Abstract
Small renal masses (SRMs) are a heterogeneous group of tumours with varying metastatic potential. The increasing use and improving quality of abdominal imaging have led to increasingly early diagnosis of incidental SRMs that are asymptomatic and organ confined. Despite improvements in imaging and the growing use of renal mass biopsy, diagnosis of malignancy before treatment remains challenging. Management of SRMs has shifted away from radical nephrectomy, with active surveillance and nephron-sparing surgery taking over as the primary modalities of treatment. The optimal treatment strategy for SRMs continues to evolve as factors affecting short-term and long-term outcomes in this patient cohort are elucidated through studies from prospective data registries. Evidence from rapidly evolving research in biomarkers, imaging modalities, and machine learning shows promise in improving understanding of the biology and management of this patient cohort.
Key points
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Increasing use of abdominal imaging over the past decade has led to detection of incidental small renal masses, many of which are <2–3 cm in size.
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Active surveillance and nephron-sparing approaches have taken over as primary modalities of treatment for small renal masses (≤4 cm).
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Prospective patient data registries have been helpful in continuously analysing granular data beginning at diagnosis and ensuring a high degree of patient compliance as well.
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Rapidly evolving research in biomarkers, imaging and machine learning shows promise in improving the pre-treatment diagnosis of malignancy.
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Wang, Y., Butaney, M., Wilder, S. et al. The evolving management of small renal masses. Nat Rev Urol (2024). https://doi.org/10.1038/s41585-023-00848-6
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DOI: https://doi.org/10.1038/s41585-023-00848-6