Active Surveillance: A Potential Strategy for Select Patients with Small Renal Masses

Abstract

Increased abdominal imaging has led to the significant incidental detection of clinically localized renal masses. While the gold standard remains surgical excision, mortality rates from kidney cancer remain relatively unchanged implying that a proportion of small renal masses may be indolent tumors that do not require surgical intervention. As a result, active surveillance has emerged as an alternative management strategy in select patients with significant competing risks. Although the contemporary literature characterizing the natural history of untreated small renal masses is limited, recent data demonstrate that many incidental renal masses demonstrate slow growth kinetics with a low rate of progression to metastatic disease over an intermediate time period. Prospective trials are necessary to define entry and intervention criteria for active surveillance protocols.

ACR Appropriateness Criteria® Indeterminate Renal Mass

“…Benign renal tumors, such as lipid-poor AML and oncocytoma, mimic RCC at imaging, as seen in one series of 70 renal mass biopsies in which a third were benign [41]. Many small RCCs demonstrate slow growth kinetics with a low rate of progression [42]. The biopsy results can be used to guide decision making aimed at minimizing kidney function loss, with active surveillance being chosen in cases of benign or favorable histology [43].…”

Surveillance and clinical outcome of bosniak IIF renal cysts: a mini review

“…Such carcinomas' prognosis is adequate compared to other renal malignancies due to the low metastatic frequency. [30][31][32][33] Hence, early detection of several malignancies had no severe consequences or adverse effect on the patients. Among elderly patients in poor physical health, follow-up examination is suggested instead of intervention.…”