ACR Appropriateness Criteria Renal Cell Carcinoma Staging

Vikram, Raghunandan; Beland, Michael D.; Blaufox, M. Donald; Moreno, Courtney C.; Gore, John L.; Harvin, Howard J.; Heilbrun, Marta E.; Liauw, Stanley L.; Nguyen, Paul L.; Nikolaidis, Paul; Preminger, Glenn M.; Purysko, Andrei S.; Raman, Steven S.; Taffel, Myles T.; Wang, Zhen J.; Weinfeld, Robert M.; Remer, Erick M.; Lockhart, Mark E.

doi:10.1016/j.jacr.2016.01.021

Cited by 41 publications

(60 citation statements)

References 67 publications

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“…Tumor thrombus cases were diagnosed on the basis of computed tomographic imaging. Although contrast‐enhanced computed tomography and magnetic resonance imaging have equal sensitivities in detecting venous involvement in the renal vein and the IVC, non‐contrast magnetic resonance imaging has a higher sensitivity and specificity in detecting tumor thrombus than non‐enhanced computed tomography . The majority of the computed tomography performed in our cohort was contrast‐induced.…”

Section: Discussionmentioning

confidence: 85%

The risk of venous thromboembolism in renal cell carcinoma patients with residual tumor thrombus

Ihaddadene

Yokom

Gal

et al. 2014

Journal of Thrombosis and Haemostasis

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To cite this article: Ihaddadene R, Yokom DW, Le Gal G, Moretto P, Canil CM, Delluc A, Reaume N, Carrier M. The risk of venous thromboembolism in renal cell carcinoma patients with residual tumor thrombus. J Thromb Haemost 2014; 12: 855-9.Summary. Background: The clinical importance of tumor thrombus in patients with renal cell carcinoma is unknown. We sought to determine the long-term risk of venous thromboembolism (VTE) in patients with residual tumor thrombus postextraction, and to evaluate the impact of residual tumor thrombus on overall survival. Patients/methods: A cohort study of patients with stage III-IV renal cell carcinoma undergoing nephrectomy was undertaken. The primary endpoint was the risk of VTE during a 2-year follow-up period. The secondary endpoint was 2-year overall survival. Results: A total of 170 surgical renal cell carcinoma patients were included, 97 (57.1%) of whom had tumor thrombus. Patients with residual tumor thrombus following surgery had a higher risk of developing VTE than those with complete tumor thrombus resection (hazard ratio [HR] 8.7, 95% confidence interval [CI] 1.7-43.4) and no tumor thrombus (HR 6.5,. Patient with residual tumor thrombus did not have worse overall survival than those with tumor thrombus completely resected or those without tumor thrombus. Conclusions: The presence of residual tumor thrombus is an important risk factor for VTE among renal cell carcinoma patients.

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Section: Discussionmentioning

confidence: 85%

The risk of venous thromboembolism in renal cell carcinoma patients with residual tumor thrombus

Ihaddadene

Yokom

Gal

et al. 2014

Journal of Thrombosis and Haemostasis

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“…This can be accomplished by using either CT or MRI. According to the American College of Radiology appropriateness criteria, either modality is generally considered to be appropriate for characterizing indeterminate renal masses and RCC staging (18,19). Although CT and MRI are comparable for staging primary renal tumors (20), MRI provides the added benefits of no radiation exposure, capability for use of subtraction techniques to detect subtle mass enhancement, and possibly improved characterization of lesions smaller than 2 cm and cystic lesions.…”

Section: Imaging Overviewmentioning

confidence: 99%

“…Although CT and MRI are comparable for staging primary renal tumors (20), MRI provides the added benefits of no radiation exposure, capability for use of subtraction techniques to detect subtle mass enhancement, and possibly improved characterization of lesions smaller than 2 cm and cystic lesions. However, MRI is more costly and time consuming than CT (18).…”

Section: Imaging Overviewmentioning

confidence: 99%

2017 AUA Renal Mass and Localized Renal Cancer Guidelines: Imaging Implications

et al. 2018

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Renal cell carcinoma (RCC) is a common cancer that is increasing in incidence because of the increased prevalence of risk factors, including tobacco use, hypertension, and obesity, and the improved detection of these tumors due to increased use of imaging. Localized renal cancer now accounts for more than 60%-70% of new RCC cases. Renal masses suggestive of cancer include enhancing solid renal lesions and Bosniak III and IV complex cystic lesions. Most of these tumors are detected incidentally, and many are slow growing with little propensity to metastasize. Radiologists have a vital role in evaluation of these tumors and subsequent patient counseling. Options for managing RCC include radical nephrectomy (RN), partial nephrectomy (PN), thermal ablation, and active surveillance. However, historically, the use of these strategies has varied among practices. Improved understanding of the biologic features of these tumors and data indicating the heterogeneous clinical course of many clinically localized renal tumors led to the development of the American Urological Association (AUA) Localized Renal Cancer Panel Guidelines in 2009, and these guidelines were updated in 2017. The format of the updated guidelines has moved from management recommendations based on index patients to individualized decision making, taking into account patient age and comorbidities, tumor characteristics, and important renal function considerations. A distinct role for RN is defined for cases of tumors with increased oncologic potential in patients with a normal contralateral kidney. Beyond this, nephron-sparing options, particularly PN, should be a priority. The updated guidelines also recommend increased use of renal mass biopsy, thermal ablation, and active surveillance in appropriately selected patients. The 2017 AUA guidelines are reviewed, with emphasis on the implications for practicing radiologists.

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“…Given its superior soft tissue characterization, MRI may be particularly useful if the CT findings of IVC tumor thrombus are equivocal. A limitation of MRI related to tumor thrombus may include the risk of motion‐related artifact secondary to venous compression due to mass effect of large tumors which can result in turbulent blood flow . Additional testing with direct venography has been employed to improve diagnostic accuracy in such cases.…”

Section: Preoperative Imaging As Guidance For Operative Planningmentioning

confidence: 99%

The role of transesophageal echocardiography in the management of renal cell carcinoma with venous tumor thrombus

et al. 2018

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We reviewed the role of transesophageal echocardiography (TEE) in the management of renal cell carcinoma (RCC) with associated tumor thrombus. Many consider intraoperative TEE as imperative in cases of Level 4 thrombi with atrial involvement, as well as in cases that require the use of cardiopulmonary bypass (CPB). However, the role of TEE in the surgical management of RCC with associated inferior vena cava (IVC) thrombus may expand beyond this subset. When performed after induction, TEE provides updated information regarding tumor thrombus staging, which is essential for optimal surgical planning. Furthermore, TEE provides feedback regarding properties of the thrombus, such as fragility and adherence, which may alter surgical technique. TEE can also be used intraoperatively for central venous line placement, to monitor cardiovascular and fluid status, to guide vascular clamp placement, and to ensure complete removal of the tumor thrombus. In some cases, the use of TEE allows for less morbid procedures and safe avoidance of CPB. We therefore recommend the use of preoperative TEE in all cases with a known tumor thrombus with discretion as to what extent TEE is used throughout the remainder of the case. Further investigation is necessary to elucidate the effect of TEE on patient outcomes, including surgical complication rates, morbidity and mortality of procedures, and cancer control.

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ACR Appropriateness Criteria Renal Cell Carcinoma Staging

Cited by 41 publications

References 67 publications

The risk of venous thromboembolism in renal cell carcinoma patients with residual tumor thrombus

The risk of venous thromboembolism in renal cell carcinoma patients with residual tumor thrombus

2017 AUA Renal Mass and Localized Renal Cancer Guidelines: Imaging Implications

The role of transesophageal echocardiography in the management of renal cell carcinoma with venous tumor thrombus

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