 0.851 and an accuracy of 81.2%. Combining age and sex did not benefit the performance. Five out of eight all-relevant features were significantly associated with VHL mutation, while all eight mRMR features were significantly associated with VHL mutation (false discovery rate-adjusted p < 0.05). |
3 |
| 4. Amin MB, Edge S, Greene F, et al. AJCC Cancer Staging Manual. 8th ed. New York, NY: Springer; 2017. |
Review/Other-Dx |
N/A |
To classify patients with cancer, define prognosis, and determine the best treatment approaches. |
No abstract available. |
4 |
| 5. Ljungberg B, Albiges L, Abu-Ghanem Y, et al. European Association of Urology Guidelines on Renal Cell Carcinoma: The 2019 Update. Eur Urol. 75(5):799-810, 2019 05. |
Review/Other-Dx |
N/A |
To provide an updated RCC guideline based on standardised methodology including systematic reviews, which is robust, transparent, reproducible, and reliable. |
No results stated in abstract. |
4 |
| 6. National Cancer Data Base (NCDB). Available at: http://www.facs.org/cancer/ncdb/index.html. |
Review/Other-Dx |
N/A |
To analyze and track patients with malignant neoplastic diseases, their treatments, and outcomes. |
No results stated in abstract. |
4 |
| 7. Leslie JA, Prihoda T, Thompson IM. Serendipitous renal cell carcinoma in the post-CT era: continued evidence in improved outcomes. Urol Oncol. 2003;21(1):39-44. |
Observational-Dx |
257 patients |
To compare patient and tumor characteristics between serendipitous and nonserendipitously discovered RCC in the recent widespread use of CT and US. Tumor registry was reviewed for diagnosis and treatment of RCC. |
Use of CT and US has led to the discovery of many asymptomatic lesions, including renal tumors. |
2 |
| 8. Flanigan RC, Campbell SC, Clark JI, Picken MM. Metastatic renal cell carcinoma. Curr Treat Options Oncol 2003;4:385-90. |
Review/Other-Dx |
N/A |
To review management of patients with metastatic RCC. |
Metastases may be found at diagnosis or at some interval after nephrectomy. A shorter interval between nephrectomy and the development of metastases is linked with poorer prognosis. Patients with metastatic RCC face a dismal prognosis, with a median survival time of only 6 to 12 months and a 2-year survival rate of 10% to 20%. |
4 |
| 9. Griffin N, Gore ME, Sohaib SA. Imaging in metastatic renal cell carcinoma. AJR Am J Roentgenol. 2007;189(2):360-370. |
Review/Other-Dx |
N/A |
To review the role of imaging in metastatic RCC. |
Imaging is likely to play an increasing role in the management, diagnosis, and monitoring of response to treatment of metastatic RCC. |
4 |
| 10. Elkassem AA, Allen BC, Sharbidre KG, Rais-Bahrami S, Smith AD. Update on the Role of Imaging in Clinical Staging and Restaging of Renal Cell Carcinoma Based on the AJCC 8th Edition, From the AJR Special Series on Cancer Staging. [Review]. AJR. American Journal of Roentgenology. 217(3):541-555, 2021 Sep. |
Review/Other-Dx |
N/A |
To review the essential role of imaging in clinical staging and restaging of renal cell carcinoma (RCC). |
No results stated in abstract. |
4 |
| 11. Blacher E, Johnson DE, Haynie TP. Value of routine radionuclide bone scans in renal cell carcinoma. Urology, 1985; 26(5):432-434. |
Observational-Dx |
85 patients |
To evaluate routine bone scanning for staging for RCC. |
Sensitivity 93%, specificity 86%. Although bone scanning was useful for confirming clinically or radiographically suspected metastatic disease, it did not influence the staging of the RCC in any patient. It is concluded that bone scans should be used to confirm the presence and to determine the extent of osseous metastases in patients with RCC but are unnecessary as a routine staging procedure. |
3 |
| 12. Koga S, Tsuda S, Nishikido M, et al. The diagnostic value of bone scan in patients with renal cell carcinoma. J Urol. 166(6):2126-8, 2001 Dec. |
Observational-Dx |
162 men; 43 women |
To assess the diagnostic value of bone scan in patients with renal cell carcinoma. |
Of the 56 patients (27%) with an abnormal bone scan 32 (57%) had osseous metastatic lesions. Overall bone metastasis was present in 34 of the 205 patients (17%). Bone scan had 94% sensitivity and 86% specificity. Of the 124 patients with clinically localized, stages T1-2N0M0 disease exclusive of bone metastasis 6 (5%) had bone metastasis only, whereas 28 of 81 (35%) with locally advanced or metastatic disease had bone metastasis, including 12 (35%) who complained of bone pain and 19 (56%) who presented with other symptoms due to local tumor growth or metastasis at other sites. Three patients (9%) were asymptomatic. There was osseous metastasis without other metastasis, enlarged regional lymph nodes or bone pain in 7 patients, including 1 with stage T1b (2% of all with that stage), 2 with stage T2 (5%), 1 with stage T3a (4%), 1 with stage T3b (6%), 1 with stage T3c (14%) and 1 with stage T4 (6%) disease. |
3 |
| 13. NCCN Clinical Practice Guidelines in Oncology. Kidney Cancer. Version 2.2022. Available at: https://www.nccn.org/professionals/physician_gls/pdf/kidney.pdf. |
Review/Other-Dx |
|
To provide NCCN practice guidelines on kidney cancer. |
No abstract available. |
4 |
| 14. Utsunomiya D, Shiraishi S, Imuta M, et al. Added value of SPECT/CT fusion in assessing suspected bone metastasis: comparison with scintigraphy alone and nonfused scintigraphy and CT. Radiology. 238(1):264-71, 2006 Jan. |
Observational-Dx |
45 patients |
To evaluate retrospectively if there is additional diagnostic value of fused single photon emission computed tomographic and CT images in assessing possible bone metastases. |
After review of fused images to classify indeterminate lesions, reviewer 1 became more confident in diagnosis of the 15 benign lesions and 2 metastases, and reviewer 2 became more confident in diagnosis of the 7 benign lesions and 1 metastasis. The area under the receiver operating characteristic curve for reviewer 1 was 0.589 for scintigraphic images, 0.831 for separate data sets of scintigraphic and CT images, and 0.947 for fused images. The corresponding areas under the receiver operating characteristic curve for reviewer 2 were 0.771, 0.885, and 0.968, respectively. |
3 |
| 15. Hallscheidt PJ, Bock M, Riedasch G, et al. Diagnostic accuracy of staging renal cell carcinomas using multidetector-row computed tomography and magnetic resonance imaging: a prospective study with histopathologic correlation. J Comput Assist Tomogr 2004;28:333-9. |
Observational-Dx |
82 RCCs |
Prospective study to compare accuracy of MDCT and MRI in staging RCC. |
MRI achieved accuracy of 78%–87% and CT 80%–83%, which are statistically identical. MRI and CT can be used interchangeably for staging renal cancer. |
2 |
| 16. Walter C, Kruessell M, Gindele A, Brochhagen HG, Gossmann A, Landwehr P. Imaging of renal lesions: evaluation of fast MRI and helical CT. Br J Radiol. 2003;76(910):696-703. |
Observational-Dx |
29 patients |
To compare triphasic helical CT and fast MRI for staging renal cancer. |
12/18 renal cancers were correctly staged by CT and MRI. Both MRI and CT are excellent in providing critical staging information, however, CT does so more quickly. |
2 |
| 17. Dalla-Palma L, Pozzi-Mucelli R. Problematic renal masses in ultrasonography and computed tomography. Clin Imaging. 1990;14(2):83-98. |
Review/Other-Dx |
N/A |
Review the use of CT and US in problematic renal masses. |
CT is helpful in most of these cases because it enables the evaluation of the calcifications and the density of the fluid content. CT is also helpful in cases of cystic tumors because it shows the enhancement of septae within the masses. Problems with solid masses are the identification of small renal tumors and the definition of the benign or malignant nature of the mass. Although both techniques enable the recognition of most tumors, even if small in diameter, they are still limited in defining the pathological structure of the tumor. |
4 |
| 18. Fuccio C, Ceci F, Castellucci P, et al. Restaging clear cell renal carcinoma with 18F-FDG PET/CT. Clin Nucl Med. 39(6):e320-4, 2014 Jun. |
Observational-Dx |
69 patients |
To assess the usefulness of FDG-PET/CT in the restaging of clear cell RCC patients. |
FDG-PET/CT was positive in 42 patients and negative in 27 patients. 16 patients presented single lesions and 26 patients presented multiple localizations of the disease. On a patient basis, 40 patients resulted true positive, 2 patient false positive, 23 patients true negative, and 4 patients false negative. Sensitivity, specificity, accuracy, PPV, and NPV were 90%, 92%, 91%, 95%, and 85%, respectively. On a lesion basis, PET/CT detected 114 areas of abnormal uptake in 42 positive patients of which 112 resulted to be true positive. FDG uptake of the true positive lesions resulted to be high in 83 cases, moderate in 17 lesions, and finally faint in 12 lesions. |
3 |
| 19. Hillner BE, Siegel BA, Hanna L, Duan F, Quinn B, Shields AF. 18F-fluoride PET used for treatment monitoring of systemic cancer therapy: results from the National Oncologic PET Registry. J Nucl Med. 56(2):222-8, 2015 Feb. |
Observational-Dx |
2,217 patients who underwent 2,839 scans |
To assess the impact of NaF PET results obtained for treatment monitoring of systemic cancer therapy. |
The overall rates of prior radionuclide bone imaging were 78%, 76%, and 66% for prostate, breast, and other cancers, respectively. 57% of patients underwent prior NaF PET. Overall change in management associated with NaF PET was 40%. In patients with prior NaF PET scans for comparison, continuing current therapy was planned in 79% when scans showed no change or a decrease or absence of osseous metastasis. Treating physicians planned to switch therapy in 59% of patients after scans showed evidence of new or progressive metastasis. When an additional parameter, estimated prognosis, was worse, switching therapy was even more common (76%). |
3 |
| 20. Hillner BE, Siegel BA, Hanna L, et al. Impact of 18F-Fluoride PET on Intended Management of Patients with Cancers Other Than Prostate Cancer: Results from the National Oncologic PET Registry. J Nucl Med. 2014;55(7):1054-1061. |
Observational-Dx |
2,819 nonprostate,
compared with 8,284 prostate cancer scans
|
To report the impact of NaF PET on intended management for patients with other cancer types and compared these results with those in prostate cancer patients. |
Overall, NaF PET led to change in intended management in a substantial fraction of nonprostate cancer patients. In the setting of suspected FOM, NaF PET had a lower immediate impact on the treat/nontreat decision in nonprostate vs prostate cancer patients, which is consistent with current practice guidelines. |
3 |
| 21. Kuhn MJ, Hammer GM, Swenson LC, Youssef HT, Gleason TJ. MRI evaluation of "solitary" brain metastases with triple-dose gadoteridol: comparison with contrast-enhanced CT and conventional-dose gadopentetate dimeglumine MRI studies in the same patients. Comput Med Imaging Graph. 1994;18(5):391-399. |
Review/Other-Dx |
4 patients |
To compare the sensitivity and safety of high dose gadoteridol (Pro Hance) with routine dose gadopentetate dimeglumine (Magnevist) in the detection of intracranial metastases on MRI when a solitary intracranial lesion was detected on contrast-enhanced cranial CT. |
18 total metastases demonstrated on MRI compared to 4 on CT. Only 9/18 of these seen on standard dose contrast MRI. |
4 |
| 22. Martinez de Llano SR, Delgado-Bolton RC, Jimenez-Vicioso A, et al. [Meta-analysis of the diagnostic performance of 18F-FDG PET in renal cell carcinoma]. Rev Esp Med Nucl. 2007;26(1):19-29. |
Meta-analysis |
7 studies |
To perform a meta-analysis of the literature to evaluate the performance and accuracy of FDG-PET in the detection of primary disease, recurrence and metastasis of RCC. |
7 out of 46 studies fulfilled the inclusion criteria and were analyzed. 3 studies evaluated the use of FDG-PET in the differential diagnosis of renal masses. 2 studies analyzed restaging and 2 analyzed the role of FDG-PET in the detection of metastatic disease. All the selected studies were classified according to Flynn's criteria. The authors found the highest sensitivity in restaging with S 0.87 (95% CI, 0.75–0.95) and in metastases detection with sensitivity 0.72 (95% CI, 0.56–0.85) as well as the high specificity in differential diagnosis of renal masses. |
M |
| 23. Park JW, Jo MK, Lee HM. Significance of 18F-fluorodeoxyglucose positron-emission tomography/computed tomography for the postoperative surveillance of advanced renal cell carcinoma. BJU Int. 2009; 103(5):615-619. |
Observational-Dx |
63 patients |
To evaluate the role of (18)F-fluorodeoxyglucose (FDG) positron-emission tomography (PET)/computed tomography (CT) for the surveillance of patients with renal cell carcinoma (RCC) who have a high risk of local recurrence or distant metastasis, by comparing the results with those of conventional imaging methods. |
The FDG PET/CT accurately classified the presence of a recurrence or metastasis in 56 (89%) patients. FDG PET/CT had an 89.5% sensitivity, 83.3% specificity, 77.3% positive predictive value, 92.6% negative predictive value, and 85.7% accuracy in detecting recurrence or metastasis, which was not significantly different from the results with conventional methods. Moreover, the accuracy of the FDG PET/CT by nuclear grade and histological subtypes was not significantly different. |
3 |
| 24. Seute T, Leffers P, ten Velde GP, Twijnstra A. Detection of brain metastases from small cell lung cancer: consequences of changing imaging techniques (CT versus MRI). Cancer. 2008;112(8):1827-1834. |
Observational-Dx |
481 consecutive patients |
To show 1) the effect of changing from CT to MRI on the prevalence of detected brain metastases in patients with newly diagnosed small cell lung cancer; 2) the difference in survival between patients with single and multiple brain metastases; and 3) the effect of the change in patient labeling on eligibility for prophylactic brain irradiation. |
The prevalence of detected brain metastases was 10% in the CT era and 24% in the MRI era. In the CT era, all detected brain metastases were symptomatic, whereas in the MRI era, 11% were asymptomatic. In both periods, patients labeled as single brain metastases survived longer than those labeled as multiple brain metastases. For patients labeled as single brain metastases or multiple brain metastases, survival was longer in the MRI era than in the CT era. The proportion of patients who were eligible for prophylactic cranial irradiation was lower in the MRI era. |
3 |
| 25. Steffens S, Junker K, Roos FC, et al. Small renal cell carcinomas--how dangerous are they really? Results of a large multicenter study. Eur J Cancer. 2014;50(4):739-745. |
Review/Other-Dx |
2,197 patients |
To evaluate the prevalence of risk factors such poor tumor differentiation and synchronous metastases in patients with small RCC (64 cm). |
At the time of surgery, tumors were staged as pT3a in 175 (8.0%) cases, 134 (6.2%) were poorly differentiated and 75 (3.5%) were metastasized. The larger the tumor size, the higher was the risk of presenting with stage pT3a (P<0.001), poor tumor differentiation (P=0.004), microscopic vascular involvement (P=0.001) and collecting system invasion (P=0.03). The 5-year cancer-specific survival rate was 93.8% for stage pT1a vs 79.4% for stage pT3a (P<0.001), and it was 93.7% for Grade 1-2 vs 76.8% for Grade 3-4 differentiation (P<0.001). Multivariate analysis identified age in years (HR 1.04, P<0.001), metastatic disease (HR 12.5, P<0.001), tumor differentiation (HR 2.8, P<0.001) and nonclear cell histology (HR 0.51, P=0.02) as independent prognosticators for cancer-specific survival rate in patients with small RCC. Interestingly, the 5-year cancer-specific mortality rate for pT1a N/M0 patients was 5.8%. |
4 |
| 26. Tsui KH, Shvarts O, Smith RB, Figlin RA, deKernion JB, Belldegrun A. Prognostic indicators for renal cell carcinoma: a multivariate analysis of 643 patients using the revised 1997 TNM staging criteria. J Urol. 2000;163(4):1090-1095; quiz 1295. |
Observational-Dx |
643 consecutive patients |
Retrospective review to determine independent prognostic indicators for RCC using the revised 1997 TNM staging criteria. |
The 5-year cancer specific survival rate was 91%, 74%, 67% and 32% for TNM stages I, II, III and IV lesions, respectively (p<0.001). Analysis demonstrated a survival rate of 83% for stage T1, 57% for stage T2, 42% for stage T3 and 28% for stage T4 disease (p<0.001), and 89% for grade 1, 65% for grade 2, and 46% for grades 3 and 4 (p<0.001). Multivariate analysis revealed that overall TNM stage and grade of disease were the most important prognostic indicators for renal cell carcinoma (p<0.001). ECOG classification was a less significant predictor (p = 0.031) and tumor stage was not shown to have any independent impact on patient survival (p = 0.138). |
2 |
| 27. Wang HY, Ding HJ, Chen JH, et al. Meta-analysis of the diagnostic performance of [18F]FDG-PET and PET/CT in renal cell carcinoma. Cancer Imaging. 2012;12:464-474. |
Meta-analysis |
14 studies |
To evaluate whether the integration of CT scans with the PET system could increase the applicability of FDG-PET for RCC. |
The pooled sensitivity and specificity of FDG-PET were 62% and 88% respectively, for renal lesions. For detecting extra-renal lesions, the pooled sensitivity and specificity of FDG-PET were 79% and 90%, respectively, based on the scans, and 84% and 91% based on the lesions. The use of a hybrid FDG-PET/CT to detect extra-renal lesions increased the pooled sensitivity and specificity to 91% and 88%, respectively, with good consistency. |
M |
| 28. Ates F, Akyol I, Sildiroglu O, et al. Preoperative imaging in renal masses: does size on computed tomography correlate with actual tumor size? Int Urol Nephrol 2010;42:861-6. |
Observational-Dx |
86 patients |
To evaluate the discrepancy between tumor sizes determined from preoperative computed tomography (CT) and surgical specimens and its clinical implications. |
Clinical stage was T1a in 13, T1b in 47, and = T2 in 26; pathologic stage was T1a in 12, T1b in 45, and = T2 in 29 patients. Histological subtype was clear cell, papillary, chromophobe, sarcomatoid, and oncocytic in 72, 7, 5, 1, and 1 patients, respectively. Mean radiographic and pathologic size was 6.33 and 6.43 cm, respectively (p = 0.342). On the average, radiographic measurement underestimated pathologic size by 1 mm. When subgroups of patients according to tumor size were formed as < 4, 4-7, and > 7 cm, mean radiographic size was 2.79, 5.44, and 9.57 cm, mean pathologic size was 3.47, 5.62, and 9.26 cm, respectively. In subgroups of < 4, 4-7, and > 7 cm; radiographic measurement underestimated pathologic size by 0.68 (p = 0.018) and 0.18 cm (p = 0.470) and overestimated by 0.31 cm (p = 0.454), respectively. |
3 |
| 29. Kurta JM, Thompson RH, Kundu S, et al. Contemporary imaging of patients with a renal mass: does size on computed tomography equal pathological size? BJU Int 2009;103:24-7. |
Observational-Dx |
521 patients |
To evaluate the difference between radiographic size on computed tomography (CT) and the pathological size of renal tumours, in contemporary patients. |
For all patients, the mean radiographic size and mean pathological size was 4.79 and 4.69 cm, respectively (P = 0.02). Therefore, on average, radiographic size overestimated pathological size by 1 mm. In patients with a tumour of 4-7 cm, radiographic size overestimated pathological size by 0.21 cm (P = 0.007). However, there was no significant difference in patients with a tumour of <4 cm or >7 cm. |
3 |
| 30. Irani J, Humbert M, Lecocq B, Pires C, Lefebvre O, Dore B. Renal tumor size: comparison between computed tomography and surgical measurements. Eur Urol 2001;39:300-3. |
Observational-Dx |
100 patients |
We studied the agreement between renal tumor size as assessed on computed tomography (CT) before surgery and that measured during histopathological examination on the radical nephrectomy specimen. |
CT estimate and surgical measurement of tumor size were highly correlated (r = 0.9; p<0.001). Median (range) tumor size was 70.0 mm (13-180) and 60.0 mm (10-180) as measured, respectively, on CT and in the specimen, with a significant difference (p = 0.005). Multiple regression did not reveal any significant influence of tumor side, location, type, nuclear grade as well as patient gender, body mass index and radiological center (p>0.3 in all cases). The extent of difference between CT and surgical measurements was significantly influenced by the surgical size of the tumor (p = 0.03): the smaller the tumor, the more the CT overestimated the tumor size. If nephron-sparing surgery had been planned for tumors equal to or less than 40 mm, 24 patients would have been selected following the CT estimate, while 27 patients would have met this criterion on the surgical measurement. |
3 |
| 31. Goel MC, Mohammadi Y, Sethi AS, Brown JA, Sundaram CP. Pathologic upstaging after laparoscopic radical nephrectomy. J Endourol 2008;22:2257-61. |
Observational-Dx |
123 patients |
Retrospective study of patients undergoing laparoscopic radical nephrectomy to determine the extent of upstaging on histopathology evaluation and correlated the clinical and pathology staging to determine the factors responsible for upstaging. |
Pathologic upstaging of malignant renal neoplasms occurred in about 31% of patients following laparoscopic radical nephrectomy. Downstaging was less common and mean tumor size does not significantly change. |
3 |
| 32. Jeffery NN, Douek N, Guo DY, Patel MI. Discrepancy between radiological and pathological size of renal masses. BMC Urol. 2011;11:2. |
Observational-Dx |
157 patients |
To compare the radiological size of solid renal tumors on CT to the pathological size in an Australian population. |
Overall, the mean radiological tumor size on CT was 58.3 mm and the mean pathological size was 55.2 mm. On average, CT overestimated pathological size by 3.1 mm (P=0.012). CT overestimated pathological tumor size in 92 (58.6%) patients, underestimated in 44 (28.0%) patients and equaled pathological size in 21 (31.4%) patients. Among the 122 patients with pT1 or pT2 tumors, there was a discrepancy between clinical and pathological staging in 35 (29%) patients. Of these, 21 (17%) patients were downstaged postoperatively and 14 (11.5%) were upstaged. Fuhrman grade correlated positively with radiological tumor size (P=0.039) and pathological tumor stage (P=0.003). |
3 |
| 33. Catalano C, Fraioli F, Laghi A, et al. High-resolution multidetector CT in the preoperative evaluation of patients with renal cell carcinoma. AJR 2003;180:1271-7. |
Observational-Dx |
40 patients, 2 observers |
To determine the accuracy of MDCT using a high resolution technique in preoperative evaluation of patients with RCC. |
For Robson stage I of RCC, fat infiltration on 1 mm scans was diagnosed with 96% sensitivity, 93% specificity, and 95% accuracy; PPV of 100% , NPV of 93%. MDCT is an accurate technique. |
3 |
| 34. Hallscheidt P, Wagener N, Gholipour F, et al. Multislice computed tomography in planning nephron-sparing surgery in a prospective study with 76 patients: comparison of radiological and histopathological findings in the infiltration of renal structures. J Comput Assist Tomogr 2006;30:869-74. |
Experimental-Dx |
76 consecutive patients, 2 blinded readers |
Prospective study to determine the diagnostic accuracy of MDCT compared to histopathologic findings in tumor staging of RCC, with the focus on tumor stage, vein and artery infiltration, and infiltration of the renal pelvis. |
Readers 1 and 2 reached a sensitivity of 1.0 and 1.0 and a specificity of 0.41 and 0.42 for arterial infiltration, a sensitivity of 1.0 and 0.86 and a specificity of 0.58 and 0.5 for venous infiltration, and a sensitivity of 0.75 and 1.0 and a specificity of 0.5 and 0.44 for infiltration of the renal pelvis. The correlation between both readers was 0.7 for all modalities. The multiplanar reconstruction capability of MDCT allowed good sensitivity in predicting arterial infiltration. The lowest specificity was reached in excluding infiltration of the renal pelvis. Despite its high temporal and spatial resolution, the capacity of MDCT to predict intrarenal infiltrations is still limited. |
1 |
| 35. Nazim SM, Ather MH, Hafeez K, Salam B. Accuracy of multidetector CT scans in staging of renal carcinoma. Int J Surg. 9(1):86-90, 2011. |
Observational-Dx |
98 patients |
To determine the diagnostic accuracy of multidetector-row computed tomography (MDCT) compared to histopathological findings in tumor staging of renal cell carcinoma, with the focus on tumor size and stage, renal vein involvement, and peri-renal infiltration. |
A total of 98 renal cell carcinomas were proven on histopathology. There was a significant (p 0.05) difference in the mean maximum radiological and maximum pathological diameter of the tumor with radiological diameter being greater. Twenty seven tumors were down staged and only 1 was up staged. The specificity of CT for capsular invasion, nodal disease and adrenal involvement was 85, 82 and 98% respectively. The specificity was over 97% for tumor thrombus in renal vein and IVC. |
2 |
| 36. Sokhi HK, Mok WY, Patel U. Stage T3a renal cell carcinoma: staging accuracy of CT for sinus fat, perinephric fat or renal vein invasion. Br J Radiol. 88(1045):20140504, 2015 Jan. |
Observational-Dx |
117 patients |
To study the accuracy of CT for staging T3a (TNM 2009) renal cell carcinoma (RCC). |
Median (range) tumour size was 5.5 (0.9-19.0) cm; and 46 (39%), 16 (14%) and 55 (47%) tumours were pT1, pT2 and pT3a RCC, respectively. The sensitivity/specificity for sinus fat, perinephric fat and renal vein invasion were 71/79%, 83/76% and 59/93% (Reader 1) and 88/71%, 68/72% and 69/91% (Reader 2) with ? = 0.41, 0.43 and 0.61, respectively. Sinus fat invasion was seen in 47/55 (85%) cases with T3a RCC vs 16/55 (29%) and 33/55 (60%) for perinephric fat and renal vein invasion. Tumour necrosis, irregularity of tumour edge and direct tumour contact with perirenal fascia or sinus fat increased the odds of local invasion [odds ratio (OR), 2.5-3.7; p < 0.05; ? = 0.42-0.61]. Stage T3a tumours were centrally located (OR, 3.9; p = 0.0009). |
2 |
| 37. Renard AS, Nedelcu C, Paisant A, et al. Is multidetector CT-scan able to detect T3a renal tumor before surgery?. Scand J Urol. 53(5):350-355, 2019 Oct. |
Observational-Dx |
96 patients with 100 pathologically proven RCC |
To evaluate the diagnostic accuracy of multidetector Computed Tomography (MDCT) in predicting T3a renal cell carcinoma (RCC |
Sensitivity for the identification of peritumoral fat, sinus fat or renal vein invasion was 77%, 86% and 86%, and specificity was 72%, 88% and 97%, respectively. Sensitivity and specificity in the prediction of T3a tumors were 72% and 70% respectively (? score = 0.38 (0.29-0.47)). Among the 38 pT3 tumors, 6 (16%) were under-staged, and the neovessels and irregular tumor edge as secondary CT signs did not significantly increase the accuracy of the prediction of local invasion. Among the 62 confined tumors, 17 (27%) were over-staged as cT3 and among these 17 false positives cases, perinephric soft-tissue stranding was present in 14 cases. |
2 |
| 38. Landman J, Park JY, Zhao C, et al. Preoperative Computed Tomography Assessment for Perinephric Fat Invasion: Comparison With Pathological Staging. Journal of Computer Assisted Tomography. 41(5):702-707, 2017 Sep/Oct. |
Observational-Dx |
161 patients |
To assess the accuracy of computed tomography (CT) imaging in diagnosing perinephric fat (PNF) invasion in patients with renal cell carcinoma. |
The overall accuracy of perinephric (PN) soft-tissue stranding, peritumoral vascularity, increased density of the PNF, tumoral margin, and contrast-enhancing soft-tissue nodule to predict PNF invasion were 56%, 59%, 35%, 80%, and 87%, respectively. Perinephric soft-tissue stranding and peritumoral vascularity showed high sensitivity but low specificity regardless of tumor size. A contrast-enhancing soft-tissue nodule showed low sensitivity but high specificity in predicting PNF invasion. Among tumors 4 cm or less, PN soft-tissue stranding showed 100% sensitivity and 70% specificity, and tumor margin showed 100% sensitivity and 98% specificity. |
3 |
| 39. Sawai Y, Kinouchi T, Mano M, et al. Ipsilateral adrenal involvement from renal cell carcinoma: retrospective study of the predictive value of computed tomography. Urology 2002;59:28-31. |
Observational-Dx |
73 patients |
Retrospective analysis to assess the value of CT in detecting ipsilateral adrenal involvement by RCC. |
CT had 100% sensitivity, 76% specificity, 11% PPV, and 100% NPV for ipsilateral adrenal involvement of RCC. Normal adrenal images on CT could exclude adrenal involvement by RCC, but radical nephrectomy should be performed in patients with large tumors. |
2 |
| 40. Blakely S, Bratslavsky G, Zaytoun O, Daugherty M, Landas SK, Shapiro O. Preoperative cross-sectional imaging allows for avoidance of unnecessary adrenalectomy during RCC surgery. Urol Oncol 2015;33:22 e23-22 e27. |
Observational-Dx |
117 patients |
To assess the frequency of adrenal involvement and the reliability of preoperative imaging to predict adrenal involvement in patients treated for cortical renal masses at a single institution. |
he mean tumor size in patients without adrenal involvement was 6.79 cm, whereas in those with adrenal involvement, it was 9.62 cm (P = 0.057). Of 6 patients with adrenal involvement, 5 had imaging studies available for review, and all 5 demonstrated suspicion for adrenal involvement preoperatively. Among 111 patients without adrenal involvement, 53 (47.7%) had imaging available for review, with only 3 (5.7%) demonstrating suspicion for adrenal involvement. The negative predictive value was 100%, whereas the sensitivity and specificity were 100% and 94.3%, respectively. |
3 |
| 41. Nason GJ, Aslam A, Giri SK. Predictive Ability of Preoperative CT Scan in Determining Whether the Adrenal Gland is Spared at Radical Nephrectomy. Curr Urol 2016;9:143-47. |
Observational-Dx |
579 patients |
To assess whether preoperative multiple detector computed tomography (MDCT) accurately predicts adrenal involvement for patients undergoing non-adrenal sparing radical nephrectomy for renal cell carcinoma. |
MDCT was found to have a sensitivity of 100% and specificity of 95.2% for identifying adrenal invasion. Total 179 patients (89.9%) had a radiographically normal ipsilateral adrenal gland, of which none were found to have adrenal involvement. Therefore, the negative predictive value of preoperative cross-sectional imaging for identification of adrenal involvement was 100%. |
3 |
| 42. Tadayoni A, Paschall AK, Malayeri AA. Assessing lymph node status in patients with kidney cancer. Transl Androl Urol 2018;7:766-73. |
Review/Other-Dx |
10 articles |
To evaluate the advantages and disadvantages of each modality and utilize sensitivities and specificities to determine the highest performing modalities for accurate lymph node involvement in renal cancer. |
Of the modalities examined, MRI demonstrated the highest sensitivity (92-95.7%) for detection of lymph node involvement in RCC. Studies of lymph node involvement in RCC using both MRI and CT indicated that using the current diameter criteria (greater than 1 cm) for determination of positive lymph nodes should be re-evaluated as micro-metastases are frequently overlooked. Studies evaluating lymph node involvement with FDG-PET had the highest specificity (100%), indicating FDG-PET is the preferred modality for confirming lymph node involvement and extent of involvement. However, due to the low sensitivity of FDG-PET, clinicians should be skeptical of negative reports of lymph node involvement in RCC patients. |
4 |
| 43. Corwin MT, Lamba R, Wilson M, McGahan JP. Renal cell carcinoma metastases to the pancreas: value of arterial phase imaging at MDCT. Acta Radiol. 54(3):349-54, 2013 Apr 01. |
Observational-Dx |
6 patients with 24 metastatic lesions |
To compare the rate of detection of renal cell carcinoma metastases to the pancreas between arterial and portal venous phase MDCT. |
Reviewer 1 identified 20/24 (83.3%) lesions on the arterial phase images and 13/24 (54.2%) lesions on the venous phase. Seventeen of 20 (85.0%) arterial lesions were deemed definite and 9/13 (69.2%) venous lesions were definite. Reviewer 2 identified 19/24 (79.2%) lesions on the arterial phase and 14/24 (58.3%) on the venous phase. Seventeen of 19 (89.5%) arterial lesions were definite and 7/14 (50%) venous lesions were definite. |
2 |
| 44. Jain Y, Liew S, Taylor MB, Bonington SC. Is dual-phase abdominal CT necessary for the optimal detection of metastases from renal cell carcinoma? Clin Radiol. 2011; 66(11):1055-1059. |
Observational-Dx |
100 patients |
To determine whether dual-phase abdominal computed tomography (CT) detected more metastases than portal-phase CT alone in patients with renal cell carcinoma (RCC). |
Metastases were identified in the liver in 27 patients, pancreas in 12, and contralateral kidney in 23 patients. Nine of the 27 (33%) liver metastases, three of the 12 (25%) pancreatic metastases, and two of the 23 (9%) renal metastases were only detected in the arterial phase, whilst four of the 27 (15%) liver metastases, three of the 12 (25%) pancreatic metastases, and two of the 23 (9%) renal metastases were only detected in the portal phase. Nine patients (9%) had metastases only visualized in the arterial phase, and six (6%) only in the portal phase. Detection of metastases only visible in the arterial phase led to a change of management in two patients (2%). |
2 |
| 45. Ng CS, Loyer EM, Iyer RB, David CL, DuBrow RA, Charnsangavej C. Metastases to the pancreas from renal cell carcinoma: findings on three-phase contrast-enhanced helical CT. AJR 1999;172:1555-9. |
Review/Other-Dx |
9 patients |
To define the lesion enhancement characteristics of renal cell carcinoma metastases to the pancreas using three-phase helical CT. |
The enhancement patterns of the metastatic deposits and the normal pancreas differed. Thirty-four lesions ranging in size from 6 to 110 mm were identified. All metastases showed rapid enhancement during the early (arterial and portal) phases, resulting in differential attenuations (compared with normal pancreatic parenchyma) of approximately 50-100 H. The differential attenuations were approximately 5-45 H on delayed-phase scans, resulting in poorer conspicuity of the lesions. Multifocal metastases were clearly identified on the early-phase scans in seven patients. |
4 |
| 46. Raptopoulos VD, Blake SP, Weisinger K, Atkins MB, Keogan MT, Kruskal JB. Multiphase contrast-enhanced helical CT of liver metastases from renal cell carcinoma. Eur Radiol 2001;11:2504-9. |
Observational-Dx |
45 patients |
To evaluate whether in patients with metastatic renal cell carcinoma (RCC) multiphase liver studies would improve detection of metastatic liver disease. |
Seventy-two liver metastases were detected in 16 patients. Of these, 54 were seen on unenhanced scans; 47 in the hepatic arterial (HA) phase, at 25 s; 65 in the portal-venous (PV) phase, at 60 s; and 49 in delayed images, at 90 s. Scanning only during the PV phase would have missed seven lesions (10%), six of which were seen on unenhanced images and six were seen in HA phase. All patients with metastatic liver disease would have been identified by combination of unenhanced and PV phase or by HA and PV phase scanning. Forty-two lesions were graded more conspicuous on the PV phase, whereas 18 (25%) were more conspicuous on the HA phase |
3 |
| 47. Fielding JR, Aliabadi N, Renshaw AA, Silverman SG. Staging of 119 patients with renal cell carcinoma: the yield and cost-effectiveness of pelvic CT. AJR. 1999; 172(1):23-25. |
Review/Other-Dx |
119 patients |
Computerized review of medical records to determine the yield and cost-effectiveness of pelvic CT in staging RCC. |
Total estimated cost of the 119 CT examinations of the pelvis was $40,698 ($342 each). No findings of probable malignancy were identified. In 27 patients, CT showed benign findings; these results did not cause planned surgery to be delayed. Three of these 27 patients underwent further radiologic tests at an estimated total cost of $243. |
4 |
| 48. Khaitan A, Gupta NP, Hemal AK, Dogra PN, Seth A, Aron M. Is there a need for pelvic CT scan in cases of renal cell carcinoma? Int Urol Nephrol. 2002; 33(1):13-15. |
Review/Other-Dx |
400 patients |
Retrospective study to determine the necessity of pelvic CT in patients of RCC. |
Of the 400 cases, 114 were stage I, 68 were stage II, 99 were stage III and 119 were stage IV. In all patients, tumor was identified in the kidney on preoperative CT scan. 14 patients (3.5%) had an abnormality on pelvic CT. Five (1.25%) had category 1, three (0.75%) had category 2 and six (1.5%) had category 3 abnormality on pelvic CT. However, all these abnormalities in pelvis were detected prior to CT by other investigations (ultrasonograms or plain radiograph). Of the six cases with malignant findings, two had superficial bladder cancer, one had RCC in a pelvic kidney and three had bone metastases in the pelvis. Pelvic CT does not offer additional information in the vast majority of cases with RCC and should be performed selectively. Thus the cost of diagnostic imaging in RCC can be reduced. |
4 |
| 49. Canvasser NE, Stouder K, Lay AH, et al. The Usefulness of Chest X-Rays for T1a Renal Cell Carcinoma Surveillance. J Urol. 196(2):321-6, 2016 08. |
Observational-Tx |
258 patients |
To evaluate the usefulness of chest x-rays based on the current AUA (American Urological Association) guidelines and National Comprehensive Cancer center (NCCC) Guidelines(R) for T1a renal cell carcinoma surveillance. |
Pulmonary metastases developed in 3 of 258 patients (1.2%) but only 1 (0.4%) was diagnosed by standard chest x-ray surveillance. Median followup in the entire cohort was 36 months (range 6 to 152) and 193 of 258 patients (75%) had greater than 24 months of followup. A mean of 3.3 surveillance chest x-rays were completed per patient. When assessed by treatment type, there was no significant difference in the recurrence rate for partial nephrectomy (0 of 191 cases), radical nephrectomy (0 of 22) or radio frequency ablation (1 of 45 or 2.2%) (p = 0.09). |
2 |
| 50. Winter H, Meimarakis G, Angele MK, et al. Tumor infiltrated hilar and mediastinal lymph nodes are an independent prognostic factor for decreased survival after pulmonary metastasectomy in patients with renal cell carcinoma. J Urol. 2010; 184(5):1888-1894. |
Observational-Dx |
110 patients |
To analyze the value of computerized tomography to predict mediastinal/hilar lymph node involvement as well as the impact of systematic lymphadenectomy on survival in patients with pulmonary renal cell carcinoma metastasis. |
Lymph node metastasis was histologically proved in 35% of patients. Metastasis was not associated with initial tumor grade, lymph node status, the number of pulmonary metastases or recurrent pulmonary metastasis. Computerized tomography had 84% sensitivity and 97% specificity to predict lymph node metastasis. Sensitivity was markedly better for detecting mediastinal than hilar lymph node metastasis (90% vs 69%). Patients with lymph node metastasis had significantly shorter median survival than patients without lymph node metastasis (19 vs 102 months, p <0.001). Multivariate analysis revealed that tumor infiltrated mediastinal lymph nodes were an independent prognostic factor for patient survival. Match paired analysis showed that after lymph node dissection patients showed a trend toward improved survival. |
3 |
| 51. Mano R, Vertosick E, Sankin AI, et al. Subcentimeter pulmonary nodules are not associated with disease progression in patients with renal cell carcinoma. J Urol 2015;193:776-82. |
Observational-Dx |
748 patients |
To determine whether the presence of indeterminate pulmonary nodules, or nodule size or number is associated with renal cell carcinoma outcomes. |
determinate pulmonary nodules were present in 382 of 748 patients (51%). Median followup was 4.1 years (IQR 2.2-6.1). The presence of indeterminate pulmonary nodules was not associated with distant metastasis or death from kidney cancer. However, compared to subcm indeterminate pulmonary nodules the nodules greater than 1 cm were associated with metastatic disease after adjusting for tumor histology, stage and size (HR 2.48, 95% CI 1.08-5.68, p = 0.031). The outcome c-index increased slightly after adding nodule size to a predictive model adjusted for tumor characteristics. |
3 |
| 52. Thompson RH, Hill JR, Babayev Y, et al. Metastatic renal cell carcinoma risk according to tumor size. J Urol 2009;182:41-5. |
Observational-Dx |
2,367 patients |
To evaluate the association between tumor size and the metastasis risk in a large patient cohort. |
Only 1 of 781 patients with a tumor less than 3 cm had M1 renal cell carcinoma at presentation and tumor size was significantly associated with metastasis at presentation (for each 1 cm increase OR 1.25, p <0.001). Of the 2,367 patients who did not present with metastasis metastatic disease developed in 171 during a median 2.8-year followup. In this group only 1 of the 720 patients with renal cell carcinoma less than 3 cm showed de novo metastasis during followup. Metastasis-free survival was significantly associated with tumor size (for each 1 cm increase HR 1.24, p <0.001). |
3 |
| 53. Umbreit EC, Shimko MS, Childs MA, et al. Metastatic potential of a renal mass according to original tumour size at presentation. BJU Int 2012;109:190-4; discussion 94. |
Observational-Tx |
2651 patients |
To determine the metastatic potential of renal masses based on original tumour size. |
Of the 2651 patients studied, 182 (6.9%) presented with M1 RCC. Tumour size was significantly greater in patients with M1 RCC than in patients with M0 RCC (a median size of 10 vs 4.5 cm; P < 0.001). Only 1 of the 629 patients (0.2%) with a tumour <3 cm had M1 RCC and that tumour was 2.5 cm. The risk of M1 RCC increased from 1.1% for patients with tumours 3-3.9 cm to 16.5% for patients with tumours =7 cm. Of the 2124 patients with M0 RCC, 430 developed distant metastases at a median (range) of 1.4 (0.1-16.2) years after surgery. Only 9 of the 498 patients (1.8%) with a tumour <3 cm developed distant metastases after surgery. Each 1-cm increase in tumour size increased the risk of death from RCC by 20%[hazard ratio (HR) 1.20; 95% confidence interval (CI) 1.18-1.22; P < 0.001] and death from any cause by 10% (HR 1.10; 95% CI 1.09-1.12; P < 0.001). For the 1346 patients who were still alive at last follow-up, the median (range) duration of follow-up was 6.9 (0.1-19.7) years. |
2 |
| 54. Larcher A, Dell'Oglio P, Fossati N, et al. When to perform preoperative chest computed tomography for renal cancer staging. BJU Int. 120(4):490-496, 2017 10. |
Observational-Dx |
1946 patients |
To provide objective criteria for preoperative staging chest computed tomography (CT) in patients diagnosed with renal cell carcinoma (RCC) because, in the absence of established indications, the decision for preoperative chest CT remains subjective. |
The rate of positive chest CT was 6% (n = 119). At multivariable logistic regression, =cT1b, cN1, systemic symptoms and Hb/PLT ratio were all associated with higher risk of positive chest CT (all P < 0.001). After 2000-sample bootstrap validation, the concordance index was found to be 0.88. At decision-curve analysis, the net benefit of the proposed strategy was superior to the select-all and select-none strategies. Accordingly, if chest CT had been performed when the risk of a positive result was >1%, a negative chest CT would have been spared in 37% of the population and a positive chest CT would have been missed in 0.2% of the population only. |
3 |
| 55. Voss J, Drake T, Matthews H, et al. Chest computed tomography for staging renal tumours: validation and simplification of a risk prediction model from a large contemporary retrospective cohort. BJU International. 125(4):561-567, 2020 04. |
Observational-Dx |
1082 patients |
To externally validate a nomogram recently proposed by Larcher et al. (BJU Int. 2017; 120: 490) and to develop a simplified model with comparable accuracy to guide on the need for staging chest computed tomography (CT) for patients with new renal masses. |
Forty-two patients (3.9%) had a positive chest CT. The Larcher nomogram had an AUC of 83.8% (95% confidence interval [CI] 77.1-90.6), but was only moderately well calibrated (calibration-in-the-large = -0.61, slope = 0.82). Specifically, the nomogram overestimated the risk of positive chest CT, and the magnitude of miscalibration increased with increasing predicted risks. Using a stepwise backward approach, a new model was developed including tumour size, nodal stage and systemic symptoms. Compared with the Larcher model, the new model had a similar AUC (82.7% [95% CI 75.5-90.0]), but improved calibration and clinical net benefit. The predicted risk of positive chest CT was <1% in the low-risk group and 1.9-79.9% in the high-risk group. |
3 |
| 56. Kotecha RR, Flippot R, Nortman T, et al. Prognosis of Incidental Brain Metastases in Patients With Advanced Renal Cell Carcinoma. J Natl Compr Canc Netw 2021;19:432-38. |
Review/Other-Dx |
1689 patients |
To characterize patients with mRCC incidentally diagnosed with asymptomatic brain metastases during screening for clinical trial participation at Gustave Roussy and Memorial Sloan Kettering Cancer Center. |
72 of 1,689 patients (4.3%) with mRCC harbored occult brain metastases. The International Metastatic RCC Database Consortium (IMDC) risk status was favorable (26%), intermediate (61%), and poor (13%), and 86% of patients had =2 extracranial sites of disease, including lung metastases in 92% of patients. CNS involvement was multifocal in 38.5% of patients, and the largest brain metastasis was >1 cm in diameter in 40% of the cohort. Localized brain-directed therapy was pursued in 93% of patients, predominantly radiotherapy. Median overall survival was 10.3 months (range, 7.0-17.9 months), and the 1-year overall survival probability was 48% (95% CI, 37%-62%). IMDC risk and number or size of lesions did not correlate with survival (log-rank, P=.3, P=.25, and P=.067, respectively). |
4 |
| 57. Naito S, Narisawa T, Kato T, et al. Clinical utility of head computed tomography scan during systemic therapy for metastatic renal cell carcinoma. International Journal of Urology. 28(4):450-456, 2021 04. |
Observational-Tx |
152 metastatic renal cell carcinoma patients |
To evaluate the utility of routine head computed tomography during systemic therapy. |
Brain metastasis occurred in 16 patients in the "Routine head computed tomography" group and six patients in the "No routine head computed tomography" group. There was no statistical difference in overall survival after metastatic renal cell carcinoma diagnosis between groups (53.4 vs 37.3 months, respectively, P = 0.357) and neurological symptom-free survival after metastatic renal cell carcinoma diagnosis (53.4 vs 36.6 months, P = 0.336). Although there was no statistical difference on incidence of unrecovered neurological symptom (25.0% vs 50.0%, P = 0.334), fewer patients in the "Routine head computed tomography" group required craniotomy (0% vs 66.7%, P = 0.002). In the "No routine head computed tomography" group, the neurological symptom resolved for all patients without craniotomy. |
2 |
| 58. Escudier B, Porta C, Schmidinger M, et al. Renal cell carcinoma: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol 2014;25 Suppl 3:iii49-56. |
Review/Other-Dx |
N/A |
To provide provide guidelines for diagnosis, treatment and follow-up of renal cell carcinoma. |
No results stated in abstract. |
4 |
| 59. Nakanishi Y, Kitajima K, Yamada Y, et al. Diagnostic performance of 11C-choline PET/CT and FDG PET/CT for staging and restaging of renal cell cancer. Ann Nucl Med. 32(10):658-668, 2018 Dec. |
Observational-Dx |
28 patients |
To compare findings obtained with 11C-choline and FDG PET/CT scanning for renal cell carcinoma staging and restaging. |
Patient-based sensitivity, specificity, positive predictive, negative predictive, accuracy, and area under the ROC curve (AUC) values for 11C-choline PET/CT for staging and restaging were 88.0% (22/25), 66.7% (2/3), 95.7% (22/23), 40.0% (2/5), 85.7% (24/28), and 0.887, respectively, while those for FDG-PET/CT were 56.0% (14/25), 66.7% (2/3), 93.3% (14/15), 15.4% (2/13), 57.1% (16/28), and 0.647, respectively. Sensitivity, accuracy, and AUC were significantly different (p = 0.013, p = 0.013, p = 0.012, respectively). Among the 120 lesions, those with kidney, lung, lymph node, bone, pancreas, venous tumor thrombosis, adrenal gland, liver, or skin localization numbered 15, 64, 16, 13, 4, 3, 2, 2, and 1, respectively. For all 120 lesions, 75 (62.5%) and 47 (39.2%) were detected by 11C-choline and FDG PET/CT, respectively (p < 0.0001). |
2 |
| 60. Gundogan C, Cermik TF, Erkan E, et al. Role of contrast-enhanced 18F-FDG PET/CT imaging in the diagnosis and staging of renal tumors. Nucl Med Commun 2018;39:1174-82. |
Observational-Dx |
62 patients |
To compare intravenous contrast-enhanced (CE) fluorine-18-fluorodeoxyglucose (F-FDG) PET/computed tomography (CE F-FDG PET/CT) with conventional methods (CT/MRI) and to evaluate the relationship of maximum standardized uptake value (SUVmax) with Fuhrman grade in patients with renal tumors. |
The sensitivity of CE F-FDG PET/CT in primary tumor detection was 98%, which was very close to that of CT/MRI (100%). CE F-FDG PET/CT resulted in correct staging in 84% of the cases, compared with 68% of the cases with conventional methods (52 vs. 42 patients). SUVmax values of early PET for the primary tumors were significantly correlated with the Fuhrman grades (P<0.001). CE F-FDG PET/CT enabled the detection of synchronous tumors in four patients, one of which was incorrectly diagnosed as having metastasis by CT. Distant metastases were detected in 16 patients with CE F-FDG PET/CT and in 13 patients with routine conventional methods. |
2 |
| 61. Gerety EL, Lawrence EM, Wason J, et al. Prospective study evaluating the relative sensitivity of 18F-NaF PET/CT for detecting skeletal metastases from renal cell carcinoma in comparison to multidetector CT and 99mTc-MDP bone scintigraphy, using an adaptive trial design. Ann Oncol. 26(10):2113-8, 2015 Oct. |
Observational-Dx |
10 participants |
To assess the sensitivity of (18)F-labelled sodium fluoride in conjunction with positron emission tomography/computed tomography ((18)F-NaF PET/CT) for detecting renal cell carcinoma (RCC) bone metastases, compared with conventional imaging by bone scintigraphy or computed tomography (CT). |
Seventy-seven lesions were diagnosed as malignant: 100% were identified by (18)F-NaF PET/CT, 46% by CT and 29% by bone scintigraphy/single photon emission computed tomography (SPECT). Standard-of-care imaging with CT and bone scintigraphy identified 65% of the metastases reported by (18)F-NaF PET/CT. On an individual patient basis, (18)F-NaF PET/CT detected more RCC metastases than (99m)Tc-labelled methylene diphosphonate ((99m)Tc-MDP) bone scintigraphy/SPECT or CT alone (P = 0.007). The metabolic volumes, mean and maximum standardized uptake values (SUV mean and SUV max) of the malignant lesions were significantly greater than those of the benign lesions (P < 0.001). |
3 |
| 62. Ergen FB, Hussain HK, Caoili EM, et al. MRI for preoperative staging of renal cell carcinoma using the 1997 TNM classification: comparison with surgical and pathologic staging. AJR 2004;182:217-25. |
Observational-Dx |
MRI in 40 consecutive patients with 42 RCCs before radical (n=35) or partial (n=4) nephrectomy or exploratory laparotomy (n=3) |
Retrospective review to determine accuracy of MRI for preoperative staging of RCC using the 1997 TNM classification. |
Agreement between MRI and surgical-pathologic staging was good for T staging (kappa = 0.72 and 0.78 for reviewers 1 and 2 respectively), poor for N staging (kappa = 0.13, both reviewers), good for M staging (kappa = 0.66, both reviewers), and excellent for the assessment of venous involvement (kappa = 0.93, both reviewers). MRI is reliable, in particular assessing venous involvement. |
3 |
| 63. Kamel IR, Hochman MG, Keogan MT, et al. Accuracy of breath-hold magnetic resonance imaging in preoperative staging of organ-confined renal cell carcinoma. J Comput Assist Tomogr 2004;28:327-32. |
Observational-Dx |
43 patients (50 lesions) |
Retrospective study to determine accuracy of breath-hold MRI for preoperative staging of organ-confined (stage I) RCC. |
MRI has accuracy of range 80% and 82% in staging patients with organ-confined RCC, with 90% agreement between readers. |
2 |
| 64. Roy C, Sr., El Ghali S, Buy X, et al. Significance of the pseudocapsule on MRI of renal neoplasms and its potential application for local staging: a retrospective study. AJR 2005;184:113-20. |
Observational-Dx |
80 tumors |
Retrospective study to evaluate the role of MRI in showing a tumoral pseudocapsule to select patients for partial surgery. |
MRI findings for isolated analysis of the pseudocapsule for differentiating stage T1/T2 from T3a were sensitivity: 86%, 50%; specificity: 95%, 92%; PPV: 95%, 33%; NPV: 88%, 92%; and accuracy: 93%, 89%, for clear cell and papillary types, respectively. For stage T3a, with both abnormalities of the pseudocapsule and perirenal fat, results were, for overall RCC sensitivity: 84%; specificity: 95%; PPV: 91%; NPV: 91%; and accuracy: 91%. The presence of an intact pseudocapsule is a sign of lack of perinephric fat invasion and predicts that the tumor can be removed by nephron-sparing surgery. |
2 |
| 65. Lal H, Singh P, Jain M, et al. Role of MRI in staging and surgical planning and its clinicopathological correlation in patients with renal cell carcinoma. Indian J Radiol Imaging 2019;29:277-83. |
Observational-Dx |
30 patients |
To assess the role of MRI in pre-operative staging of RCC in patients undergoing radical nephrectomy and nephron sparing surgery (NSS) and correlate it with histopathological findings. |
30 patients with suspected RCC underwent NSS (n = 10) and radical nephrectomy (n = 20). Mean tumor size was 9.66 ± 2.99 cm in the radical nephrectomy group and 4.06 ± 1.16 cm in the NSS group. There was perfect agreement between MRI, surgical and pathological staging for breach of pseudocapsule (? =1.0, Percentage of Agreement = 100%, P < 0.05). In none of the patients, MRI missed extension beyond the Gerota's fascia or presence of venous thrombus. |
3 |
| 66. Hallscheidt PJ, Fink C, Haferkamp A, et al. Preoperative staging of renal cell carcinoma with inferior vena cava thrombus using multidetector CT and MRI: prospective study with histopathological correlation. J Comput Assist Tomogr 2005;29:64-8. |
Experimental-Dx |
23 patients |
Prospective study to evaluate the accuracy of MDCT and MRI in staging RCC with caval thrombus. |
CT thrombus detection sensitivity and specificity for both readers was 0.93 and 0.8 respectively. MRI sensitivity and specificity for both readers was 1.0/0.85 and 0.75. CT and MRI accuracy was 78% and 72%, 88% and 76% respectively. |
2 |
| 67. Aslam Sohaib SA, Teh J, Nargund VH, Lumley JS, Hendry WF, Reznek RH. Assessment of tumor invasion of the vena caval wall in renal cell carcinoma cases by magnetic resonance imaging. J Urol 2002;167:1271-5. |
Observational-Dx |
12 patients |
To evaluate the role of MRI in patients with renal cancer and inferior vena caval involvement with reference to its ability to characterize the extent and nature of inferior vena caval tumor extension and wall invasion. |
On MRI the extent and nature of the inferior vena caval tumor was correctly defined in all cases. The sensitivity, specificity and accuracy of inferior vena caval wall invasion were 100%, 89% and 92%, respectively. |
3 |
| 68. Zini L, Destrieux-Garnier L, Leroy X, et al. Renal vein ostium wall invasion of renal cell carcinoma with an inferior vena cava tumor thrombus: prediction by renal and vena caval vein diameters and prognostic significance. J Urol 2008;179:450-4; discussion 54. |
Observational-Dx |
446 patients |
To determine whether renal vein ostium wall invasion could be predicted by renal vein and IVC diameter on imaging. To also determine whether it is a prognostic factor for recurrence and survival after radical nephrectomy and thrombus ablation for RCC with an IVC tumor thrombus. |
Renal vein ostium wall invasion was present in 13/32 patients (40.6%). It significantly correlated with mean +/- SD IVC anteroposterior diameter (27.8 +/- 10.2 vs 17.3 +/- 6.8 mm, P=0.01) and with the largest mean renal vein ostium diameter (22.3 +/- 7.9 vs 12.6 +/- 6.9 mm, P=0.01). The upper level of the IVC thrombus correlated with renal vein ostium invasion (P=0.002). The IVC anteroposterior diameter or renal vein ostium diameter cutoff value to predict wall invasion with 90% sensitivity was 18 and 14 mm, respectively. The AUC was 0.78 for IVC diameter and 0.86 for renal vein ostium diameter. No IVC recurrence was observed. Renal vein ostium wall invasion was associated with a higher risk of recurrence and decreased specific survival (P=0.01 and 0.03, respectively). The association of ostium renal vein wall invasion with death from RCC was seen on multivariate analysis after adjusting for tumor size, TNM stage and thrombus level (RR 5.9, 95% CI, 1.45–30.8, P=0.01). |
3 |
| 69. Adams LC, Ralla B, Bender YY, et al. Renal cell carcinoma with venous extension: prediction of inferior vena cava wall invasion by MRI. Cancer Imaging 2018;18:17. |
Observational-Dx |
48 patients |
To determine the diagnostic performance of contrast-enhanced magnetic resonance imaging (MRI) for the assessment of wall invasion by IVC thrombus in patients with RCC, validated with intraoperative findings. |
Complete occlusion of the IVC lumen or vessel breach could reliably assess IVC wall invasion with a sensitivity of 92.3% (95%-CI: 0.75-0.99) and a specificity of 86.4% (95%-CI: 0.65-0.97) (Fisher-test: p-value< 0.001). The positive predictive value (PPV) was 88.9% (95%-CI: 0.71-0.98) and the negative predictive value reached 90.5% (95%-CI: 0.70-0.99). There was an excellent interobserver agreement for determining IVC wall invasion with a kappa coefficient of 0.90 (95%CI: 0.79-1.00). |
2 |
| 70. Levine E, Maklad NF, Rosenthal SJ, Lee KR, Weigel J. Comparison of computed tomography and ultrasound in abdominal staging of renal cancer. Urology 1980;16:317-22. |
Observational-Dx |
22 patients |
To compare the accuracy of CT and ultrasound for staging of renal cancer |
CT is capable of detecting tumor invasion of perinephric fat and adjacent muscles, which cannot usually be shown by ultrasound. While both CT and ultrasound demonstrate venous and retroperitoneal tumor extension, CT is more reliable since bowel gas not infrequently obscures the retroperitoneum on ultrasonic scanning. |
3 |
| 71. Karp W, Ekelund L, Olafsson G, Olsson A. Computed tomography, angiography and ultrasound in staging of renal carcinoma. Acta Radiol Diagn (Stockh) 1981;22:625-33. |
Observational-Dx |
27 patients |
To assess the value of different radiologic imaging procedures in the staging of renal carcinoma. |
In 26 of these cases the ultrasound examination was similarly reviewed. Comparison of ultrasound, CT, and angiography demonstrated that staging of renal tumors with ultrasound is mainly limited by its inability to demonstrate extrarenal infiltration. Both CT and ultrasound proved reliable in the demonstration of tumor spread to the renal vein and inferior vena cava. CT and angiography were equally effective in the evaluation of tumor extension; since CT is easier to perform, less invasive and less time consuming than angiography it should be the primary method for staging of renal neoplasms. Angiography offers detailed information on the vascular supply of the tumor important for the choice of surgical approach and should be performed only on special indications. |
3 |
| 72. Sun Y, Wang W, Zhang Q, Zhao X, Xu L, Guo H. Intraoperative ultrasound: technique and clinical experience in robotic-assisted renal partial nephrectomy for endophytic renal tumors. Int Urol Nephrol 2021;53:455-63. |
Observational-Tx |
58 patients |
To introduce the role and use of intraoperative ultrasound (IOUS) performed in robotic-assisted renal partial nephrectomy (RAPN) for endophytic renal tumors. |
Patients in IOUS-guided group had significantly lower estimated blood loss (P < 0.001), shorter warm ischemia time (P = 0.010) and improved MIC (Margin, ischemia, and complications) rate (P = 0.026) and Pentafecta achievement (P = 0.016) compared to non IOUS-guided group. In multivariate logistic regression analysis, RAPN with IOUS was an independent predictor of MIC achievement (odds ratio 3.595; confidence interval 1.023-12.633; P = 0.046). Surface-intermediate-base (SIB) margin score was lower for IOUS-guided group vs non IOUS-guided group (P = 0.029). |
2 |
| 73. Gunelli R, Fiori M, Salaris C, et al. The role of intraoperative ultrasound in small renal mass robotic enucleation. Arch Ital Urol Androl 2016;88:311-13. |
Observational-Tx |
22 enucleations |
To report our experience of the use of intraoperative ultrasound imaging in simple enucleation (SE), showing how, besides providing more accurate anatomic detection of neoplasias, it may improve the surgeon’s spatial proprioception, thus facilitating SE performance. |
Once kidney had been isolated from the adipose capsule at the site of the neoplasia (2), the exact position of the lesion could be easily identified in all cases (22/22), even for mostly endophytic lesions, thanks to the insertion of the ultrasound probe through the assistant port. Images were produced and visualized by the surgeon using the TilePro feature of the DaVinci surgical system for producing a picture-in-picture image on the console screen. The margins of resection were then marked with cautery, thus allowing for speedy anatomical dissection. This reduced the time of ischemia to 8 min (6-13) and facilitated the enucleation technique when performed without clamping the renal peduncle (6/22). |
3 |
| 74. Bonsib SM. The renal sinus is the principal invasive pathway: a prospective study of 100 renal cell carcinomas. Am J Surg Pathol. 2004;28(12):1594-1600 |
Review/Other-Dx |
100 RCCs |
To prospectively examine 100 RCCs for renal sinus invasion. |
Renal sinus invasion is the most common site of extrarenal extension of renal carcinoma and correlates with tumor type, grade and size. Appropriate evaluation for sinus invasion reduces the incidence of T1b and T2 CC tumors, limiting prognostic utility and suggesting reassessment of the T1 and T2 stage designations. |
4 |
| 75. Margulis V, Tamboli P, Matin SF, Meisner M, Swanson DA, Wood CG. Redefining pT3 renal cell carcinoma in the modern era: a proposal for a revision of the current TNM primary tumor classification system. Cancer. 2007;109(12):2439-2444. |
Observational-Dx |
419 patients |
To evaluate the prognostic significance of venous tumor thrombus and its extent, the presence and location of extrarenal tumor extension, and a combination of both features on survival after the surgical management of patients with pathologic T3 (pT3) RCC. |
In multivariate Cox regression analyses, the 2002 AJCC primary tumor classification was not found to be an independent predictor of cancer-specific mortality. A total of 211 patients with extrarenal tumor extension only (50.4%) and 72 patients with venous tumor thrombus only (17.2%) were found to have a similar risk of death from RCC (HR of 1.018; P=.957), whereas 136 patients harboring both features (32.5%) were found to be significantly more likely to die from RCC (HR of 2.660; P<.001). The authors proposed a new primary tumor classification in which they grouped patients with both ERE and venous tumor thrombus (which was found to be an independent predictor of cancer-specific survival) into a separate staging category, and demonstrated improved prognostic ability when compared with the 2002 AJCC classification (c indexes of 0.625 vs 0.580, respectively). |
3 |
| 76. American College of Radiology. ACR Appropriateness Criteria® Radiation Dose Assessment Introduction. Available at: https://www.acr.org/-/media/ACR/Files/Appropriateness-Criteria/RadiationDoseAssessmentIntro.pdf. |
Review/Other-Dx |
N/A |
To provide evidence-based guidelines on exposure of patients to ionizing radiation. |
No abstract available. |
4 |
