�Small renal masses ar defined as stage T1a lesions (less than 4cm), but for sure lesions less than 2cm fall into this definition. There is a 126% increase in the detection of nephritic cell cancers since 1950, due to increased imaging and incidental detection of renal people. It is suggested that the beggarly tumor growth rate of a grade 2 nephritic cancer is 0.28cm/yr, compared to 0.93cm/yr for a grade 3 tumor. The adequacy of a nephritic biopsy has been demonstrated to by over 96% in legion studies, with sufficient tissue acquired when an 18 gauge core needle is used. Most often, the core sample is sufficient to provide a histology and tumour grade. These improved biopsy outcomes ar the outcome of improved imaging and the usance of a core acerate leaf as opposed to needle aspirations, which were historically used. Some argue that a needle biopsy testament not change treatment, merely 4 studies show that treatment was changed in 30-60% of patients wHO had a biopsy.
Surveillance is based upon victimisation a biopsy to square up histology and grade. Over 90% of renal masses are
Cryoablation or radiofrequency ablation tin be performed using a laparoscopic or percutaneous attack. The transdermal approach should involve the urologist in the decisiveness process and procedure. The percutaneous approaching is limited on the upper pole of the left kidney due to the spleen, but we have reported the transhepatic approach to the right upper pole lesions without difficulties. Followup imaging has historically been with CT or MRI and signs of tumour viability ar enhancement or growth. One abstract reported that scorn radiographic evidence of no active tumor in 86% of patients after RFA, biopsies were negative in only 65%. For cryoablation the numbers were 89% and 94%, respectively, prompting perhaps better ablation using cryotherapy. At present, minimally invasive approaches are still selectively applied, as long-term outcomes are best with nephron-sparing operating theater. Patients undergoing surveillance, ablation or NSS should get regular follow-up, which will differ based upon the treatment strategy employed.
References:Kato, M. J Urol 2004;172:863-66.
Cambio and Evans, BJU Int, 97:456-60, 2006
Lebret, et.al. J. Urol, 178:1184, 2007
Neuzillet, et.al., J. Urol, 171:1802, 2004
Wood, et.al., J. Urol, 161:1470, 1999
Volpe et.al. 8;178(2):379 2007
Presented by: Christopher P. Evans, MD, at the Masters in Urology Meeting - July 31, 2008 - August 2, 2008, Elbow Beach Resort, Bermuda
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