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Indeterminate renal masses:
an increasingly common problem
Noninvasive diagnostic
solutions are urgently needed
Many renal masses are detected incidentally during US, CT, and MRI for medical conditions, clinical situations, and other pathologies.1
Most solid renal masses are malignant,2 and up to 85% of malignancies are ccRCC—a highly aggressive and common RCC.3,4
Approximately 20% of detected masses are IRMs,5 underscoring the need for more accurate renal imaging.
Kidney cancer diagnoses are expected to continue rising as imaging technology improves and renal imaging continues to play a fundamental role in evaluating patients6
This year in the United States7
≈
81610
new kidney cancer
diagnoses will be made
diagnoses will be made
≈
14390
patients will die
from this disease
from this disease
Faced with an IRM, clinicians and patients have 4 management choices8
Active Surveillance
"Watch and wait"
for signs of continued growth
for signs of continued growth
Biopsy
Tissue sampling for
pathological examination
pathological examination
Ablation
Use of heat or cold to
destroy the suspect tissue
destroy the suspect tissue
Surgery
Partial or
radical nephrectomy
radical nephrectomy
To confirm whether a mass is malignant or benign, a biopsy may be performed. However, renal mass biopsies are invasive, risky, and not always conclusive.9
10% to 23%
are nondiagnostic9
5%
cause postsurgical
complications10
complications10
Patients with renal masses under active surveillance via biopsy face an immense psychological burden and experience significant anxiety.11
In a multicenter study of 136 small renal masses biopsied and managed under active surveillance,
68
%
were confirmed ccRCC.12
Nearly 50% of patients pursued delayed intervention due to preference or anxiety—even in the absence of clinical progression11,*
Indications for treatment pursued by patients electing delayed intervention
Reasons for delayed intervention11
Patients (n=46), n (%)
Growth rate >0.5 cm/y or stage progression
23 (50.0)
Patient preference or anxiety, growth rate <0.5 cm/y
22 (47.8)
Qualification for renal transplantation
1 (2.2)
- In a study of 371 patients managed under active surveillance, 46 patients pursued delayed intervention after a median of 1 year.11
Limitations in current imaging modalities may contribute to increased surgical interventions
Explore CHALLENGESccRCC, clear cell renal cell carcinoma; CT, computed tomography; IRM, indeterminate renal mass; MRI, magnetic resonance imaging; RCC, renal cell carcinoma; US, ultrasonography.
References: 1. 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. 2. 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. 3. 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. 4. 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. 5. Butaney M, Wilder S, Patel AK, et al. Initial management of indeterminate renal lesions in a statewide collaborative: a MUSIC-KIDNEY analysis. J Urol. 2023;210(1):79-87. 6. Fried JG, Morgan MA. Renal imaging: core curriculum 2019. Am J Kidney Dis. 2019;73(4):552-565. 7. American Cancer Society. Key statistics about kidney cancer. Accessed June 21, 2024. https://www.cancer.org/cancer/types/kidney-cancer/about/key-statistics.html 8. Ballard BD, Guzman N. Renal Mass. In: StatPearls. Treasure Island, FL: StatPearls Publishing; January 2, 2023. 9. 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. 10. Serhal M, Rangwani S, Seedial SM, et al. Safety and diagnostic efficacy of image-guided biopsy of small renal masses. Cancers (Basel). 2024;16(4):835. 11. 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. 12. Finelli A, Cheung DC, Al-Matar A, et al. Small renal mass surveillance: histology-specific growth rates in a biopsy-characterized cohort. Eur Urol. 2020;78(3):460-467.