J Korean Soc Radiol.  2019 Jul;80(4):600-612. 10.3348/jksr.2019.80.4.600.

Imaging-Guided Biopsy, Percutaneous Ablation, and Active Surveillance for Small Renal Masses

Affiliations
  • 1Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea. kim.jeongkon@gmail.com

Abstract

The diagnosis rates of small renal masses less than 4 cm in diameter are increasing with the increasing number of CT and MRI examinations. Since these small renal masses include a high proportion of benign tumors and low-malignant renal cell carcinomas, image-guided biopsy plays an important role in facilitating accurate diagnosis, low-invasive percutaneous radiofrequency- or cryo-ablation, and active surveillance for these masses. Therefore, the diagnostic accuracy and safety of image-guided biopsy for small renal masses, but awareness of the technical aspects of image-guided percutaneous ablation and an understanding of active surveillance are crucial in establishing an adequate treatment plan. The purpose of this review is to present the basic knowledge and clinical usefulness of the diagnosis trends for small renal masses, discuss the diagnostic accuracy of imaging-guided biopsy, and assess the use of low-invasive therapy with percutaneous ablation and active surveillance.


MeSH Terms

Ablation Techniques
Biopsy*
Carcinoma, Renal Cell
Diagnosis
Image-Guided Biopsy
Kidney Neoplasms
Magnetic Resonance Imaging

Figure

  • Fig. 1 Suggested algorithm for the management of SRMs. RMB depicts the clinical scenarios in which RMB can be considered. *When technically feasible. †Benign pathology, chromophobe, papillary type 1, or Fuhrman grade 1 to 2 mRCC. AS = active surveillance, CCI = Charlson Comorbidity Index, mRCC = metastatic renal cell carcinoma, PN = partial nephrectomy, QOL = quality of life, R.E.N.A.L. = Radius, Exophytic/endophytic properties, Nearness of tumor to the collecting system or sinus in millimeters, Anterior/posterior Location relative to polar lines, RMB = renal mass biopsy, SRMs = small renal masses, TA = thermal ablation

  • Fig. 2 A case of successful radiofrequency ablation for renal cell carcinoma in a 70-year-old female patient. A. MRI shows a contrast-enhancing mass in the left kidney. B. The mass closely abuts the descending colon in the prone position. C. Hydrodissection ensured sufficient space between the mass and the descending colon. D. Radiofrequency ablation was performed for the renal mass. E. The CT image obtained immediately after ablation shows no residual contrast enhancement in the renal mass. F. The CT image obtained 24 hours after ablation shows a completely ablated mass without complication.

  • Fig. 3 A case of bowel perforation after radiofrequency ablation for renal cell carcinoma in a 57-year-old male patient. A. CT image shows a 2-cm recurrent mass in the left kidney after right partial nephrectomy for renal cell carcinoma. B. Radiofrequency ablation was performed for the recurrent tumor in left kidney. C. Immediately after the ablation, there was no ablation-related complication on CT images. D. At 24 h after ablation, the patients complained of persistent abdominal pain. CT images obtained 24 h after the procedure show pneumoperitoneum (arrows) caused by perforation of the ileal loop.


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