Conservative management of incidental contrast-enhancing renal masses as safe alternative to invasive therapy.
OBJECTIVE
To describe small contrast-enhancing renal masses suggestive of cancer that were managed conservatively with watchful waiting and serial computed tomography scans. Advanced diagnostic imaging has led to the increased incidental detection of renal masses in patients whose multiple comorbid conditions preclude invasive management.


METHODS
A retrospective review was conducted of 29 consecutive patients with 29 incidentally detected asymptomatic renal masses less than 3.5 cm in diameter that were managed conservatively with watchful waiting (because of patient wishes or multiple comorbid conditions) and serial computed tomography scans.


RESULTS
The average patient age was 70 years (range 51 to 88), and the average duration of follow-up imaging was 32 months (range 10 to 89). The average number of follow-up computed tomography scans was 4.9 per patient (range 1 to 11). The average width of the renal masses at diagnosis was 1.83 cm (range 0.4 to 3.5), and the average change in size per year was 0.12 cm for all patients. Four patients underwent radical nephrectomy because of growth of the renal mass (n = 1) or patient wishes (n = 3). The histologic findings in 3 of these 4 patients were consistent with renal cell carcinoma. Two patients underwent radiofrequency ablation of the masses. At last follow-up, metastatic disease had not developed in any patient, and no patient had died of renal cell carcinoma. Two patients had died of other causes.


CONCLUSIONS
The results of our study showed that when comorbid conditions or patient wishes preclude invasive treatment, contrast-enhancing renal masses less than 3.5 cm wide that are suggestive of cancer can be safely managed with watchful waiting and serial computed tomography scans.
Wehle
Michael J
MJ
Department of Urology, Mayo Clinic, Jacksonville, Florida 32224, USA.
Thiel
David D
DD
Petrou
Steven P
SP
Young
Paul R
PR
Frank
Igor
I
Karsteadt
Nolan
N
D018249:Adenoma, Oxyphilic / Q000000981:diagnostic imaging / Q000601:surgery; D000368:Aged; D000369:Aged, 80 and over; D002292:Carcinoma, Renal Cell / Q000000981:diagnostic imaging / Q000601:surgery; D019090:Case Management; D015897:Comorbidity; D003287:Contrast Media; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D033162:Incidental Findings; D007674:Kidney Diseases / Q000000981:diagnostic imaging / Q000628:therapy; D007680:Kidney Neoplasms / Q000000981:diagnostic imaging / Q000601:surgery / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed
D003287:Contrast Media