Preoperative renal tumor evaluation by three-dimensional magnetic resonance imaging: Staging and detection of multifocality

Radiologic evaluation of small renal masses (I): pretreatment management

When characterizing a small renal mass (SRM), the main question to be answered is whether the mass represents a surgical or nonsurgical lesion or, in some cases, if followup studies are a reasonable option. Is this a task for a urologist or a radiologist? It is obvious that in the increasing clinical scenario where this decision has to be made, both specialists ought to work together. This paper will focus on the principles, indications, and limitations of ultrasound, CT, and MRI to characterize an SRM in 2008 with a detailed review of relevant literature. Special emphasis has been placed on aspects regarding the bidirectional information between radiologists and urologists needed to achieve the best radiological approach to an SRM.

Surgical management of large renal tumors

In addition to an increased occurrence of small, localized, incidentally discovered renal cell carcinomas (RCCs), there has been an upward trend in the incidence of advanced renal tumors per unit of population and in disease mortality worldwide. As radical nephrectomy remains the standard of care in treating localized RCC, this manuscript focuses on surgical approaches. We defined 'large renal tumors' as those greater than 7 cm or those with venous involvement. We discuss operative strategies in both open and laparoscopic surgery as well as approaches to special circumstances, including patients with tumor thrombus and the indications for nephron-sparing surgery in patients with greater than T2 RCC. The literature pertaining to controversial areas such as preoperative renal artery embolization and the clinical utility of metastectomy and cytoreductive therapy are also reviewed. The theoretical basis and potential applications of neoadjuvant therapy for larger renal tumors is examined as well.

Detection, staging and surveillance in renal cell carcinoma

This article discusses the computed tomography (CT) and magnetic resonance (MR) scanning techniques used for the detection and staging of renal cell carcinoma and their pitfalls. Comparison between the Robson and recent modifications to the TNM classifications is also addressed. The accuracy of CT and MR in the staging of renal cell carcinoma and the role of positron emission tomography (PET) scanning is outlined and finally the surveillance of patients who have had curative treatment of renal cell carcinoma is briefly addressed.