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In the absence of reliable RCC imaging,

Management Decisions Can Be Challenging1,2

In the absence of reliable RCC imaging,

Management Decisions Can Be Challenging1,2

Novel, noninvasive diagnostic solutions are urgently needed

Increased use of abdominal imaging has led to greater detection of undiagnosed renal masses, triggering a cascade of diagnostic and tumor management challenges.3 Rates of renal mass detection are expected to continue increasing, underscoring the need for early, accurate detection of renal cell carcinomas (RCC).4

Considerations for renal mass management

Surgical Intervention

Partial Nephrectomy

Prioritized for most small (≤4 cm) renal masses, when intervention is indicated5

Key considerations: Long operative time; high immediate postoperative risks, such as bleeding, hematoma, or urinary fistula; favorable long-term outcomes6,7

Radical Nephrectomy

Typically reserved for larger tumors not amenable to partial nephrectomy, or when the anatomy or tumor location precludes safe partial nephrectomy5

Key considerations: Offers high cure rates for localized disease, but at the cost of total loss of renal function in the affected kidney; increases risk of chronic kidney disease, especially in those with baseline renal insufficiency8

Diagnostic Dilemma

≈6,000 benign renal masses are removed annually in the United States9

Not a comprehensive list.

Ablation

Recommended for patients with small (<3 cm), solid renal masses who may not be ideal surgical candidates or for those who prefer a less invasive procedure5,10

Key considerations: Carries a higher risk of tumor recurrence than surgical resection; repeat ablation or surgery may be necessary for recurrence; requires continued surveillance5,11

Diagnostic Dilemma

Diagnosing tumor viability with MRI after ablation can be challenging, as post-procedural enhancement may persist for up to 3 to 6 months and does not necessarily indicate recurrence.

Not a comprehensive list.

Biopsy

Should be considered when the result may alter management decisions, such as distinguishing between benign and malignant lesions5

Key considerations: Low complication rates (<5%), including bleeding, hematoma, and infection; a negative result does not rule out malignancy; repeat sampling may be necessary if initial samples are nondiagnostic5,12,13

Diagnostic Dilemma

10% to 23% of renal mass biopsies yield nondiagnostic results14

Not a comprehensive list.

Active Surveillance

Recommended for patients with small (<2 cm) renal masses where the risks of treatment outweigh the potential oncologic benefits, or in patients who understand and accept the potential risks of delayed intervention11

Key considerations: Avoids the operative risks, costs, and potential decrease in renal function associated with ablation or surgery, but requires patient willingness to adhere to follow-up imaging (typically 3- to 6-month intervals); anxiety related to living with an untreated renal mass may lead to delayed intervention11,15

Diagnostic Dilemma

In a cohort of 371 patients initially managed under active surveillance (AS), 46 pursued delayed intervention after a median 12 months15

  • Nearly 50% (22/46) chose delayed intervention due to preference or anxiety—even in the absence of clinical progression
Not a comprehensive list.

Early, accurate identification of ccRCC is critical

Most solid renal masses are malignant, and up to 75% of RCCs are the clear cell subtype (ccRCC)—the most aggressive and common form of kidney cancer.16-18 Early, accurate detection can have a direct impact on prognosis, treatment decisions, and outcomes for patients.19

  • Delayed diagnosis of RCC significantly reduces the 5-year relative survival rate to ≈12% for metastatic disease20
  • Early detection and treatment of localized RCC are associated with 5-year relative survival rates >90%20

Diagnostic uncertainty can put

patients at risk

for suboptimal renal mass management2

EXAMINE CURRENT LIMITATIONS

References: 1. Yanagi M, Kiriyama T, Akatsuka J, et al. Differential diagnosis and prognosis of small renal masses: association with collateral vessels detected using contrast-enhanced computed tomography. BMC Cancer. 2022;22(1):856. 2. van Oostenbrugge TJ, Fütterer JJ, Mulders PFA. Diagnostic imaging for solid renal tumors: a pictorial review. Kidney Cancer. 2018;2(2):79-93. 3. Skelton WP, Leslie SW, Guzman N. Renal mass. In: StatPearls. Treasure Island (FL): StatPearls Publishing; April 12, 2025. 4. Mytsyk Y, Dutka I, Yuriy B, et al. Differential diagnosis of the small renal masses: role of the apparent diffusion coefficient of the diffusion-weighted MRI. Int Urol Nephrol. 2018;50(2):197-204. 5. Campbell SC, Clark PE, Chang SS, Karam JA, Souter L, Uzzo RG. Renal mass and localized renal cancer: evaluation, management, and follow-up: AUA guideline: part I. J Urol. 2021;206(2):199-208. 6. Tanagho YS, Kaouk JH, Allaf ME, et al. Perioperative complications of robot-assisted partial nephrectomy: analysis of 886 patients at 5 United States centers. Urology. 2013;81(3):573-579. 7. Chaurasia A, Singh S, Homayounieh F, et al. Complications after nephron-sparing interventions for renal tumors: imaging findings and management. Radiographics. 2023;43(7):e220196. 8. Yan Y, Liu Y, Li B, et al. Trends and predictors of changes in renal function after radical nephrectomy for renal tumours. BMC Nephrol. 2024;25(1):174. 9. Johnson DC, Vukina J, Smith AB, et al. Preoperatively misclassified, surgically removed benign renal masses: a systematic review of surgical series and United States population level burden estimate. J Urol. 2015;193(1):30-35. 10. Gunn AJ, Gervais DA. Percutaneous ablation of the small renal mass—techniques and outcomes. Semin Intervent Radiol. 2014;31(1):33-41. 11. Campbell SC, Uzzo RG, Karam JA, Chang SS, Clark PE, Souter L. Renal mass and localized renal cancer: evaluation, management, and follow-up: AUA guideline: part II. J Urol. 2021;206(2):209-218. 12. Patel HD, Johnson MH, Pierorazio PM, et al. Diagnostic accuracy and risks of biopsy in the diagnosis of a renal mass suspicious for localized renal cell carcinoma: systematic review of the literature. J Urol. 2016;195(5):1340-1347. 13. Bakdash K, Schramm KM, Annam A, Brown M, Kondo K, Lindquist JD. Complications of percutaneous renal biopsy. Semin Intervent Radiol. 2019;36(2):97-103. 14. de Silva S, Lockhart KR, Aslan P, et al. Differentiation of renal masses with multi-parametric MRI: the de Silva St George classification scheme. BMC Urol. 2022;22(1):141. 15. Gupta M, Alam R, Patel HD, et al. Use of delayed intervention for small renal masses initially managed with active surveillance. Urol Oncol. 2019;37(1):18-25. 16. Tsili AC, Andriotis E, Gkeli MG, et al; Oncologic Imaging Subcommittee Working Group of the Hellenic Radiological Society. The role of imaging in the management of renal masses. Eur J Radiol. 2021;141:109777. 17. Qi X, Li Q, Che X, Wang Q, Wu G. The uniqueness of clear cell renal cell carcinoma: summary of the process and abnormality of glucose metabolism and lipid metabolism in ccRCC. Front Oncol. 2021;11:727778. 18. Long Z, Sun C, Tang M, et al. Single-cell multiomics analysis reveals regulatory programs in clear cell renal cell carcinoma. Cell Discov. 2022;8(1):68. 19. Quinn AE, Bell SD, Marrah AJ, Wakefield MR, Fang Y. The current state of the diagnoses and treatments for clear cell renal cell carcinoma. Cancers (Basel). 2024;16(23):4034. 20. Padala SA, Barsouk A, Thandra KC, et al. Epidemiology of renal cell carcinoma. World J Oncol. 2020;11(3):79-87.

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