Téma: 

Comparison of progression of small solid renal lesions (diameter versus volume rates using single and two dimensions

Peter Weibl, Milan Hora, Tomáš Urge, Ivan Lutter, Martin Romančík, Milan Obšitník

Objective: The aim of our study was to evaluate the progression of solid enhancing renal masses in elderly or unfit patients for surgery by serial helical CT scans. Progression rates and volume changes were compared when using 1 and 2 dimensions respectively. Materials and methods: 16 patients (pts) with solid renal lesion were enrolled in this prospective study. All pts were not cured because of advanced age, high preoperative risk ASA 3 - 4 or according to patient’s wishes. Patients were followed by serial helical CT scans (3 months after initial exam and then at 6 monthly intervals). All lesions had pathological enhancement on post contrast CT scan (> 20 HU). The mean diameter of the lesions at presentation was 3,2 cm (range 1,9 from to 4,0 cm; V = 18,9 cm3), the mean period of observation was 24 months (range from 8 to 52 months). Results: 6 pts underwent partial nephrectomy and 1 pt radical nephrectomy (renal cell carcinoma – RCC was confirmed in all cases: papillary – 2 pts; clear-cell – 4 pts; chromophobe – 1 pt). The average growth rates per 12 months using 1 dimension and volume calculated out of 1 dimension among solid enhancing (9 pts who did not undergo surgery) and RCC lesions (7 pts – histologically proven) were [(0,1 cm; V = 1,8 cm3; V2 = 9,4 % ); (0,2 cm; V = 3,5 cm3; V2 = 23 %) V2 – the average percentage volume increase] for both groups respectively. Mean tumour volume of solid enhancing lesions that progressed at the last follow up was 29,9 cm3 using 2 diameters vs. 23,9 cm3 when using 1 diameter the (which accounts for the volume difference of V = 25 %). Conclusions: The vast majority of small solid renal masses grow at slow rates. High risk or elder patients with renal lesion less than 2 or 3 cm in diameter should be observed at least initially. Monitoring volume increases using 2 dimensions seems more accurate compared to 1 dimension or overall increase in diameter only. It is still not clearly defined at what progression, it is necessary to consider a surgical intervention.

Ročník 2007  Témy časopisu Clinical urology 1 / 2007

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