title: Incidentally detected small renal masses - investigation and management.
abstract: BACKGROUND
  With increasing use of imaging to diagnose other conditions, incidentally detected small renal masses and cysts are now a common clinical scenario for both the general practitioner and the urologist.
  
  
  OBJECTIVE
  This article outlines a diagnostic and management approach to the incidental finding of a small renal mass or cyst.
  
  
  CONCLUSIONS
  Renal cell carcinoma represent 2-3% of all cancers and more than 50% of these are detected incidentally. Small renal masses are defined as renal masses less than 4 cm in diameter. They comprise a heterogeneous group of lesions; 20% are benign and only 20-25% prove to be potentially aggressive kidney cancers at the time of diagnosis. Work-up involves a full history, looking for evidence of paraneoplastic syndromes and examination, which is usually normal. Recommended blood tests include basic biochemistry and haematology, and imaging. A four phase contrasted computerised tomography scan of the kidneys allows a detailed examination of each aspect of the functional anatomy of the kidney, which can help approximate risk of malignancy and direct management. Not all patients with small renal masses require a biopsy. However, biopsy is required in patients who opt for active surveillance or ablative therapy. Management options include surveillance, surgery and ablative techniques.
authors: Department of Urology, Alfred Hospital, Melbourne, Victoria. drkantharao@hotmail.com
authors: Kantha
authors: K
authors: Rao
authors: Peter L
authors: PL
authors: Royce
mesh_terms: D002292:Carcinoma, Renal Cell / Q000175:diagnosis* / Q000453:epidemiology / Q000601:surgery; D006801:Humans; D033162:Incidental Findings; D007680:Kidney Neoplasms / Q000175:diagnosis* / Q000453:epidemiology / Q000601:surgery; D008875:Middle Aged; D009392:Nephrectomy; D057832:Watchful Waiting