Diagnostic Imaging Pathways - Renal Cell Cancer (Staging)
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This pathway provides guidance on the staging of adult patients with renal carcinoma confirmed by biopsy or previous imaging.
Date reviewed: March 2019
Date of next review: March 2022
Published: July 2019
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The relative radiation level (RRL) of each imaging investigation is displayed in the pop up box.
| SYMBOL | RRL | EFFECTIVE DOSE RANGE |
 | None | 0 |
 | Minimal | < 1 millisieverts |
 | Low | 1-5 mSv |
 | Medium | 5-10 mSv |
 | High | >10 mSv |
Images
Image GalleryNote: These images open in a new page | ||
|---|---|---|
| 1 |  |
Renal Cell Carcinoma Image 1 (Computed Tomography): Large right kidney mass with central necrosis consistent with renal cell carcinoma. There is tumour extension into the right renal vein (arrow).
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| 2a |  |
Renal Cell Carcinoma
Image 2a: Nephrectomy showing a circumscribed and encapsulated renal cell carcinoma arising from the lower pole of the kidney. The cut surface shows a heterogenous appearance typical of malignancy with patchy areas of necrosis (blue arrow) and haemorrhage (red arrow). |
| 2b |  |
Image 2b (H&E, x10): Histological section of a conventional clear cell renal cell carcinoma showing sheets and nests of malignant cells with intervening thin-walled vessels. The cells demonstrate irregular and hyperchromatic nuclei surrounded by abundant clear cytoplasm (clear cells). |
Teaching Points
Teaching Points
- Imaging plays a key role in renal cell carcinoma (RCC) staging to plan the most appropriate therapy
- The American Joint Committee on Cancer’s Tumour, Node, Metastasis (TNM) classification is currently the most widely used staging system 1-3
- Contrast-enhanced CT of the abdomen is the primary investigation in RCC staging 4,5
- MRI has a similar staging accuracy to CT, however, it is generally only used when CT is contraindicated, for further tumour characterisation when findings are equivocal on CT, or in patients who require recurrent imaging (e.g. young patients with hereditary syndromes affecting the kidneys such as Von-Hippel Lindau) 4
- CT of the chest is useful when there is suspicion of pulmonary metastases and is routinely performed in RCC staging at some centres 3
- Most bone and brain metastases are symptomatic at diagnosis and therefore bone and brain imaging is usually only performed when indicated 3
hs1
Staging of Renal Cell Carcinoma (RCC)
- Accurate pre-operative staging is important to determine the most appropriate treatment and to estimate prognosis
- The American Joint Committee on Cancer’s Tumour, Node, Metastasis (TNM) classification is the most widely used RCC staging system, having largely replaced the Robson classification 6-8
- Staging of the primary tumour (T stage) requires identification of the tumour: 9,10
- Location
- Size
- Organ confinement
- Presence and extent of tumour invasion or thrombus into the renal vein and inferior vena cava (IVC)
- Assessment of lymph node involvement (N stage) and metastatic disease (M stage) are also important 9,10
- Tumour size is critical in staging RCCs that are confined to the kidney
- Smaller tumours confer a significant survival benefit over larger tumours and partial nephrectomy can be considered 6
- Extrarenal tumour extension into perinephric or renal sinus fat, and venous infiltration/thrombus (T3 or higher) are negative prognostic factors 6
- Metastatic lesions are found in 20-30% of patients at time of diagnosis 11
- The most common sites of distant metastases are the lungs, bone, retroperitoneal and mediastinal lymph nodes, liver, and brain 6
- There are a number of different histologic subtypes of tumour including: 1,12
- Clear cell (75-85%)
- Papillary (10-15%)
- Chromophobe (4-5%)
- Different subtypes are associated with different frequency and patterns of metastatic spread. This has implications for therapy and prognosis 3,13-15
- Treatment of RCC can include: 3,12,19-21
- Partial nephrectomy - preferred in organ-confined tumours up to 7cm (T1a-b) to better preserve general kidney function and lower the risk of developing metabolic or cardiovascular disorders
- Radical nephrectomy - recommended for T2 and above tumours
- Radiofrequency ablation or cryoablation to small cortical tumours - especially in patients who are frail, with high surgical risk, a solitary kidney, compromised renal function, hereditary RCC or multiple bilateral tumours
- Active surveillance in elderly patients with significant co-morbidities or with a short life-expectancy with a solid renal tumour <4cm
- Systemic chemotherapy
- Radiotherapy for palliation and symptom relief, particularly in unresectable or recurrent disease
Staging of RCC (AJCC/UICC TNM classification, 7th edition) 1,16-18
| Primary Tumour (T) | |
|---|---|
| T1 | Confined to kidney ≤ 7cm |
| T1a | ≤4cm |
| T1b | >4cm but ≤7cm |
| T2 | Confined to kidney > 7cm |
| T2a | >7cm but ≤10cm |
| T2b | >10cm |
| T3 | Tumour extends into major veins or perinephric tissues but not into the ipsilateral adrenal gland and not beyond Gerota’s fascia |
| T3a | Extrarenal extension into perinephric/renal sinus fat or renal vein but not beyond Gerota’s fascia |
| T3b | Extension of tumour into IVC below the diaphragm |
| T3c | Extension of tumour into IVC above the diaphragm or invades wall of the vena cava |
| T4 | Adjacent organ involvement, extension beyond Gerota’s fascia or involvement of the ipsilateral adrenal gland |
| Nodal Disease (N) | |
| N0 | No regional lymph node metastasis |
| N1 | Metastasis in regional lymph node(s) |
| Metastatic Disease (M) | |
| M0 | Clinically no distant metastasis |
| M1 | Clinically distant metastasis |
| Stage I | T1N0M0 |
|---|---|
| Stage II | T2N0M0 |
| Stage III | T1-2N1M0 OR T3N(any)M0 |
| Stage IV | T4N(any)M0 OR T(any)N(any)M1 |
hs2
Computed Tomography (CT) abdomen
- Contrast-enhanced multi-detector CT of the abdomen is the first line imaging investigation to characterise and stage the primary tumour, nodal and distant metastases 6,22-24
- Overall staging accuracy is estimated to be at least 90% 25-27
- CT is accurate in estimating tumour size, although often overestimates size by 2-3 mm compared to histopathology 28-33
- Although CT can identify perinephric fat and renal sinus invasion with relatively high sensitivity (75-100%), specificity is poor (44-50%). Perinephric stranding can occur due to other causes such as perinephric oedema, vascular engorgement and previous inflammation from stone disease, fibrosis, etc. MRI is thought to have similar or superior accuracy 28,34,35
- MRI was previously thought to be superior in detecting vascular invasion, however, modern CT performs equally as well with a sensitivity of 84-100% and accuracy of 78-96% for identifying renal vein involvement 2,28,36-38
- Identification of lymph node metastases on CT is usually based on size (>10mm) which is associated with a high false positive rate mainly due to reactive hyperplasia. Metastatic spread to non-enlarged nodes is often missed. CT has a sensitivity of 77% and specificity of 82% for lymph node positivity on histopathology 9
- CT can accurately differentiate between benign and metastatic adrenal masses in patients with RCC. CT has a high negative predictive value for adrenal gland metastases (99-100%) but a low positive predictive value (26-73%) 39
- CT also has a limited positive predictive value (40%) for detecting invasion into other adjacent organs such as colon, pancreas, liver, spleen, etc.
- Although not strictly part of the staging system, CT can accurately assess invasion into the renal collecting system which may be important for treatment planning 40,41
- Including the pelvis in a routine staging examination is of limited value and unlikely to change management except in rare instances of ectopic kidneys located in the pelvis 6
hs3
Plain Chest Radiograph (CXR)
- Given that the most common site of metastasis is the lungs, staging should include imaging of the chest 2
- There is current controversy as to whether this should be in the form of plain chest radiography or chest CT
- CXR is useful as a screening tool to detect pulmonary metastasis, particularly in stage T1 disease when the overall incidence of pulmonary metastases is less than 5% 6,42
- Small pulmonary metastases are easily missed on chest radiographs and therefore in high-risk patients chest CT is preferred 5,6
- A study by Lim et al. to evaluate the role of chest CT concluded that plain chest radiography is sufficient for pulmonary staging in patients with small tumours (T1). For patients with a nodule on chest radiograph, with chest symptoms suggestive of endobronchial metastasis, or with extensive regional disease a chest CT is preferred 43
- Current National Comprehensive Cancer Network (America) guidelines recommend a chest radiograph in the initial staging workup, however, European guidelines recommend chest CT as a routine 5,19,44
hs4
Magnetic Resonance Imaging (MRI) abdomen
- MRI is generally used as a problem-solving tool rather than a first-line imaging modality for RCC staging due to its higher cost, lower availability, and increased complexity. It is also used when CT is contraindicated (e.g. pregnancy or severe allergy to iodinated contrast medium) or in patients who require recurrent imaging (e.g. young patients with hereditary syndromes affecting the kidneys such as Von-Hippel Lindau, tuberous sclerosis) 6,19,25,45
- Provides excellent soft-tissue contrast resolution and similar staging accuracy to CT
- 78-87% for MRI compared to 80-83% for CT 25,46-49
- Useful in lesions that have equivocal contrast enhancement on CT and haemorrhagic lesions
- Both MRI and CT demonstrate good agreement with surgical T-stage and M-stage. They are both poor in evaluating N-stage because nodal involvement is generally based on size criteria and metastatic spread to normal sized lymph nodes is often missed 50,51
- Both contrast-enhanced CT and MRI have equal sensitivity in detecting venous involvement, however, when there are equivocal findings for venous thrombus on CT, MRI may still be helpful 5,6,52
- MRI is superior in assessing the cranial extent of venous thrombus as CT does not always demonstrate sufficient opacification of the IVC to accurately evaluate extension 45,53,54
- MRI is superior to CT in detecting involvement of the renal capsule, perinephric fat, and Gerota’s fascia. Therefore, MRI may be useful to delineate between stage T2 and T3a, as well as T3 and T4 when this is not adequately defined on CT 36,45,55
- MRI can also distinguish benign from malignant renal tumours with a sensitivity of 86% and specificity of 78%, and can accurately differentiate clear cell from papillary RCCs 13,14,50,56-58
hs5
Doppler Ultrasound (US)
- When venous extension is not clearly defined on CT and MRI is unavailable, Doppler US can be used as a complementary technique to assess venous extension into the renal vein, IVC or right side of the heart 59
- Doppler US is, however, inferior to MRI for detecting venous thrombus with a sensitivity of 75% and specificity of 96% for US compared to 86-94% and 75-100% respectively for MRI 4
- US can also be useful to differentiate solid and cystic renal masses 6,60
- Limitations of US include:
- Bowel gas and large body habitus often limit visualisation of the renal vein, IVC and retroperitoneal lymph nodes 26,45,55
- The primary mass may be incompletely visualised
- Acoustic shadowing can occur from partially calcified cysts/masses
- Haemorrhagic cysts can demonstrate variability in echogenicity
- Isoechoic small renal tumours can be missed
- US is therefore rarely used for local staging of RCC 6
hs6
Computed Tomography (CT) Chest
- The lungs are the most common site for distant metastases 44
- CT of the chest is the most accurate imaging modality to detect small pulmonary metastases and metastases to mediastinal lymph nodes 6
- Currently, no clear consensus exists as to whether CT chest should be performed as part of the routine RCC staging workup or whether plain chest radiography is sufficient
- The European Association of Urology and the European Society for Medical Oncology guidelines recommend that all patients have a staging CT chest 19
- American guidelines recommend that plain chest radiography should be performed for all patients and CT chest should be reserved for those patients with a high risk of pulmonary metastases or with suspicious findings on chest radiograph 6,44
- Risk of pulmonary metastasis increases as the size of the primary tumour increases and, although there is no universally accepted criteria, chest CT is justified for larger primary tumours, when the plain chest radiograph is suspicious or positive, or when the patient has chest symptoms 5,6,44
- Larcher et al. reviewed CT chest findings in 1946 patients with RCC and concluded that preoperative chest CT could be avoided in patients with favourable RCC clinical characteristics at diagnosis because of their extremely low risk of pulmonary metastases. They proposed a system of determining preoperative risk based on T stage, N stage, presence/absence of systemic symptoms, platelet and haemoglobin counts 44
- They propose that patients with ≥ T1b tumours, patients with N1 tumours, patients with systemic symptoms or patients with anaemia and thrombocytopaenia should be selected for chest CT 44
- Using their cut-off criteria, a negative chest CT would be spared in 37% of cases while a positive chest CT would be missed in 0.2% of cases 44
hs7
Bone Scan
- Not recommended as a routine part of RCC staging 21,61,62
- Bone metastases are seen in approximately 30% of patients with metastatic disease and are symptomatic in the majority of patients 61
- The European Association of Urology and National Comprehensive Cancer Network (America) guidelines recommend a preoperative staging bone scan only in patients with bony symptoms, with advanced disease, or with abnormal laboratory findings (e.g. elevated alkaline phosphatase) 5,6,26,61
- Based on these guidelines, however, the decision to perform a bone scan remains a subjective assessment 61
- Larcher et al. performed a study of 2008 patients with RCC to determine the risk of a positive bone scan using preoperative variables such as T stage, N stage, presence/absence of symptoms, platelet and haemoglobin counts. They determined that when performing bone scans only in those patients with an estimated risk of a positive result of 5% or above, negative bone scans could be avoided in 80% of patients and 2% of positive bone scans would be missed 61
hs8
MRI brain or contrast-enhanced CT scan of the head
- Brain metastases are seen in up to 17% of patients with metastatic RCC and most of these patients have neurological symptoms 6
- Therefore patients with acute neurological signs or symptoms should have a MRI of the brain or a contrast-enhanced CT scan of the head 5,6
- There is no evidence to justify the routine use of brain MRI, however, it can be used to detect asymptomatic occult brain metastases in patients who have advanced RCC 6
References
References
References are graded from Level I to V according to the Oxford Centre for Evidence-Based Medicine, Levels of Evidence. Download the document
- Hancock SB, Georgiades CS. Kidney Cancer. Cancer J. 2016;22(6):387-92 (Review article). View the reference
- Dunnick NR. Renal cell carcinoma: staging and surveillance. Abdom Radiol (NY). 2016;41(6):1079-85 (Review article). View the reference
- Ljungberg B, Albiges L, Abu-Ghanem Y, Bensalah K, Dabestani S, Montes SF, et al. European Association of Urology Guidelines on Renal Cell Carcinoma: The 2019 Update. Eur Urol. 2019 (Clinical guidelines). View the reference
- Sankineni S, Brown A, Cieciera M, Choyke PL, Turkbey B. Imaging of renal cell carcinoma. Urol Oncol. 2016;34(3):147-55 (Review article). View the reference
- Motzer RJ, Jonasch E, Agarwal N, Bhayani S, Bro WP, Chang SS, et al. Kidney Cancer, Version 2.2017, NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Canc Netw. 2017;15(6):804-34 (Clinical guidelines). View the reference
- Vikram R, Beland MD, Blaufox MD, Moreno CC, Gore JL, Harvin HJ, et al. ACR Appropriateness Criteria Renal Cell Carcinoma Staging. J Am Coll Radiol. 2016;13(5):518-25 (Clinical guidelines). View the reference
- Jonasch E, Gao J, Rathmell WK. Renal cell carcinoma. BMJ. 2014;349:g4797 (Review article). View the reference
- Krajewski KM, Giardino AA, Zukotynski K, Van den Abbeele AD, Pedrosa I. Imaging in renal cell carcinoma. Hematol Oncol Clin North Am. 2011;25(4):687-715 (Review article). View the reference
- Nazim SM, Ather MH, Hafeez K, Salam B. Accuracy of multidetector CT scans in staging of renal carcinoma. Int J Surg. 2011;9(1):86-90 (Level III evidence). View the reference
- Murphy G, Jhaveri K. The expanding role of imaging in the management of renal cell carcinoma. Expert Rev Anticancer Ther. 2011;11(12):1871-88 (Review article). View the reference
- Ma H, Shen G, Liu B, Yang Y, Ren P, Kuang A. Diagnostic performance of 18F-FDG PET or PET/CT in restaging renal cell carcinoma: a systematic review and meta-analysis. Nucl Med Commun. 2017;38(2):156-63 (Level I evidence). View the reference
- Frey GT, Sella DM, Atwell TD. Image-Guided Renal Intervention. Radiol Clin North Am. 2015;53(5):1005-19 (Review article). View the reference
- Cupido BD, Sam M, Winters SD, Ahmed B, Seidler M, Huang G, et al. A practical imaging classification for the non-invasive differentiation of renal cell carcinoma into its main subtypes. Abdom Radiol (NY). 2017;42(3):908-17 (Level II evidence). View the reference
- Goyal A, Sharma R, Bhalla AS, Gamanagatti S, Seth A, Iyer VK, et al. Diffusion-weighted MRI in renal cell carcinoma: a surrogate marker for predicting nuclear grade and histological subtype. Acta Radiol. 2012;53(3):349-58 (Level III evidence). View the reference
- Tsimafeyeu I. Management of non-clear cell renal cell carcinoma: Current approaches. Urol Oncol. 2017;35(1):5-13 (Review article). View the reference
- Kim SP, Alt AL, Weight CJ, Costello BA, Cheville JC, Lohse C, et al. Independent validation of the 2010 American Joint Committee on Cancer TNM classification for renal cell carcinoma: results from a large, single institution cohort. J Urol. 2011;185(6):2035-9 (Level III evidence). View the reference
- Chapin BF, Delacroix SE, Jr., Wood CG. Renal cell carcinoma: what the surgeon and treating physician need to know. AJR Am J Roentgenol. 2011;196(6):1255-62 (Review article). View the reference
- Edge SB, American Joint Committee on Cancer. AJCC cancer staging manual. Seventh ed. Chicago: American Joint Committee on Cancer; 2010.(Clinical guidelines)
- Escudier B, Porta C, Schmidinger M, Rioux-Leclercq N, Bex A, Khoo V, et al. Renal cell carcinoma: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2016;27(suppl 5):v58-v68 (Clinical guidelines). View the reference
- Bradley AJ, MacDonald L, Whiteside S, Johnson RJ, Ramani VA. Accuracy of preoperative CT T staging of renal cell carcinoma: which features predict advanced stage? Clin Radiol. 2015;70(8):822-9 (Level III evidence). View the reference
- Pierorazio PM, Johnson MH, Patel HD, Sozio SM, Sharma R, Iyoha E, et al. Management of Renal Masses and Localized Renal Cancer: Systematic Review and Meta-Analysis. J Urol. 2016;196(4):989-99 (Level I evidence). View the reference
- Mueller-Lisse UG, Mueller-Lisse UL. Imaging of advanced renal cell carcinoma. World J Urol. 2010;28(3):253-61 (Review article). View the reference
- Dinney CP, Awad SA, Gajewski JB, Belitsky P, Lannon SG, Mack FG, et al. Analysis of imaging modalities, staging systems, and prognostic indicators for renal cell carcinoma. Urology. 1992;39(2):122-9 (Level II evidence). View the reference
- El-Hefnawy AS, Mosbah A, El-Diasty T, Hassan M, Shaaban AA. Accuracy of multi-detector computed tomography (MDCT) in staging of renal cell carcinoma (RCC): analysis of risk factors for mis-staging and its impact on surgical intervention. World J Urol. 2013;31(4):887-91 (Level III evidence). View the reference
- Hilton S, Jones LP. Recent advances in imaging cancer of the kidney and urinary tract. Surg Oncol Clin N Am. 2014;23(4):863-910 (Review article). View the reference
- Benson MA, Haaga JR, Resnick MI. Staging renal carcinoma. What is sufficient? Arch Surg. 1989;124(1):71-3 (Level II/III evidence). View the reference
- Johnson CD, Dunnick NR, Cohan RH, Illescas FF. Renal adenocarcinoma: CT staging of 100 tumors. AJR Am J Roentgenol. 1987;148(1):59-63 (Level III evidence). View the reference
- Ganeshan D, Morani A, Ladha H, Bathala T, Kang H, Gupta S, et al. Staging, surveillance, and evaluation of response to therapy in renal cell carcinoma: role of MDCT. Abdom Imaging. 2014;39(1):66-85 (Review article). View the reference
- Choi SM, Choi DK, Kim TH, Jeong BC, Seo SI, Jeon SS, et al. A comparison of radiologic tumor volume and pathologic tumor volume in renal cell carcinoma (RCC). PLoS One. 2015;10(3):e0122019 (Level III evidence). View the reference
- Chen W, Wang L, Yang Q, Liu B, Sun Y. Comparison of radiographic and pathologic sizes of renal tumors. Int Braz J Urol. 2013;39(2):189-94 (Level III evidence). View the reference
- Meskawi M, Sun M, Trinh QD, Bianchi M, Hansen J, Tian Z, et al. A review of integrated staging systems for renal cell carcinoma. Eur Urol. 2012;62(2):303-14 (Review article). View the reference
- Jeffery NN, Douek N, Guo DY, Patel MI. Discrepancy between radiological and pathological size of renal masses. BMC Urol. 2011;11:2 (Level III evidence). View the reference
- Kim C, Choi HJ, Cho KS. Diagnostic performance of multidetector computed tomography in the evaluation of perinephric fat invasion in renal cell carcinoma patients. J Comput Assist Tomogr. 2014;38(2):268-73 (Level III evidence). View the reference
- Landman J, Park JY, Zhao C, Baker M, Hofmann M, Helmy M, et al. Preoperative Computed Tomography Assessment for Perinephric Fat Invasion: Comparison With Pathological Staging. J Comput Assist Tomogr. 2017;41(5):702-7 (Level III evidence). View the reference
- Sokhi HK, Mok WY, Patel U. Stage T3a renal cell carcinoma: staging accuracy of CT for sinus fat, perinephric fat or renal vein invasion. Br J Radiol. 2015;88(1045):20140504 (Level III evidence). View the reference
- Bagheri MH, Ahlman MA, Lindenberg L, Turkbey B, Lin J, Cahid Civelek A, et al. Advances in medical imaging for the diagnosis and management of common genitourinary cancers. Urol Oncol. 2017;35(7):473-91 (Review article). View the reference
- Liu Y, Song T, Huang Z, Zhang S, Li Y. The accuracy of multidetector Computed Tomography for preoperative staging of renal cell carcinoma. Int Braz J Urol. 2012;38(5):627-36 (Level III evidence). View the reference
- Leveridge MJ, Bostrom PJ, Koulouris G, Finelli A, Lawrentschuk N. Imaging renal cell carcinoma with ultrasonography, CT and MRI. Nat Rev Urol. 2010;7(6):311-25 (Review article). View the reference
- Sasaguri K, Takahashi N, Takeuchi M, Carter RE, Leibovich BC, Kawashima A. Differentiation of Benign From Metastatic Adrenal Masses in Patients With Renal Cell Carcinoma on Contrast-Enhanced CT. AJR Am J Roentgenol. 2016;207(5):1031-8 (Level III evidence). View the reference
- Karlo CA, Di Paolo PL, Hricak H, Tickoo SK, Russo P, Akin O. CT of renal cell carcinoma: assessment of collecting system invasion. AJR Am J Roentgenol. 2013;201(6):W821-7 (Level III evidence). View the reference
- Liu J, Yang S, Jin H, He X, Nie P, Wang C. The diagnostic value of multi-slice spiral computed tomography in patients with renal carcinoma. J Cancer Res Ther. 2018;14(4):795-8 (Level III evidence). View the reference
- Canvasser NE, Stouder K, Lay AH, Gahan JC, Lotan Y, Margulis V, et al. The Usefulness of Chest X-Rays for T1a Renal Cell Carcinoma Surveillance. J Urol. 2016;196(2):321-6 (Level III evidence). View the reference
- Lim DJ, Carter MF. Computerized tomography in the preoperative staging for pulmonary metastases in patients with renal cell carcinoma. J Urol. 1993;150(4):1112-4 (Level III evidence). View the reference
- Larcher A, Dell'Oglio P, Fossati N, Nini A, Muttin F, Suardi N, et al. When to perform preoperative chest computed tomography for renal cancer staging. BJU Int. 2017;120(4):490-6 (Level II evidence). View the reference
- Kang SK, Kim D, Chandarana H. Contemporary imaging of the renal mass. Curr Urol Rep. 2011;12(1):11-7 (Review article). View the reference
- Tamas-Szora A, Socaciu M, Crisan N, Dobrota F, Prundus P, Bungardean C, et al. Investigation of Renal Cell Carcinoma by Contrast-Enhanced Ultrasound- Predictive Value of Time Intensity Curve Analysis in Establishing Local Tumor Invasion and Stage: A Pilot Study. Urol J. 2015;12(3):2173-81 (Level III evidence). View the reference
- Gardner TA, Tirkes T, Mellon M, Koch MO. Imaging techniques for the patient with renal cell carcinoma. Semin Nephrol. 2011;31(3):245-53 (Review article). View the reference
- Spero M, Brkljacic B, Kolaric B, Marotti M. Preoperative staging of renal cell carcinoma using magnetic resonance imaging: comparison with pathological staging. Clin Imaging. 2010;34(6):441-7 (Level III evidence). View the reference
- Semelka RC, Shoenut JP, Magro CM, Kroeker MA, MacMahon R, Greenberg HM. Renal cancer staging: comparison of contrast-enhanced CT and gadolinium-enhanced fat-suppressed spin-echo and gradient-echo MR imaging. J Magn Reson Imaging. 1993;3(4):597-602 (Level II evidence). View the reference
- Eisner BH, Kurtz MP, Harisinghani MG. Evolving role of magnetic resonance imaging in renal cancer imaging. J Endourol. 2010;24(5):707-11 (Review article). View the reference
- Fritzsche PJ, Millar C. Multimodality approach to staging renal cell carcinoma. Urol Radiol. 1992;14(1):3-7 (Review article). View the reference
- Kallman DA, King BF, Hattery RR, Charboneau JW, Ehman RL, Guthman DA, et al. Renal vein and inferior vena cava tumor thrombus in renal cell carcinoma: CT, US, MRI and venacavography. J Comput Assist Tomogr. 1992;16(2):240-7 (Level II evidence). View the reference
- Goldfarb DA, Novick AC, Lorig R, Bretan PN, Montie JE, Pontes JE, et al. Magnetic resonance imaging for assessment of vena caval tumor thrombi: a comparative study with venacavography and computerized tomography scanning. J Urol. 1990;144(5):1100-3; discussion 3-4 (Level III evidence). View the reference
- Czarnecka AM, Kornakiewicz A, Kukwa W, Szczylik C. Frontiers in clinical and molecular diagnostics and staging of metastatic clear cell renal cell carcinoma. Future Oncol. 2014;10(6):1095-111 (Review article). View the reference
- Kang SK, Chandarana H. Contemporary imaging of the renal mass. Urol Clin North Am. 2012;39(2):161-70, vi (Review article). View the reference
- Mirka H, Korcakova E, Kastner J, Hora M, Hes O, Hosek P, et al. Diffusion-weighted imaging using 3.0 T MRI as a possible biomarker of renal tumors. Anticancer Res. 2015;35(4):2351-7 (Level III evidence). View the reference
- Kang SK, Zhang A, Pandharipande PV, Chandarana H, Braithwaite RS, Littenberg B. DWI for Renal Mass Characterization: Systematic Review and Meta-Analysis of Diagnostic Test Performance. AJR Am J Roentgenol. 2015;205(2):317-24 (Level I evidence). View the reference
- Mytsyk Y, Dutka I, Borys Y, Komnatska I, Shatynska-Mytsyk I, Farooqi AA, et al. Renal cell carcinoma: applicability of the apparent coefficient of the diffusion-weighted estimated by MRI for improving their differential diagnosis, histologic subtyping, and differentiation grade. Int Urol Nephrol. 2017;49(2):215-24 (Level II evidence). View the reference
- Habboub HK, Abu-Yousef MM, Williams RD, See WA, Schweiger GD. Accuracy of color Doppler sonography in assessing venous thrombus extension in renal cell carcinoma. AJR Am J Roentgenol. 1997;168(1):267-71 (Level III evidence). View the reference
- Schwerk WB, Schwerk WN, Rodeck G. Venous renal tumor extension: a prospective US evaluation. Radiology. 1985;156(2):491-5 (Level II evidence). View the reference
- Larcher A, Muttin F, Fossati N, Dell'Oglio P, Di Trapani E, Stabile A, et al. When to Perform Preoperative Bone Scintigraphy for Kidney Cancer Staging: Indications for Preoperative Bone Scintigraphy. Urology. 2017;110:114-20 (Level II evidence). View the reference
- Campbell RJ, Broaddus SB, Leadbetter GW, Jr. Staging of renal cell carcinoma: cost-effectiveness of routine preoperative bone scans. Urology. 1985;25(3):326-9 (Level III evidence). View the reference
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