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Nephron-sparing approaches for small renal masses lead to increased consumption of post-treatment imaging

Commentary from Professor Susanne Osanto

10th April 2014

With the increasing incidence of small renal masses, there is greater use of ablation, nephron sparing surgery and surveillance compared to radical nephrectomy. 

Using SEER and Medicare data during 2005 to 2009, a total, 1,682 subjects diagnosed with small renal mass and treated with open partial nephrectomy (330), minimally invasive partial nephrectomy (160), open radical nephrectomy (404), minimally invasive radical nephrectomy (535), thermal ablation (212) and surveillance (42) were identified. The use of imaging within 24 months of treatment was studied to identify factors associated with increased imaging use. 
Thermal ablation was associated with almost eightfold greater odds of surveillance imaging compared with open radical nephrectomy (OR 7.7, 95% CI 1.01-59.4), more specifically, with increased computerized tomography (OR 5.28) and magnetic resonance imaging (OR 2.19) use and decreased ultrasound use (OR 0.59). 

Other forms of nephron-sparing surgery, i.e. minimally invasive partial nephrectomy (OR 3.28) and open partial nephrectomy (OR 3.19) were associated with increased computerized tomography use.

Thus, in particular thermal ablation was shown to be associated with significantly greater use of post-treatment imaging compared to other small renal mass treatments and thus a potential increase in costs and radiation exposure.


Use of surveillance imaging following treatment of small renal masses

Kowalczyk KJ, Harbin AC, Choueiri TK, Hevelone ND, Lipsitz SR, Trinh QD, Tina Shih YC, Hu JC.

J Urol. 2013 Nov;190(5):1680-5