Diagnosis And Treatment Strategies For Small Renal Masses

Objective:Summarize our department small renal tumors (≤4cm) in diameter diagnosis and treatment, assessment of preoperative imaging studies to determine the nature of the tumor value and improve the preoperative diagnostic accuracy, provide the basis for a reasonable choice of treatment options.Methods:Retrospective analysis of patients with clinical data of59patients with small renal tumors (small renal masses SRMs), compare the various features of imaging in the diagnosis of small renal tumors and value analysis of a variety of choice of surgical approach is appropriate, regular follow-up efficacy.Results:1、59cases of kidney cancer patients, the maximum diameter:1.4to4.0(2.65±0.85) cm, in which a single hair on one side in57cases (96.62%), unilateral in1case (1.69%), bilateral singlecases (1.69%);2、59patients underwent color Doppler ultrasound examination, the misdiagnosis (1.69%), the missed one cases (1.69%), diagnostic accuracy was92.14%;59patients underwent X-ray computer tomography (computed tomography CT) examination, misdiagnosis20routine magnetic resonance imaging (magnetic resonance imaging MRI) examination, misdiagnosed patients (5%), the diagnostic accuracy was95%;3underwent positron emission computer cases (3.39%), the diagnostic accuracy rate of94.73%; tomography (Positron Emission computer Tomography PET/CT) examination, diagnostic accuracy rate of100%;3、59patients were treated surgically, line radical nephrectomy surgery (radical nephrectomy, RN)40cases (67.80%),23cases (57.50%) open surgery, laparoscopic surgery after17cases (42.50%); reserved nephron-sparing surgery (nephron sparing surgery, NSS)19cases (32.20%), open surgery in10cases (52.63%) after laparoscopic surgery in9cases (47.37%);4、Pathological diagnosis:renal cell carcinoma (Renal clear cell carcinoma CCRCC)47cases (79.66%), renal papillary adenocarcinoma (Renal papillary adenocarcinoma RPA)1(1.69%), chromophobe renal cell carcinoma (renal chromophobe cell carcinoma RCCC)1(1.69%), renal angiomyolipoma (renal angiomyoliPoma RAML)10cases (16.95%), tumor pathologic stage for T1aNOM058cases, T1aN1M01cases. After36regular follow-up, follow-up of832months (mean17.43months), no recurrence of local or distant metastasis, there was no tumor survived so far.Conclusions:1、Small renal tumors in patients with subclinical, mostly for medical examination found that the incidence of people younger age trend, and vicious rate, once discovered, should attach great importance;2、Imaging studies help to prompt the nature of small renal tumors, CT and MRI with high accuracy, and specificity; simultaneously both checks help to improve the diagnostic accuracy of color Doppler ultrasound examination accurate than CT and MRI slightly lower, can be used as an initial screening tool; PET/CT accuracy rate, but the cost is high, it is recommended for suspected tumor metastases; 3、Nephron-sparing surgery is the main method for the treatment of small renal tumors, effective and reliable. When regional lymph node metastasis or tumor is located in the center of the kidney and renal vascular adhesion close to the NSS or NSS fails, you can line the radical nephrectomy surgery, and the prognosis of patients with NSS significantly better than the RN.