ACR Appropriateness Criteria® Post-Treatment Follow-up and Active Surveillance of Clinically Localized Renal Cell Cancer

The role of imaging in the management of renal masses

“…Nephrometry score • Tumor radius (cm) • Exophytic > 50%, Exophytic < 50%, Endophytic • Distance to the collecting system [> 7, 4-7, < 4] (mm) • Location: Anterior/Posterior (A/P/X) • Location regarding to the Polar lines (above/below/cross/ between) • Extension into renal vein Extrarenal structures adjacent to the lesion (distance to the nearest anatomic structure and renal hilar vasculature) Perinephric fat stranding Amount of perinephric visceral fat [ post-ablated RCC, allowing the detection of intralesional enhancement, indicative of residual or recurrent tumor, with a sensitivity, specificity, PPV, NPV, and overall accuracy of 96.6 %, 100 %, 100 %, 95.8 %, and 98.1 %, respectively [18,29,58]. Table 3 shows main clinical indications for renal US and CEUS.…”

“…CT is indicated for RCC follow-up after surgery or post-ablation, in moderate to high-risk patients [18]. A baseline chest and abdominal CT within three to six months after surgery is recommended, followed by imaging every six months for at least three years and annually thereafter, for two years [118].…”

“…Multiparametric MRI represents a valuable complementary imaging technique for the assessment of renal masses, providing both morphologic and functional information [5][6][7][12][13][14]18,31,32]. MRI is mainly recommended when optimal CT cannot be performed (severe allergy to iodinated CT contrast or high risk for contrast-induced nephropathy) or when radiation exposure is contraindicated (young age or pregnant women) [5][6][7][12][13][14]18,31,32].…”

“…Surgery, including radical nephrectomy or partial nephrectomy is the recommended treatment for localized RCC [2,18]. Elderly and patients with comorbidities and incidental small renal masses have a low RCC-specific mortality and significant competing-cause mortality, therefore ablative techniques and active surveillance may represent alternative treatment options [2,[18][19][20].…”

“…Surgery, including radical nephrectomy or partial nephrectomy is the recommended treatment for localized RCC [2,18]. Elderly and patients with comorbidities and incidental small renal masses have a low RCC-specific mortality and significant competing-cause mortality, therefore ablative techniques and active surveillance may represent alternative treatment options [2,[18][19][20]. Active surveillance defined as the initial monitoring of tumor size by serial imaging, with delayed intervention reserved for tumors showing clinical progression during follow-up, represents a safe management option, not compromising oncologic outcomes [2,18,21,22].…”